Tag: teenagers

This article originally appeared in Macaroni Kid on February 23, 2021, by Luanne Starr Rhoades, LCPC, LADC, CCS; Health Affiliates Maine.  

Question: My son has battled depression and anxiety since late elementary school. He is 16 now. We have tried multiple medications for him, and he sees a therapist regularly. He seems to have gotten worse in the last six months which is no surprise given the difficulties of the past year. I am frustrated because I don’t feel like the meds he is on do enough. It feels like we have tried them all. Any advice would be appreciated.

Answer: Whatever you do, keep trying. I can just imagine how frustrated and hopeless you and he feel—you are doing the right things, and you are not seeing any change. Do not give up.

I hope I can give you some things to think about that might provide ways to further explore and treat his depression. Some people have what is called “treatment-resistant depression.” It means they are not responding as expected to the usual methods of treatment. That means it is necessary for everyone, both professionals and family, to look at other interventions. These are things which need to be considered:

Is the diagnosis correct? There are different kinds of depression which require different kinds of treatment. Since your son’s depression has gone on for this long, he should be treated by a psychiatrist and not a primary care physician.

Is the dose correct? Many psychiatrists are like artists and chemists, in a sense, adding some of this and tweaking some of that, until they get just the right combination. It can take time to find just the right formula of medications. Every person is unique and responds to medications differently.

Are there other mental health conditions complicating treatment? For example, if your son has Attention Deficit Hyperactivity Disorder (ADHD), he could be having trouble both socially and academically, which may contribute to him feeling bad about himself. Treating the ADHD could help with this.

Are there other medical conditions complicating treatment? Medical conditions such as thyroid disorders, mononucleosis, iron deficiency anemia and other vitamin deficiencies like Vitamin D, B2, B6, or folate (Treatment-Resistant Depression in Adolescents, David Brent, MD) can all contribute to depression. Lab work can help assess for these.

How well is your son sleeping? Adolescents are known to spend late night hours on screens and devices; this can interfere with a normal sleep cycle and greatly impact his mood. Medication is not a substitute for lifestyle deficits. Sleep, exercise, good nutrition, and social interactions make life better.

Is your son taking his medication regularly and as prescribed? Missing doses, for example, greatly reduces a medication’s effectiveness.

Is there depression in the family? Is there a family member’s depression, particularly a parent’s, which is not being treated or fully treated? This has a significant influence on how a child views the world.

Is your son currently experiencing bullying, or does he have a history of trauma or abuse? Medication does not treat these issues; however, they have a profound effect on mood. If he has these issues, is he working on them in therapy? Does he need additional assistance from parents, school officials or other professionals with these situations?

Is your son struggling with his sexuality or gender identity? Sexuality and gender identity are big and confusing to adolescents. Could his sexuality or gender identity lead him to family rejection or bullying by peers?

Is your son using substances like alcohol, marijuana or other drugs? Is there alcohol or drug abuse in the family? Using these substances or being affected by someone else’s use of substances alters normal emotional coping.

Is your son thinking about suicide or self-harm? This is so important. Ask him. Educate him that these choices are sometimes the result of feeling very depressed and hopeless. Help him know that there is hope, that as a family you will keep trying to help him feel better. Do not hesitate to take him to the hospital if he is doing things or saying things that make you think he is suicidal. He may be angry, but it is the safest thing to do. If you need help getting him there, do not hesitate to call 911.

Does he have a good relationship with his therapist? Not every therapist is right for every person. Check-in and make sure that he feels connected with and heard by his therapist.

It is very hard to have a child with prolonged depression. Parents feel hopeless and lost. Sometimes parents of depressed children need to talk to someone about it. Call a counselor to help you. Thank you for asking this question. You are not alone.

This and other helpful information on Treatment-Resistant Depression in Adolescents can be found here.

Luanne Starr Rhoades, LCPC, LADC, CCS is a professional counselor and the Outpatient Therapy Director at Health Affiliates Maine.

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This article originally appeared in Macaroni Kid on October 21, 2020, by Luanne Starr Rhoades, LCPC, LADC, CCS; Health Affiliates Maine. 

Question:  My son is 11 and has some significant behavioral issues including outbursts of anger, aggression, and yelling. We have been working hard with him on coping skills when he feels angry and this has helped some. He has been asking for a dog for a couple of years now. My husband thinks it could be a good time to get one and have our son work toward a dog by showing good behavior. I’m on the fence. Though I think it could be a motivator, I worry he would digress after we got a dog. If I am honest, I also am a little wary that he could show aggression toward the dog. He does now with my husband and me. I would appreciate some advice.

Answer: Both you and your husband have made some good points. Under any circumstances, adding a pet to the home takes a family commitment of time, energy, money, and affection. This is a long-term commitment that can pay off in lots of shared joy. 

A dog could be very therapeutic for your son. Pets love and accept us, without judgment, unconditionally; they are reliable and loyal. Pets can teach children many great and valuable lessons. Your son can learn responsibility to provide for the dog’s needs of food, water, exercise, play, and grooming in turn for endless love and affection. Pets help a child experience caring for another, a lifelong lesson in empathy.   

