Supporting Teens

As with children and adults, the signs and symptoms of mental health concerns can vary significantly. Each person experiences them differently. The onset of warning signs can be slow or sudden. All the hormonal changes and social pressures can bring mood swings, changes in attitudes, and even reckless behaviour that are part of normal development, including the ones listed below:

• Emotional ups and downs (moodiness, sadness, irritability, anger, etc.)
• Increased outbursts, arguments or quarrels
• Challenging/testing parental and societal rules, norms, and ways of doing things
• Changing their appearance (experimenting with styles of hair & dress, tattoos & body piercing) or being concerned about their appearance
• Some withdrawal from family life (friends take on a greater importance)
• Change in sleep patterns (staying up all night, sleeping all day, sleeping more, insomnia)
• Changes in academic performance (grades sliding or improving)
• Alcohol and drug use and experimentation
• Becoming sexually active
• Increased need for privacy, including lying or withholding information to achieve that privacy
• Increased verbal, and sometimes physical, aggression
• Lack of frustration tolerance
• Low impulse control
• Changes in appetite (eating more or less)
• Light risk taking/taboo breaking
• Low self-esteem
• Abandoning commitments or not following through
• Unmotivated or indifferent
• Increased selfishness
• Curfew violations
• Struggling with identity
• Frequent changes in relationships (friendships and romantic)

While many of the items listed above can be part of normal development and are often a phase that self-corrects as the individual matures. However, they can also be signs of an underlying mental health concern or disorder. If you are unsure if you should be concerned, it is always best to consult a counsellor. Some indicators that things may have become serious are:

• Intensity/severity (moods are extreme or disproportionate for the situation)
• Frequency (happing consistently)
• Duration (persisted over long periods of time)
• Life impact (events are impacting other aspects of their life such as, school, hobbies, activities, health, relationships)
• Escalation (becoming more severe or happening more often)
• Not caring about things that use to be important (grades, impacts on others, future, themselves, family, etc.)
• Future impact (actions and behaviours have the potential to negatively impact their future)

Other warning signs can include more severe behaviours such as:

• Anxiety or sadness that never seems to go away
• Blames everyone around them and never takes responsibility for their actions
• Obsessing about weight, dramatic changes in eating habits, and/or purging through laxatives or vomiting
• Has no friends or social circle, or associates with a dangerous crowd
• Self-harming (hairpulling, cutting, skin picking)
• Lying about where they are going, or staying out all night without telling anyone where they are
• Openly defiant and/or refusing to follow rules
• Being verbally abusive, intimidating, threatening or destructive
• Stealing or vandalizing
• Alcohol and/or drug use is a regular/daily occurrence
• Spreading rumours and other forms of harassment, stalking, or bullying (verbally, physically, sexually, or digitally)
• Deliberately harming animals
• Getting into fights regularly or assaulting another person
• Getting arrested
• Extreme risk taking, or numerous (serious) accidents
• Accidental overdose or suicide attempt

Most mental health issues experienced in adulthood onset before age 18. It’s important to recognize early signs and symptoms and get help soon.

Some of the most common mental health disorders among youth include:

• Anxiety/panic disorders - There are a variety of anxiety disorders that impact youth including: panic attacks, social anxiety and generalized anxiety. Anxiety can be caused by a number of factors such as: traumatic events, moving, changing schools, parents’ divorce/illness, being bullied, social pressure, harassment/assault, etc.
• Bipolar disorder - Is a medical condition that causes a person to cycle through periods of depression and elevated mood. It usually consists of three states: mania, depression, and a well state)
• Borderline personality disorder - is a complex mental health condition in which people often struggle with self-image, mood swings, impulse control, an intense fear of abandonment, and low feelings of self-worth. It often occurs in combination with other mental health conditions such as anxiety and depression.
• Conduct disorder - Is a type of behavior disorder that is characterized by antisocial behavior ranging from the disregard of basic social standards and rules (irresponsible) to criminal behaviour (assault).
• Depression and other mood disorders – Depression is the most common adolescent mental health disorder. Rates of depression amongst children and youth have increased over the past few decades. Untreated depression can lead to other serious conditions such as substance use, self-harm, and suicidal ideation.
• Eating disorders - Usually start in the teenage years and are more common in girls than boys, however they can onset earlier. Common eating disorders include: binge/stress eating, anorexia nervosa, and bulimia nervosa. Eating disorders are not the same as picky eating. Left untreated eating disorders can have serious impacts on physical health and cognitive development.
• Post-traumatic stress disorder (PTSD) - Can follow witnessing or experiencing frightening or traumatising events such as emotional, physical, or sexual abuse, being the victim of bullying or violence, or surviving a disaster or accident.
• Schizophrenia - One of the biggest myths around schizophrenia is that it is not treatable. Schizophrenia is a serious mental illness, however with the right supports people can go to school, work, volunteer and live active and full lives.
• Self-harm - Is a common problem among young people. It can include: skin picking, pulling out eyelashes or hair, cutting, and other variations. Self-harm is often used as a coping mechanism to help process emotional pain.
• Substance misuse disorder – Occurs is when an individual regularly uses drugs and alcohol in an unhealthy or harmful way. It is a serious condition that can have a lasting and destructive impact on development, family relations, and life trajectory. SMD puts teens at greater risk of accidental overdose and suicide.
• Suicidal ideation – Suicide is the third leading cause of death amongst adolescents. It can range from passive suicidal ideation (vague thoughts about dying by suicide) to active suicidal ideation (persistent thoughts of suicide and/or taking steps to carry out a suicide attempt). Suicidal ideation should always be taken seriously. The Ontario Association for Suicide Prevention has training opportunities and information on their website.

