Is my teen OK? Helping parents identify anxiety and depression in their adolescents

As children become adolescents, they start to experience several developmental changes that affect them physically, psychologically, emotionally and behaviorally. Because of these changes, parents may start to notice that their teens may be irritable, withdrawn and overwhelmed.

Some of these behaviors are natural during this developmental stage, but if these behaviors are recurring for many weeks, they may serve as a red flag that a teen is experiencing symptoms of anxiety and/or depression.

Baleska Alfaro, a licensed marriage and family therapist at CHOC’s Co-Occurring Clinic, helps parents understand the typical teen developmental changes and describes the signs and symptoms of depression and anxiety to watch for.

What developmental changes do teens experience during adolescence?

Adolescence is a time of many changes for teenagers’ physical bodies, how they connect socially and emotionally and how they think and learn, says Baleska. They are becoming autonomous — developing their own personalities and sense of connectedness.

Physical changes

Physically, teens might experience significant changes to their body size, shape or weight during adolescence.

Most teens assigned as female at birth will be physically mature by adolescence and most will have completed puberty. They may be developing breasts, experiencing hormonal changes and starting menstruation.  

Teens assigned as male at birth may still be in the process of maturing physically at this time – they are hormonally driven, may develop a deeper voice and begin to grow facial hair.

For all teens, these physical changes can impact their mood — they may start to behave and interact differently with their family and friends. 

Emotional and social changes

During this time, teens may start to have more interest in romantic relationships and sexuality —however, they may not always be overt about this interest and may start asking questions about sexuality covertly. 

In pursuit of autonomy, teens may start to withdraw from their families and start to form their own opinions about religion, politics and social world around them. This may cause conflicts with their parents because these new thoughts and changes may be confusing for their teens, causing them to be irritable or feel lost.

Although teens may show some distance from their families during this time, they will draw closer to friends. They start to have a deeper capacity for caring and sharing and want to develop more intimate relationships.

With all of these new feelings, emotions and relationships, teens may experience quick fluctuations in mood — often having difficulty regulating their emotions.

Thinking and learning

Because adolescence is just a step under adulthood, Baleska says that teens may be prompted — both biologically and socially — to think about their future. They may start to develop more defined work habits and a better work ethic.

Contrary to their previous tendency as kids to have concrete, structured thoughts — often only seeing the here and now — teens develop more abstract thinking. They can grasp bigger-picture thinking; they are able to give reasons for their own choices and start to realize that they may have long-term consequences. 

All of these changes in thinking may lead teens to have the following teen behaviors, says Baleska:

• Changes in sleep – Because social connection is so important to teens, they may stay up late on their phones, often texting or going on social media.
• Mood fluctuations
• Changes to academic focus – As they start to think of their future, they may focus more on grades. Or they may realize that school is not for them and focus less on schoolwork and grades.
• Defiance of rules at home or school – This may not be a conduct issue as much as that when teens become more independent, they may develop opinions that may clash with their parents’ beliefs.   
• Need for space from family of origin in the desire of autonomy.  
• Prioritizing social relationships over family.
• Experimentation and questioning of sexuality, values and political views may be very natural for teens.

What’s the difference between natural teen behavior and depression?

Symptoms of depression may not be overt, such as a teen exhibiting sadness. It is common for teens to be overwhelmed easily during all of their developmental changes or appear irritated and withdrawn from family because they rather be with their friends.

It’s important for parents, caregivers and educators to be able to spot the difference between natural teen behavior and depressive behavior, says Baleska.

According to the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5), clinically diagnosed depression may be called Major Depressive Disorder or Other Specified Depressive Disorder. 

The DSM-5 states that common symptoms of depression may include irritable mood, lack of motivation, inability to concentrate, fatigue, physical symptoms like stomach aches and headaches, social withdrawal, sadness and behavioral issues such as non-compliance and or defiance.

