How parents can play a key role in prevention, treatment of teen mental health problems
Toria Herd, Postdoctoral Researcher in Psychology, Penn State, and Sarah A. Font, Associate Professor of Sociology and Public Policy, Penn State
More than 44% of teens reported persistent feelings of sadness and hopelessness in the first half of 2021, according to a report from the Centers for Disease Control and Prevention. The early 2022 report, which was based on an online survey, also found that nearly 20% had seriously considered suicide, and 9% attempted suicide.
The COVID-19 pandemic is a likely contributor to these startling figures, but rates of teen mental illness have been rising over the past decade.
One crucial factor that has received little attention in supporting teen mental health is the role that parents can play.
This is surprising, since research has clearly established that participation by a caregiver in their child’s mental health treatment is directly related to a successful outcome. A key reason for this is that parents generally interact with their teen on a daily basis and can model and cultivate coping skills.
Yet, for mental health professionals, it can be challenging to integrate parents into teens’ treatment when there are discrepancies between the perspectives, goals and expectations of teens and parents. In addition, consent and privacy laws sometimes limit providers’ abilities to disclose key details about a teen’s mental health to parents.
Parents often dread the teenage years, anticipating mood swings, risk-taking behaviors and endless arguments. Some of this is developmentally normal: Teens are developing their identities, testing limits and asserting their autonomy. These combined factors can lead to hostility and a lower-quality parent-teen relationship.
Mental health problems in teens can sometimes take unexpected forms. Depression and anxiety can manifest as irritability and noncompliance, which parents may reasonably view as disrespect and laziness. Understanding what is beneath those behaviors is challenging. Teens are quite secretive, so they may not disclose the extent of their struggles.
Although anxiety is a normal emotional response at any age, about a third of adolescents have some type of anxiety disorder, and about 10% experience severe impairment as a result. Teens struggling with chronic anxiety may experience agitation or irritability, issues with sleep, perfectionist tendencies, or may try to avoid stressful things altogether.
Keeping a journal, exercising regularly and maintaining a sleep routine are three ways for teens to cope with stress.
Among teens, 17% struggle with depression. Depression generally involves a loss of interest or pleasure in daily activities, but it is more than feeling blue. For teens, symptoms of depression may look like withdrawing from family or social activities, shutting down during conversations or conflict, lethargy, difficulty concentrating, hopelessness about the future or negative feelings of self-worth.
Depression can also be associated with self-harm and suicide.
In determining whether a teen is experiencing a mental illness, parents should consider how behaviors are affecting their teens’ everyday lives and plans for the future. Those who are falling behind in school, damaging important relationships or engaging in high-risk behaviors may be most likely to be experiencing a mental health issue – as opposed to typical teenage challenges.
A shortage of mental health care
Despite the growing need for mental health care, the U.S. has a dire shortage of professionals to meet the demand. Insurance companies create barriers to accessing mental health care by restricting the numbers of in-network providers and approved sessions. As a result, many providers prioritize patients who will pay out of pocket.
Parents and teens may wait months for an appointment, and the quality and effectiveness of the services they receive are highly variable. All the while, symptoms may worsen, straining the family and compromising teens’ social and academic opportunities.
The powerful role parents can play
This is where parents come in, since they can serve as role models for teens’ coping and emotional development.
While good sleep, consistent exercise and quality meals can often be the first line of defense in preventing and managing symptoms of mental health problems, there are several behavioral strategies for parenting struggling teens. Indeed, foster parents care for children with complex histories of trauma, and many of the behavior management strategies taught to foster parents may be useful for traditional family settings as well.
When teens are unkind or disrespectful, parents may take it personally. But parents who are aware of and able to manage their own triggers can react calmly to challenging behavior, creating opportunities for effective communication with their teen.
Building and maintaining the parent-teen connection, such as by watching a TV show together or other low-pressure opportunities to be together, is key. These experiences create safe spaces and opportunities for teens to communicate about difficult emotions or situations. Parents who assist teens in recognizing, talking about and dealing with difficult thoughts and feelings help them to understand how their thoughts and feelings can affect their behavior.
Parents can also help their teens manage negative emotions by reinforcing their self-esteem and strengths and encouraging self-efficacy. Parents who offer praise to their teens who are working hard to overcome challenges — as opposed to focusing solely on the outcome — can help teens see their worth beyond their accomplishments.
At the same time, teens require boundaries that allow them to build self-reliance, exercise independence and practice compromise in certain situations. Behavior contracts — in which teens and their parents agree to certain conditions in writing — can provide a structured way to establish shared expectations.
When consequences are necessary, natural consequences allow teens to learn without parental intervention. For example, if a teen stays up late the night before a big softball game, their coach may bench them for playing poorly. Parents can help teens to connect the frustration and disappointment they experience to their choices regarding sleep, which can be more helpful for their future decision-making than getting into an argument with a parent about their decision or receiving a parent-imposed consequence, such as removing phone privileges.
When natural consequences are not an option, discipline should be specific, time-limited and focused on a specific outcome, such as not allowing preferred activities until homework and chores are complete.