For an overview of mental health conditions and treatment options, see the Canadian Mental Health Association mental health info page.

Neurodivergence

Neurodivergence isn't a disability or a mental health condition. Neurodivergent refers to individuals whose brain development or cognitive processes differ from what is considered "typical". These individuals have different strengths and different struggles from those whose brains develop more typically. Some people who are neurodivergent have impactful or visible medical conditions, others can have conditions that are more challenging to identify--often referred to as "invisible" impacts.

While neurodivergence is not a mental health condition, being neurodivergent in a world that was not designed for diverse ways of learning and processing can impact mental health and overall wellbeing. Signs of neurodivergence can also mimic other health conditions and developmental growth phases, making it more difficult to understand what is happening for your child. Common types of neurodivergence include:

• Attention-deficit/hyperactivity disorder (ADHD) — also known as attention deficit disorder (ADD)
• Autism spectrum disorder
• Dyslexia
• Dyspraxia

The Verywellmind website has some additional information you may find valuable.

As with adults, mental health concerns and mental illnesses in youth are caused by a complex interplay of environmental, biological, genetic, and personality factors. Information and research into causes and risk factors is constantly revealing new insights and findings. Having mental health challenges as an adolescent does not mean the individual will have challenges throughout their entire life. Many conditions present in adolescence resolve with effect supports and treatment. Some do continue through-out the lifespan, making early intervention and support especially important. Some of the factors that are known to increase risks of mental illness are:

• Gender – girls are more at-risk for depression/anxiety and boys are more at-risk for conduct disorders
• Early puberty
• Low self-esteem, feelings of inadequacy or incompetence
• Insecure attachments
• Poor social and communication skills
• Head injury
• Substance use
• Witnessing or experiencing traumatic events, emotional or physical violence, or sexual abuse (personal, school, or community events)
• Environmental factors such as not feeling safe, supported, or cared for
• Lack of access to adequate housing and nutrition
• Lack of access to effective health care or treatment
• Having a long-term physical illness
• Having a parent who has a chronic illness (physical or mental) or substance use disorders
• Bullying or other forms of humiliation and discrimination, including cyber bullying/exploitation
• Parents separation or divorce
• The death of someone close to them (including pets)
• Caring for a relative, taking on adult responsibilities
• Lack of family support or professional treatment for mental health concerns 
• Peer rejection, lack of social circle and friendships
• Relationship break-ups

The range of environmental, biological, genetic, and personality factors that increase the risk of mental health challenges also provides parents with a range of strategies that are known not only to foster overall healthy development, but to also reduce the risk of menta health concerns. Supporting teens with their emotional development is as important as supporting their physical development.

Learning to acknowledge and process feelings, how to deal with disappointment and setbacks, as well as developing resilience and the inner skills needed to cope with whatever life throws at them will set the stage to help teens grow into healthy, well-rounded adults. Some factors that help keep teens mentally well include:

• Overall good health -- physical health and mental health are interconnected. Eating a balanced diet, and regular exercise are important for overall development and wellbeing
• Loving, supportive home environment where everyone gets along and cares about each other (most of the time) helps to create the sense of safety and stability that fosters healthy development.
• Support and guidance through challenges and difficulties
• Developing strong emotional regulation skills
• Academic achievement/intellectual development
• Taking part in two or more of the following activities: school, social activities with friends, athletics, employment, religion, hobbies, and interests
• An environment where mental health is understood, supported, and nurtured
• Feeling loved, supported, trusted, understood, and safe
• Having choices, options, and a sense of control over their lives (as is developmentally appropriate)
• Validating feelings and modeling supportive ways to process feelings and build resilience
• Clear expectations for behaviour and values
• Stability and consistency at home (structure without being overly rigid)
• Mentors, other adults, and support for developing skills, interests, and navigating life dilemmas

As parents, it can be agonizing for us when our children are hurting. Supporting a child or other family member can also take a significant toll on our own wellbeing. It is important to take care of ourselves at the same time we take care of our loved one.

