By Dr. Amy Glaser
Parents fear the adolescent monster: sulky, withdrawn, hostile, and defiant. He or she may not be like that all the time. But let’s face it, hormonal change in adolescence often introduces a moodiness that we may not have seen in our comparably upbeat pre-teens. Okay, so when is adolescent moodiness normal and when is it something more? Reality testing with other parents is difficult. Not all teens act out to the same degree, and it is always a shock to experience the adolescent personality change even for parents who know it is coming. Worst of all, some children presenting a sullen front to their parents seem genuinely unhappy. Even parents who despair of getting an adolescent to get them to unburden their deep dark secrets may become concerned that they are missing something serious. So the question becomes for the parent, how do I know when my child needs help?
According to Dr. Nancy Rubinstein, a child and adolescent psychiatrist practicing in Lower Manhattan, this is a legitimate concern and parents should remain sensitive to mood disorders beyond normal growing pains in the adolescent years. Some mood disorders, such as bipolar disease (manic/depressive illness), often develop during adolescence and are a frequently missed diagnosis, particularly because of the background moodiness of the teenage years.
“There are certain vulnerable children in whom moodiness, irritability, school failure and risky behaviors can be diagnostic clues of a more serious psychiatric disorder,” she says. According to the National Institute of Mental Health, over 1.5 million children under the age of 15 are severely depressed.
Children and teens, particularly those with a family history of mood disorders, can show symptoms of this more serious illness, which may be explained away as stereotypical teen angst. Also the behavioral symptoms can overlap with symptoms of other disorders such as Attention Deficit Hyperactivity Disorder.
“The diagnosis becomes trickier because young people with a serious mood disorder can have A.D.H.D. at the same time. The overlap of these two disorders is estimated to be at least 15 %. Your child may have difficulty paying attention, be hyperactive, irritable even explosive and have acting out behaviors. They may have been treated with stimulant medication but still have significant problems. Their moods may be erratic, fluctuating between sadness/hopelessness, and exaggerated good moods with impulsive judgment. Sometimes these various emotions are present at the same time. Parents can feel overwhelmed and not know how to proceed.
Dr. Rubinstein suggests that these difficult children be evaluated by a competent adolescent psychiatrist who can make the diagnosis and begin treatment. “There are a number of effective medications which can help stabilize moods and behaviors and return children to optimal functioning,” Dr. Rubenstein adds.
Untreated, these children, particularly in their teen years, are at risk for school difficulty, alcohol and drug problems, risky sexual behavior and most alarmingly, suicide. Suicide remains an important cause of death among teenagers with successful attempts most common among males.
There is a persistent controversy about antidepressant medication and its potential to cause suicidal thinking in young people. It appears that some children, particularly those with a genetic predisposition to bipolar illness, can reportedly show a paradoxical response the otherwise highly effective antidepressants called selective serotonin reuptake inhibitors (S.S.R.I.’s). The risk may be greatest in the first few weeks of treatment. However, when these children are closely monitored by a medical professional, evidence of emerging suicide ideation can be handled immediately, according to Dr. Rubinstein. “In my experience antidepressant medications have been overwhelmingly helpful for depressed children and adolescents. And mood stabilizers, such as lithium, Depakote, and Lamictal can treat bipolar symptoms in young people with gratifying effectiveness.”
By the time our children reach their teen years, parents have a good idea of who they are, what they are good at, and where they are vulnerable. Some moodiness during adolescence can be expected, but marked personality changes should alert parents of possible problems. Changes in their ability to take pleasure in activities, inability to sleep, decreased or extremely heightened energy levels, and rage inappropriate to the stimulus may all be signs of depression. And of course signs of failure in their own world, such as withdrawal from peer group activities, school cutting, and school behavior problems, may be a cry for help. Such a cry should not be overlooked.
Amy Glaser, MD, a mother of two teenagers, has a private adolescent practice at 430 West Broadway, 212-941-1520. She can also be reached at aglasermd@aol.com.
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