Teenagers: How do we know if they’re okay?

Adolescence is a whole new challenge when it comes to parenting. Is your teen’s behaviour ‘normal’? Is your adolescent displaying signs of mental illness like depression, anxiety, self harm or an eating disorder? Here, a doctor in Singapore shares his top tips on navigating the teenage years, particularly during these challenging times.

The teenage brain

The teenage years are a time of great physical change for young people. This includes huge changes in their brains, explains UK-trained family GP, DR NEIL FORREST of Osler Health International. As a doctor who has been caring for the international community in Singapore for the past five years, he sees both adults and teens with mental health and other medical concerns.

“Teenage brains really are different! We believe that one of the last parts of the brain to mature is the part that controls reasoning and encourages us to think before we act,” he says. “A typical adolescent will make many of their decisions using a part of the brain that’s responsible for immediate and instinctive decisions based on fear or emotion. This is why many teenagers can make seemingly rash and impulsive decisions, which can put themselves or others at risk.”

Of course, adding a global pandemic into the mix of adolescence doesn’t help. Months of virtual learning, more time isolated from friends, a lack of clarity about the future, the cancelling of important social activities, and not being able to travel to see family have likely made a mark. So it’s no surprise that parents are more concerned about their teens’ psychological and physical health, and what’s considered “normal.”

What is “normal” teenage behaviour?

Many traits and behaviours that you notice in your teenager are normal developmental stages. While this doesn’t mean that they can’t be challenged or modified by good parenting, they do not represent a mental illness such as depression. Here’s a list of what is considered “normal” behaviour during adolescence:

• rebelling against rules and boundaries, and sometimes behaving more aggressively;
• becoming more argumentative with other family members;
• wanting to spend more time alone or with friends than with their family;
• being less communicative;
• being disrespectful to adults; and
• being late to bed and hard to get up in the morning.

When should I be concerned as a parent?

One of the challenges for parents and doctors is working out when these fairly typical teenage traits are masking something more serious in terms of mental health, says Dr Forrest. So, although your teen may become more moody and experience more intense emotions, it’s important to look out for certain signs of concern:

• social withdrawal;
• a marked change in appetite or weight;
• negative views of themselves or the world;
• thoughts of self-harm or suicide; and
• risky or reckless decisions.

These behaviours could indicate that something more serious is going on. The most common mental health issues Dr Forrest sees in teenagers include:

Anxiety

Anxiety in teenagers is, by far, the most common. In fact, the majority of people will experience some form of anxiety disorder in their lifetime.

“Anxiety itself is a common and useful human emotion. We’re supposed to feel anxious in certain situations,” says Dr Forrest. “Anxiety disorder occurs when this emotion becomes problematic, either in terms of severity or duration, and interferes with your ability to function.

In its most extreme form, this can manifest as panic attacks, which are not uncommon among young people. We use a variety of methods to help manage anxiety. These may include behavioural techniques (breathing exercises, laddering, grounding), psychological therapies, or, occasionally, medication.”

Depression

Teen depression is also very common. Like anxiety, depression centres around a normal emotional response – in this case, sadness – which has reached a point where it has become pervasive and impacts daily life, explains Dr Forrest.

Signs of teen depression may include:

• tearfulness;
• aggression;
• social withdrawal;
• changes in sleep or appetite; and
• deterioration in school performance.

In some instances, there is an obvious trigger – for instance, bullying or bereavement. But, the cause of teen depression is often hard to pin down, says Dr Forrest.

“Sometimes, depression can lead to self-harm or suicidal thoughts. There are lots of treatments for depression that have been proven to work. So, if you are worried that you child is suffering, please speak to your doctor so we can help.”

Eating disorders

Common eating disorders include anorexia, bulimia and binge eating. All three conditions are serious, and carry the highest mortality of any teenage mental illness, says Dr Forrest.

Signs include:

• distorted body image;
• obsession about food and health;
• excessive exercise; and
• tiredness and loss of concentration.

“In my experience, eating disorders are impossible for a parent to manage alone. Therapy for the whole family is often required. As with most conditions, the earlier the treatment can be started, the more successful it tends to be.”

If I’m worried, how can I get help for my teenager?

Of course, the optimal situation would allow an open dialogue between doctor, parent and teenager, explains Dr Forrest. But sometimes this can prevent the teen from being able to fully express their concerns or symptoms. So, it’s important to be open to giving your teen some space and speaking with a doctor privately about how he or she is feeling.

Additionally, giving teenagers a reassurance about confidentiality if they are seeing a doctor is key, he says.

“As in all medical care, there are exceptional cases where the right to confidentiality is not absolute – for example, if someone is in imminent danger, or if a serious crime is being committed. Thankfully, cases such as this are extremely rare.”

How a GP can help

According to Dr Forrest, a GP offers a confidential, non-judgemental and understanding ear. And, this ‘objective ear’ is particularly liberating for teens.

“For many people, just being able to talk to someone can help,” he says. “We are professionals and have the perspective on having seen so many other teens going through similar troubles. This perspective is of particular value to parents who may be concerned.”

In addition, there are many different ways a GP can help. This could mean guiding your teen to help themselves or referring them for psychological counselling.

“We work with many other health professionals. And, as a GP, my job is often to help people navigate their way around the system to find the best specialist.”

Dr Forrest’s top 5 tips for parenting teens

1. Remember that you are the parent
2. Respect their boundaries
3. Listen more and talk less
4. Show resilience and don’t rise to aggression
5. Be kind – it’s hard for them!

Osler Health International
#02-27/02-34 Raffles Hotel Arcade, 328 North Bridge Road | 6332 2727
#B1-27, The Star Vista, 1 Vista Exchange Green | 6339 2727
osler-health.com

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