Additionally, depression is more commonly seen in teens assigned as female at birth. They may develop eating disorder symptoms like eating too much or too little or over exercising.

If your teen is not usually this way, Baleska explains, and if there is a pattern of these symptoms popping up for more than two weeks, it may be a red flag that your teen may be experiencing a depressive episode.

Is my teen just anxious or do they have anxiety?

The DSM-5 lists the common symptoms of anxiety as excessive worries about one or more areas of daily life, muscle tension, irritability, inability to concentrate and trouble sleeping (insomnia). They may also have additional physical symptoms like stomachaches or headaches and an increase or decrease of appetite due to stress.

Anxiety is a sense of urgency to get something done or quiet a concern, says Baleska, some anxiety can be OK if it helps teens study for a test, train for a big game or prepare for a presentation.

However, if a teen is having excessive worries that are impacting their functioning, they may be having an anxiety episode or have an anxiety disorder.

When should I be concerned about my teen’s depression and anxiety symptoms?

The COVID-19 pandemic caused a spike in depression-like and anxiety-like symptoms such as isolation, lack of motivation, fatigue and even lack of hygiene, says Baleska. She encourages parents to watch for the following behaviors and compare them to how their teens normally behave:

School warning signs

• A rapid decline in a teen’s grades.
• Saying they don’t want to go to school or missing classes.
• Loss of interest in extracurricular activities that they enjoyed prior.
• Changes in appearance or personal hygiene.

Emotional and social warning signs

• Suddenly not able to balance school load and extracurriculars.
• Being constantly irritable and talking about being overwhelmed or that they “can’t do it anymore.”
• Having difficulty regulating emotions, having anger or tearful spells.
• Withdrawing from support system and isolation.
• Appearing overwhelmed.

Physical warning signs

• Behavior changes like excessive sleeping, eating or biting nails.
• Changes in energy level or activity – feeling fatigued or even feeling restless can both be a sign of anxiety.

If any of these behaviors are happening more often than not, says Baleska, it could be a sign of anxiety or depression.

How can parents help?

“Small actions can make a big impact,” says Baleska. 

Parents should know when to access professional help. If a teen is having suicidal ideation or wanting to harm themselves or others, seek immediate help. Call 911, a crisis team, or visit your nearest emergency department.  

Baleska says that if a teen is exhibiting signs or symptoms of anxiety or depression that are not an immediate concern, consider the following ways to help:

• Schedule hang-out time. Either as a family or one-on-one, watch a show together, do a craft or play a sport.
• Play the peak and valley game. In this game, all family members share the peak, or best part, of their day, and the valley, or hardest part, of their day. This is a great way to find out how your teens are feeling.
• Have an open-door policy. Let your teen know that you are always available to have a nonjudgmental conversation. They need to know that they have an advocate.
• Promote family activities. Let your teen know that they can include their family in their support system.
• Get to know your teen’s friends. Learn about what they do and who they are.
• Normalize feelings. Express your own feelings to your teens and how you deal with them. Maybe you’re expressing that you are angry, anxious or sad—so you decide to go for a run or take a bubble bath. Let your teen know that it’s okay to have an emotional expression or reaction, but also do something to manage those emotions in a healthy way.
• Set limits and rules. Social media and technology can be a trigger for teens if they are being bullied or negatively impacted by things they are seeing. It’s also important to set rules for sleep, hygiene and mealtimes – physical health is directly correlated to mental health.
• Keeping in contact with teen’s school. The school’s social worker, counselor or therapist could be a great ally, and also keep up to date with their grades and how they are doing academically.
• Know the community resources available to you and your teen regarding mental health like the phone numbers above. CHOC also has additional mental health resources available in English, Spanish and Vietnamese.

Watch Baleksa’s full webinar on this topic as part of CHOC’s Mental Health Education Program (MHEP), which offers free webinars to parents on a variety of topics. To view upcoming webinars, view the MHEP events calendar.

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