Mark Banschick

Stress is unavoidable in life. As good parents we want to shield our children, but we also know that we can only do so much. Stressful situations come in many shapes and sizes and affect our teenagers, whether we like it or not. Moving from one city to another or one yeshiva to another; the illness of a parent or a sibling; a parental psychiatric disorder like depression or anxiety; a difficult divorce; a parent losing a job and worried about finance; being victimized by a bully or an authority figure; and even the rejection of friends can all be significant sources of teenage stress.

Children, especially teenagers, are easily affected by the environment they're in and can reflect their surrounding conditions in their moodiness, oppositional behaviors (like defying religious requirements in your home), depression or drug use.

But don't let these symptoms fool you. Teen angst is prevalent for many kids at some point during their adolescence. Normal teens are entitled to be moody, questioning, inconsistent and troubled with the status quo.

So here is the question at hand. Your teenager is stressed, that's clear, but is an assessment and treatment needed?

First, three important points about normal teen development:

1.      The teenage brain is a rapidly and unsteadily developing organ. Most people are not truly their adult selves until they are twenty five or so. I often tell parents that maturation will serve their teen as a healthy tail wind, and the key is to guide them sufficiently not to make big mistakes along the way that can hurt their relationships, progress forward or self esteem. But during this period, your teen has to deal with increased moodiness, impulsivity and irritability that can make life miserable for all.

2.      Teenage cognitive development shifts to abstract thinking. The teen may challenge the way the world is presented, either directly to you or privately. Often, we as parents, rabbis and teachers lose our respected status. The normal outcome is often satisfactory when teens are then engaged on their level and have a sense of being respected, yet understand what is required of them. A special mentor, coach or therapist often can help an oppositional teen find a middle path.

3.      Teenage sexual development is powerful and confusing. Their bodies develop in ways that affect how they feel - and how others perceive them. Sexual attractiveness is confusing, no matter where a teen grows up. How the immature teenage brain deals with the powerful sexual urges at this stage of life is a challenge at best.

How can you tell the difference between a normal stressed-out teen and a stressed out teen who is in trouble?

Here are five important questions.

1.      Does your teen show evidence of extreme moodiness, anxiety, or the like?     A teen may complain, for instance, of being "depressed," but talk constantly with friends, enjoy life and look forward to going out. Assessment: probably teenage angst. But if she doesn't want to go to school, is avoiding friends, can't find a way to feel good, sleeps too much or too little, or shows evidence of self harm, you don't have to be a doctor to know that she needs to be seen professionally, and soon.

2.      Did the teen's symptoms precede the stressful situation they're now going through? Some psychological problems are not directly related to the stress. Do you have a family history of depression or anxiety? If so, your teen may be developing a problem that is more or less inherited. Once again, if the symptoms interfere with functioning, getting a professional opinion is probably a good idea.

3.      Has the teen's condition worsened?  Even if your child has a pre-existing issue like anxiety, an eating disorder or moodiness, ask yourself if it's worsened because of the stress. Divorce, for instance, can force kids to take sides, or expose them to terrible fights between their parents.  They can feel abandoned by a father, for example, who is preoccupied by his new life - or a mother who is too depressed to pay much attention to her child's needs. These kinds of stressors will always make matters worse.

4.      Is your teenager self-medicating with drugs or alcohol? The frum community is not immune to drugs and alcohol. When a teen is actively abusing drugs or alcohol, this needs to be dealt with head on, because it's next to impossible to treat the underlying hurt, depression or anger while a person is numbing his or her mind.

5.      Are you, the parent, visibly stressed or irritable about a troublesome situation that is beginning to affect your teen? Are you unhappy in your marriage, angry, or just not yourself? Your teen will experience this as a real stress. Parents burdened by a divorce, a medical problem, unemployment, or worries about a sick relative may help their child by getting support themselves.

Now that you have a better handle of whether or not to get a consultation, let's talk about how to go about it.

In most communities the pediatrician is a good source for an initial consult. Bring your concerns to him or her, based on the five questions above. If drugs are major presenting problem, a drug treatment counselor is the next place to go. Your pediatrician or a knowledgeable rabbi in your community may know who is best.

If the issue is more family related, such as a divorce or a broken relationship within the family, have a consultation with a social worker or a psychologist who specializes in family therapy.  If one or both parents are bringing stress down upon the teen, the family therapist should make sure they get the help needed. Believe me, it feels good to tackle your problems, and teens respect parents who are getting their act together.

If your pediatrician thinks the problem is more complex, she may want you to see a child and adolescent psychiatrist. This referral is often obvious, because if the symptoms are truly getting in the way of functioning, a more thorough assessment will be needed.  It may be that your teenager is struggling with an underlying anxiety disorder that has worsened because she's been bullied. The problem: She won't go to school and is having panic attacks. A child like this may need a combination of therapy and medication. I know that talk of medicine makes parents anxious, and you have that right. But, don't be too frightened, because a good doctor knows how to minimize risks, and a child who responds to treatment is a child who has been spared much pain.

To review: The first stop is the pediatrician, who may reassure you that teenage angst is teenage angst, and not to worry. If more is required, a pediatrician can help you find the right professional to consult. Whether you end up working with a drug counselor, a social worker, psychologist or psychiatrist, I would encourage you to ask for a diagnosis and a treatment plan. Sometimes different professionals help in tandem with each other. For example, in the case of the girl with panic attacks and bullying, a social worker may help her deal successfully with the bully, while a psychiatrist may temporally medicate the constant anxiety. And, with the social worker using CBT or another contemporary technique, that girl may eventually learn to manage her anxiety without the need for medication.

Ultimately, teens usually respond well to proper treatment. And stress is almost always a part of the problem. My advice is to be attentive, ask the five questions, and when in doubt, get a consultation. The biggest mistake parents make is usually waiting too long.

Ultimately it is a special experience to have your teen back.

Mark Banschick, MD is a Child Psychiatrist and member of The Young Israel of Stamford. He is the author of The Intelligent Divorce and writes a weekly blog for Psychology Today. His parenting course for Divorcing Parents can be found at: www.familystablizationcourse.com . On the radio at: http://www.divorcesourceradio.com/category/audio-podcast/the-intelligent-divorce/ Contact: [email protected]