October 25, 2017 – October 25, 2017
NYC-Parents in Action Fall Seminar 2017: EMOTIONAL WELL-BEING BEGINS AT HOME
By Melanie Wells
Teen anxiety may be up, but there is help, and hope. That’s the encouraging message the 300+ parents who attended Parents in Action’s Fall Seminar, a collaborative event with The Jed Foundation (JED), heard on October 25th.
A trend many parents have noticed – an increase in anxiety disorders among teens and young adults – was confirmed. But the good news is, experts have gotten better at clinically identifying young people in crisis, and today’s youth are more open to talking about their emotions than those even just ten years ago. To concerned parents, eager to know what they can do, an impressive panel of experts from JED and Columbia University offered data, anecdotes, gentle humor, sympathy, and sound advice.
JED, a nonprofit “that exists to protect emotional health and prevent suicide for our nation’s teens and young adults,” provided three of the four panelists, with a fourth from Columbia University.
Moderated by John MacPhee (Executive Director, JED), the panel, collectively, offered a dazzling breadth of expertise: Nance Roy, Ed.D., Chief Clinical Officer, JED; Victor Schwartz, MD, Chief Medical Officer, JED; and Anne Marie Albano, Ph.D., ABPP, Director of Columbia University’s Clinic for Anxiety and Related Disorders, all engaged in a lively conversational presentation, prompted by questions posed by John MacPhee.
John MacPhee: What, currently, are the most common teen mental health issues?
Victor Schwartz: After ADHD (about 10%), the big issues are “mood disorder and anxiety disorder, with increased rates of diagnosis over the past ten years.” Mood disorders include problems such as depression, he added, noting also increased reporting of thoughts of self-harm among young people, though the rate for suicide is still significantly lower than in older people.
Anne Marie Albano added: “Anxiety disorder comes in many forms – phobias, separation anxiety, generalized anxiety, OCD.” First onset of anxiety can show up in a child as young as six years, who, by high school age, she said, may exhibit several types of anxiety at once. In the high school years, as many as one in four teens suffer from some kind of anxiety disorder.
Nance Roy: The problem doesn’t go away with the end of high school: “Anxiety disorders now surpass depression” among college students, she noted.
JM: What other stressors afflict teens today, or exist in combo with an anxiety diagnosis?
VS: Social media is a foremost stressor although “not everything about it is bad,” he noted. Its increased usage seems to have risen in tandem with the rise in anxiety. While it’s “nice to connect,” he added, the capacity social media offers to “gang up” on others, or to dilute the strength of relationships, can be stress-inducing.
He also noted pressures driven by a rise in income inequality; there is a growing sense among kids that there is “no room for error,” and with that comes a desperate fear of missing the point of entry into the winning team, the “1%.” For anxious teens, “every step” feels like it counts.
JM: What about the interplay of substance abuse and mental health?
AMA: “Children who have an anxiety disorder before adolescence are eight times more likely to have a substance abuse problem by the end of adolescence,” she said. Social phobias, a primary source of anxiety, can lead to use of marijuana, alcohol and nicotine, to which teens turn in order to help “loosen up” and manage anxiety-producing social interaction.
NR: For teens, self-medicating with substances is often seen as an “easier step” than finding a psychiatrist or therapist. She emphasized that, for many safety reasons, keeping focus on substance abuse is a priority. As more states legalize marijuana, there will be more challenges in controlling use. For example, currently there are no “sobriety tests” for marijuana so driving under the influence goes undetected; as opiate misuse rises it will reach more communities, including our high schools and colleges. And, she warned, opiate misuse with alcohol is a potentially fatal combination.
MacPhee noted research at JED showing millennials (over age 21) and Gen Z (under 21) are more open to talking about emotional issues, and more culturally accepting than previous generations; both factors can be helpful in reducing stigma and encouraging more people to seek treatment. In light of that, he asked the panel:
How can parents best determine if a teen is struggling?
AMA: Adolescence has long been labelled “the storm and stress” age, with moodiness to be expected – yet, “you know your child better than anyone.” Look for danger signs that go beyond ordinary moodiness, she said, such as a sustained low mood, isolation from the family, sleep patterns that veer way off from the usual.
NR: Ask yourselves how long the troubled behavior is sustained; whether it subsides, and if not, pay close attention.
VS: Comparing anxiety distress signals to headaches, he noted “people get them” and that’s not alarming, but if “they worsen, interfere with daily life, and do not get better,” pay attention.
JM: What should a parent do if he or she DOES detect alarming signs?
AMA: LISTEN. Keep conversations going, she advised, but do it on their [the kids’] terms. After they “grunt,” avoiding coherent response, she said, “stick around, be available.” Don’t jump to telling THEM how THEY feel, she urged, but instead ask open-ended questions like, “Tell me more about that,” or, “What you do you think about that?” Then: LISTEN.
NR: Car pools are a “good place to listen in on kids’ chatter.” Say nothing, she advised; instead, LISTEN. She also suggested engaging in activities where conversation can “unfold naturally,” rather than targeted conversations where kids may feel under scrutiny. And, she added, when they do talk, validate. Don’t jump to being judgmental.
VS: If parents were to ask their kids every 15 minutes, “How are you NOW?” it would reveal their own anxiety, and wouldn’t really help the kids. Echoing the other panelists, he advised parents to “be available,” and to “hang around, listen.”
AMA: Parents should “catch the positives;” in other words, don’t overreact to errors while failing to notice and point out positive behaviors. Roy agreed, adding that she recalled suffering over her daughter’s worries but then finding, the next day, that everything was fine. “Keep your reactions in check,” she advised.
JM: If you believe your child does need clinical care, what do you say/do?