There are several things you can do to support young children who are struggling with mental health concerns.

• Listen to your teen without judgement and take their feelings seriously (judgement can make them feel misunderstood and shut down communication)
• Respect their growing need for privacy and body autonomy
• Ask them how you can support them
• Follow recommendations and suggestions from counsellors and physicians
• Understand that sleep patterns, and everything else is changing
• Stay calm – raising your voice could lead to an escalation of the situation
• Ensure they know you love them despite their struggles, and that you will support them through this difficult time
• Make it OK for you, or your teen, to walk away and calm down if things start getting heated
• Explain the rationale and reasoning behind your decisions rather than just saying no
• Provide opportunities for independence and decision making
• Accept that your teen will have different values and want to do different things than you
• Ensure your teenager knows the risks of sexting, unprotected sex, gender-based violence, etc. and create safe ways to talk about these concerns
• Provide practical help with scheduling and attending appointments, as well as finding services. Take them appointments but wait in the waiting room. This way they know you are active and present with them through this process, but not intruding on their privacy or growing need for independence
• Respect their wishes, even if you don’t agree with their choices. Forcing someone, to choose a particular treatment or service provider can damage relationships and additional psychological damage
• Many teens begin to question and explore their gender identity. Even if you are uncomfortable with their discoveries, do your best to respect their need to explore who they are, use pronouns, and learn more about LGBTQ2S+ identities and experiences
• Increase your own emotional intelligence, empathy, and compassion. The more you understand about the impacts of mental health conditions the easier it is to engage in supportive action
• Take care of yourself. Taking care of others takes a toll on your own wellbeing

Mental Health Literacy (Ontario) has a fantastic 72 page “Adolescent Development: Primer for Parents” that contains information, suggestions, resources to support parents. They have a similar primer for teens to help them communicate with their parents.

Finding the services you need can be time consuming and challenging. Strong advocacy skills are often needed to obtain the right support for your child. It can be difficult to know where to start. Below is a list of suggestions that may help:

• Physicians/Pediatricians: Family doctors are often a good starting point. Physicians treat a variety of health conditions, and usually have a list of services and practitioners they can provide. Some programs and treatments, such as Psychiatrists require a physician referral. Family doctors are an important member of everyone’s health care team.
• The Employee and Family Assistance Program, delivered through Homewood Health Inc., provides employees of the University of Waterloo employees and their dependent family members with a range of health and wellness services. The program is a complement to the current benefits program, at no additional cost to employees. Find out more about Homewood Health's services.
• Canadian Mental Health Association: CMHA has a resources and information on their website, as well as links to resources.
• The Hospital for Sick Children (SickKids): SickKids has a youth mental health hub on their website. They also have many services to support adolescent mental health. Accessing physician may require a referral from your child’s doctor.
• Children's Mental Health Ontario: CMHO has extensive resources on their website to support youth struggling with mental health and their families including, resources, supports for parenting, and peer support groups.
• Ask a Friend: Referrals are still one of the best ways to find the support you need. Parents with teens experiencing similar challenges are often happy to share information about services – they remember how difficult it was trying to find the help they needed.
• Campus Wellness "Other Resources Off-Campus" listing: Campus Wellness has a limited list of therapists in Waterloo region. Many of these therapist work with adolescents.
• EngSoc Off-Campus Mental Health Resources listing: EngSoc compiled a list of Counsellors in the Waterloo region. The list is not exhaustive, but it is more extensive than the Campus Wellness listing.
• Provincial or National Programs and Associations: There are many programs and associations that were created to support individuals dealing with specific mental health challenges, such as the Mood Disorders Association of Canada. Many of these associations maintain a list of resources, programs, and practitioners.
• Provincial and National licensing organizations: In Canada, Mental health practitioners must be licensed. Many provincial and national licensing bodies, such as provincial psychological associations, College of Registered Psychotherapists of Ontario, and Talking Can Help have listings on their website to help you find a counsellor.
• Pharmacists: Pharmacists are trained in a number of drug and non-drug approaches to supporting wellbeing. Some even specialize in pediatric medications. Pharmacists are an important member of your child’s health team. Many Pharmacists are aware of community-based programs and practitioners.

The good news is, there are many effective and reliable resources available. Learning more about mental and how it effects youth is a key part of supporting your teen. Below are some resources you may find helpful:

• Canadian Mental Health Association
• American Mental Wellness Association
• Mental Health Foundation (UK)
• Mental Health Literacy
• VeryWellMind
• Children’s Mental Health Ontario (Youth resources)