It is also important that parents avoid power struggles with their teens by modeling respectful communication without trying to manage the teen’s reaction or perspective. Teens are unlikely to admit to being wrong — particularly in a heated moment — and if the point is made, there is rarely a benefit to insisting upon a particular reaction such as a forced apology.
Parents can best support their teens by maintaining connection alongside enforcing structure and discipline. While challenging behaviors can be the status quo of adolescence, parents should be on the lookout for signs that might reflect a pervasive mental health issue, since early detection and treatment is crucial.
The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.
This article is republished from The Conversation under a Creative Commons license.
How parents can play a key role in prevention, treatment of teen mental health problems
wavebreakmedia // Shutterstock
Every school year, parents and caregivers are once again faced with the age-old struggle of wrangling groggy kids out of bed in the morning. For parents of preteens and teenagers, it can be particularly challenging.
Sometimes this gets chalked up to laziness in teens. But the main reason why a healthy person is unable to wake up naturally without an alarm is that they are not getting the sleep their brain and body need.
But the likelihood that you know a teenager who gets enough sleep is rather slim. In the U.S., less than 30% of high school students—or those in grades 9 through 12—sleep the recommended amount, according to the Centers for Disease Control and Prevention. Among middle schoolers in grades 6 through 8, nearly 60% do not get enough sleep at night.
Yet my laboratory's research suggests that a much higher percentage of teens are getting too little sleep.
I am a professor of biology and have been studying sleep and circadian rhythms for more than 30 years. For the past seven years, my laboratory at the University of Washington has been doing research on sleep in Seattle-area teenagers. Our research has found that, just as in other areas of the U.S., high schoolers in Seattle are not getting the amount of sleep they need. Our study objectively measured sleep in 182 high school sophomores and seniors and found only two that slept at least nine hours at night during school days.
Every school year, parents and caregivers are once again faced with the age-old struggle of wrangling groggy kids out of bed in the morning. For parents of preteens and teenagers, it can be particularly challenging.
Sometimes this gets chalked up to laziness in teens. But the main reason why a healthy person is unable to wake up naturally without an alarm is that they are not getting the sleep their brain and body need.
But the likelihood that you know a teenager who gets enough sleep is rather slim. In the U.S., less than 30% of high school students—or those in grades 9 through 12—sleep the recommended amount, according to the Centers for Disease Control and Prevention. Among middle schoolers in grades 6 through 8, nearly 60% do not get enough sleep at night.
Yet my laboratory's research suggests that a much higher percentage of teens are getting too little sleep.
I am a professor of biology and have been studying sleep and circadian rhythms for more than 30 years. For the past seven years, my laboratory at the University of Washington has been doing research on sleep in Seattle-area teenagers. Our research has found that, just as in other areas of the U.S., high schoolers in Seattle are not getting the amount of sleep they need. Our study objectively measured sleep in 182 high school sophomores and seniors and found only two that slept at least nine hours at night during school days.
How parents can play a key role in prevention, treatment of teen mental health problems
Canva
The time people go to bed, fall asleep, and wake up is governed by two main factors in the brain. The first is a so-called "wakefulness tracker," a physiological timer that increases our need to sleep the longer we stay awake. This is in part the consequence of the accumulation of chemical signals released by neurons, such as adenosine.
Adenosine accumulates in the brain when we are awake, leading to increased sleepiness as the day wears on. If, for instance, a person wakes up at 7 a.m., these chemical signals will accumulate throughout the day until the levels are high enough that the person will fall asleep, typically in the late evening.
The second factor that drives the sleep/wake cycle is a 24-hour biological clock that tells our brain what times of the day we should be awake and what times we should be sleeping. This biological clock is located in an area of the brain called the hypothalamus. The clock is composed of neurons that coordinate the brain areas regulating sleep and wakefulness to a 24-hour sleep/wake cycle.
These two regulators operate with relative independence from each other. But under typical conditions, they are coordinated so that a person with access to electric-powered light would fall asleep in the late evening—between about 10-11 p.m.—and wake up in the early morning, around 6-7 a.m.
So why do teenagers often want to go to bed later and wake up later than their parents?
It turns out that during adolescence, the wakefulness tracker and biological clock conspire to delay the timing of sleep. First, adolescents can be awake until later hours before their wakefulness tracker makes them feel sleepy enough to fall asleep.
Second, the biological clock of teenagers is delayed because in some cases it appears to run at a slower pace and because it responds differently to light cues that reset the clock daily. This combination leads to a sleep cycle that operates a couple of hours later than in an older adult: If an older adult feels the signals to fall asleep around 10-11 p.m., this won't happen until midnight or later in a teenager.
Canva
The time people go to bed, fall asleep, and wake up is governed by two main factors in the brain. The first is a so-called "wakefulness tracker," a physiological timer that increases our need to sleep the longer we stay awake. This is in part the consequence of the accumulation of chemical signals released by neurons, such as adenosine.