VS: Start with your primary care doctor/pediatrician. Ask friends who’ve sought help in similar circumstances. Talk to the school’s guidance staff. He reminded parents to also discuss appointments/treatment with the child before embarking on a plan.
AMA: Parents need to be informed consumers. “Get professionals who understand evidence-based courses of action,” she advised. Studies have shown treatments (cognitive behavioral therapy, medications, or combination of the two) to be effective, she said, and parents need to find clinicians “specifically trained to effectively deliver the treatments that will work,” but not all fit that criterion. Ultimately, she said, the goal is to give your children tools so they can be “out enjoying the world, not just on a therapist’s couch.” Send them back out once they have those tools, she said, but teach them to “touch base and use mental health services from time to time,” if needed.
JM: How does a parent deal with a child who imposes self-pressure?
NR: A recent focus group at a rigorous, prestigious college revealed that students’ peers are the “ones who put the most pressure” on each other. She cited a conversation between two students:
Student A: “I studied until 2 a.m.”
Student B: “You slept???”
Roy emphasized the importance of “keeping a balance.” Encourage kids to “develop passions and strive for balance,” she said, rather than focus solely on academic accomplishments.
VS: The sense that one must be either “a winner” or “in trouble” isn’t helpful. The evidence is clear, he added, that non-academic skills like knowing how to play and to use the imagination help build life skills, inter-personal skills and social skills. Tell kids it’s “okay to do something frivolous,” he said. And, added Roy: “It’s okay to mess up.”
JM: What about bullying and exclusion?
AMA: “Look for signs of changes in attitude; attempts to self-isolate; fears about arriving at a social event before the last minute; or shutting down social media contacts.” Parents should get involved, she said, but not judge. Rather, say: “Please tell me what you are feeling,” and try to get them to open up. “Hear the details” without overreaction, then make decisions.
VS: You can try to problem solve with your kids. Help them identify interests that might lead them to join new groups; talk them through strategies.
JM: How can parents help their kids develop protective factors, in advance?
NR: We’re hearing from colleges that students arrive “less resilient than ever before,” lacking basic skills like doing laundry, managing an ATM card, or eating and sleeping well.
Prepare your kids with basic life skills, she advised, so they can manage everyday tasks and can then better focus on their school work. “Give them opportunities to try to navigate for themselves,” she said, especially in conflicts or hard situations. Sometimes, “let them fail.”
Dr. Albano listed factors associated with resilience:
1) Social support – “relationships you can count on,” which can be established and nurtured early through playdates, clubs, interests;
2) Ability to delay gratification – teach them to put off gratification by saying “you cannot have it right now” so they learn to wait, and eventually, to prioritize.
VS: Let them join an orchestra, band, sports team, club or activities-centered group – all “good places to ‘hit wrong notes’ and see it’s not the end of the world.”
JM: Recently, suicide has been presented not only in the media but in the arts, e.g., 13 Reasons Why and Dear Evan Hansen – sometimes done well, sometimes not. How should parents respond to this?
VS: It all depends on the age and maturity of the viewer. For pre-adolescents, he added, 13 Reasons Why wasn’t helpful; although its intent was cautionary, the viewer needed a “sense of irony” to grasp that intent. “Be thoughtful about what your child can handle,” he advised, and be aware that “many may be overwhelmed” by some material. Read about or pre-screen a show first. Or, if like 13 Reasons Why, it’s already streaming on the internet and hard to monitor, sit down and “watch with your child,” he said, so you can “use it as an opportunity for thoughtful conversation.”
JM: How can parents know if a college has strong mental health services available?
NR: Check to see if it is a JED campus (www.jedcampus.org), which means it will have a comprehensive approach to promoting emotional wellbeing and addressing suicide and substance abuse prevention. If your child already has a history, ask about services ahead of time – don’t wait until arrival. Check the “campus climate” (fast-paced? compassionate? pressured?). Check opportunities to develop community, e.g., clubs and groups. Loneliness can be a huge problem in the first year, she warned. Consider factors like distance from home and the campus size; help your child find a good fit.
AMA: Parents sometimes mistakenly think “it will all be different at college” with RA’s, new friends, etc., but instead the kids may “flame out.” Anxiety does NOT disappear with the high school diploma, she said. There’s no stigma: if your child is struggling, connect her before she goes with short term college readiness groups, or services she will need.
Q and A: Several questions were taken from the audience. One parent wondered how to spot teen symptoms of depression and withdrawal in an era where there is so much “silence.” With teen lives now lived largely on social media, there’s little for a parent to hear, and very little transparency. Kids may say, “I’m fine,” but really aren’t – so, how does the parent know?
VS: “Find time for meals together and shared activities,” to counter this silence. Look closely at function: are they sleeping/eating okay? Getting their school work done? If not, probe further.
AMA: Make family time a priority, where all the phones go into a basket, such as dinner time. Also, take the phone away at bedtime, not only to help kids have better sleep, but also to teach them how to get themselves up with an alarm clock. Teach them to self-regulate, she urged. Finally, establish a centrally located place out in the open to do homework, like the dining room table, to ensure regular time when parents can see and monitor their children.
The rise in anxiety is real, and parents, in turn, are justifiably anxious about it. But the take-away of the evening was hopeful: there are simple things parents can do, now, without preparation or expertise, to support their kids:
COMMUNICATE – keep conversation alive, without judgmental overreaction.
LISTEN – to your child’s responses.
WATCH – for signs of changes that don’t seem like the usual adolescent moodiness.
TEACH – ordinary life skills, to build confidence and resilience.
ACT –if you do suspect deeper problems, and seek expert help.
Set To Go – JED’s Guide to the Transition from High School to College and Adulthood:
The Columbia University Clinic for Anxiety and Related Disorders (CUCARD):