Adenosine accumulates in the brain when we are awake, leading to increased sleepiness as the day wears on. If, for instance, a person wakes up at 7 a.m., these chemical signals will accumulate throughout the day until the levels are high enough that the person will fall asleep, typically in the late evening.
The second factor that drives the sleep/wake cycle is a 24-hour biological clock that tells our brain what times of the day we should be awake and what times we should be sleeping. This biological clock is located in an area of the brain called the hypothalamus. The clock is composed of neurons that coordinate the brain areas regulating sleep and wakefulness to a 24-hour sleep/wake cycle.
These two regulators operate with relative independence from each other. But under typical conditions, they are coordinated so that a person with access to electric-powered light would fall asleep in the late evening—between about 10-11 p.m.—and wake up in the early morning, around 6-7 a.m.
So why do teenagers often want to go to bed later and wake up later than their parents?
It turns out that during adolescence, the wakefulness tracker and biological clock conspire to delay the timing of sleep. First, adolescents can be awake until later hours before their wakefulness tracker makes them feel sleepy enough to fall asleep.
Second, the biological clock of teenagers is delayed because in some cases it appears to run at a slower pace and because it responds differently to light cues that reset the clock daily. This combination leads to a sleep cycle that operates a couple of hours later than in an older adult: If an older adult feels the signals to fall asleep around 10-11 p.m., this won't happen until midnight or later in a teenager.
Based on the recommendation of sleep experts, the Seattle school district, beginning with the 2016-2017 school year, delayed middle school and high school start times by nearly an hour, from 7:50- a.m. to 8:45 a.m. In a study our team conducted after the district enacted the plan, we found that students gained 34 minutes of daily sleep: a huge gain by sleep medicine standards. In addition, student attendance and punctuality improved, and median grades went up by 4.5%.
Despite an abundance of research evidence and advice from virtually all sleep experts in the country, most school districts are still stuck with school start times that promote chronic sleep deprivation in teenagers. The early school starts are further aggravated by daylight saving time – when clocks are set one hour ahead in the springtime. This time shift – one that could become permanent in the U.S. in 2023 – exposes teenagers to artificially dark mornings, which exacerbates their naturally delayed sleep timing.
Based on the recommendation of sleep experts, the Seattle school district, beginning with the 2016-2017 school year, delayed middle school and high school start times by nearly an hour, from 7:50- a.m. to 8:45 a.m. In a study our team conducted after the district enacted the plan, we found that students gained 34 minutes of daily sleep: a huge gain by sleep medicine standards. In addition, student attendance and punctuality improved, and median grades went up by 4.5%.
Despite an abundance of research evidence and advice from virtually all sleep experts in the country, most school districts are still stuck with school start times that promote chronic sleep deprivation in teenagers. The early school starts are further aggravated by daylight saving time – when clocks are set one hour ahead in the springtime. This time shift – one that could become permanent in the U.S. in 2023 – exposes teenagers to artificially dark mornings, which exacerbates their naturally delayed sleep timing.
How parents can play a key role in prevention, treatment of teen mental health problems
Me dia // Shutterstock
School start times aside, kids also need to learn the importance of healthy habits that promote sufficient sleep.
Getting bright daylight exposure, particularly during the morning, pushes our biological clock to an earlier time. This, in turn, will promote an earlier bedtime and a natural early morning wake time.
In contrast, light in the evening – including the light emitted by screens – is highly stimulating to the brain. It inhibits the production of natural signals such as melatonin, a hormone that is produced by the brain's pineal gland as the night arrives and in response to darkness. But when these cues are inhibited by artificial light in the evening, our biological clocks are delayed, promoting a later bedtime and a later morning wake time. And thus the cycle of having to rouse a sleepy, yawning teenager from bed for school begins again.
Yet few schools teach the importance of good daily routines and sleep timing, and parents and teens also do not fully appreciate their importance. Chronic sleep deprivation disrupts every physiological process in the body and has been consistently linked to disease, including depression and anxiety, obesity, and addictive behavior.
This story originally appeared on The Conversation and has been independently reviewed to meet journalistic standards.Â
Me dia // Shutterstock
School start times aside, kids also need to learn the importance of healthy habits that promote sufficient sleep.
Getting bright daylight exposure, particularly during the morning, pushes our biological clock to an earlier time. This, in turn, will promote an earlier bedtime and a natural early morning wake time.
In contrast, light in the evening – including the light emitted by screens – is highly stimulating to the brain. It inhibits the production of natural signals such as melatonin, a hormone that is produced by the brain's pineal gland as the night arrives and in response to darkness. But when these cues are inhibited by artificial light in the evening, our biological clocks are delayed, promoting a later bedtime and a later morning wake time. And thus the cycle of having to rouse a sleepy, yawning teenager from bed for school begins again.
Yet few schools teach the importance of good daily routines and sleep timing, and parents and teens also do not fully appreciate their importance. Chronic sleep deprivation disrupts every physiological process in the body and has been consistently linked to disease, including depression and anxiety, obesity, and addictive behavior.