Before any of this happens, however, you and your husband need to come together to work on communication and an agreement about behavioral expectations, rewards, and consequences, both for current behavior and for future behavior with the dog. A dog is not going to immediately solve the aggressive behaviors you are currently seeing. As you alluded to, some children can turn that aggression on a pet. This can be serious and needs professional attention if it occurs.

Anger, aggression, and yelling is concerning, and it is also concerning that he is acting out aggressively toward you. Finding the source of his anger and frustration is extremely important. As with the check engine light on the dashboard of your car, his behavior is signaling unmet needs or underlying emotions that he is having trouble expressing in healthy ways. I am glad that you are helping him with coping skills. Seeking counseling for your son can be another way to help him learn to express and deal with distress before it turns aggressive. A counselor can also help him talk about what might be making him angry and afraid (fear is often covered up by anger). Family counseling can also give you and your husband tools to help you help your son so he can grow up happy with his dog.

 

Luanne Starr Rhoades, LCPC, LADC, CCS is a professional counselor and the Outpatient Therapy Director at Health Affiliates Maine.

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Divorced Dad Has Disinterested Kids

 I am a divorced dad and don't see my teenage children as much as I would like due to my work requiring significant travel. We've grown apart a lot in recent months and now even when we do see each other, I feel like I don't even know what to say or ask.

This article originally appeared in Macaroni Kid on August 15th, 2019 by Luanne Starr Rhoades, LCPC, LADC, CCS; Health Affiliates Maine

Question:  I am a divorced dad and don’t see my teenage children as much as I would like due to my work requiring significant travel. We’ve grown apart a lot in recent months and now even when we do see each other, I feel like I don’t even know what to say or ask. My kids seem disinterested in maintaining a relationship with me. They often do not answer my texts or phone calls. I think sometimes they make excuses for not seeing me too. I’m looking for unique ways to help strengthen my relationship with my kids and connect again. Thanks.

Answer: 

What an important and difficult situation, thank you for asking about this, I am sure others can relate.  The situation sounds like you need an immediate, (take some vacation time) and go camping, fishing or anything that would give you some extended time together to rekindle a connection.  

Let’s start with communication.  Often we talk to our kids by asking yes/no questions, questions that can be answered with one word like: “How was your day?”  “Fine”  “Is Mike coming over?” “Yes.”  “Was your test difficult?”  “No.”  “Did you get your homework done?”  You know the drill.  This is not conversation, and it is especially brutal when it is on the phone.   Instead, ask the questions in such a way that they must provide more information, like:   “Tell me something about your day?” “If Mike comes over what do you think you would like to do?”  When you are engaged in what they are studying or who their friends are, your questions can be more relevant, allowing for more conversation.  Remember that conversation goes both ways.  Without burdening them with your troubles, tell them things about yourself.  How are they like you?  What was important when you were their age, or a story about something that struck you as funny.  Send them pictures from your travels.   Whatever you do, be genuine.  Teens know when you don’t really care.  Learn their favorite video games and have them also teach you to play when you are with them.  Then you can ask about what levels they have achieved, they will know you understand.  Find an app that has a game you can play back and forth, while apart.  I know a dad that always has a chess match going with his teen.  Teens also prefer texts and many don’t answer calls.  Texting a note or picture is like communicating to them that right now, I am thinking about you. 

When you are together, you will have to put in some time to plan.  Set out to make your short time together meaningful.   TV and pizza, as much a kid’s like that, do not really make for relationship building experiences.  Ask yourself; are we making memories?  Try making your own pizzas with lots of fun ingredients, or go on a hike, fishing, or roller skating.  Make some family rituals for when you and your kids are together:  like morning waffle making or bike riding.  There are a lot of ideas online.  If at all possible, take one child along on one of your travels if they are old enough to safely bide their time when you are working.  Consider adding a day to the trip to explore, and make memories.  If your teens have special events, important sport activities or a role in a play, do whatever you can, alter your schedule when possible, to be able to be there.  I have had many people say, “My father never came to one of my games”.  

It is important to have fun, make memories, it is also vitally important to be a dad who participates in the heavy lifting of parenting, when necessary.  That is why you have no time to lose, to improve those connections with your teens.  You will want them to take you seriously and to listen to you when struggles come.  One way to do this, if the situation allows, is to have a positive-parenting connection with their mother.  Parenting with two parents is no walk in the park.  Being a divorced dad, who travels for work, is doubly hard. Don’t let your work be an excuse for not being involved.   You might want to try counseling around parenting issues, which can also be done confidentially online, when you travel.  Be careful not to put your kids in the middle between you and their mother, by asking what she is doing, if she is dating, or saying things to them about her which upsets them.  Kids will naturally want to defend her, which means, you are out. 

The other night I was with family in a pizza shop. When looking around the room, I could see dads alone with kids; thinking perhaps they were divorced and it was ‘their weekend.’  One father and teenage son stood out to me, because the teenager looked over my way rather bored and forlorn.  Dad was deep in his phone as they ate, scrolling away and texting.  This went on for some time.  It occurred to me that I would not want to be sitting there either, with no company.  The message we send our children and teens, when we are constantly consumed with other things, is that they are not important.  They feel invisible to us. This is a set-up for children to develop low self-esteem, a serious and sad condition.  As parents we need to be careful of the magnetic draw of our phones and other media, when the kids are around.  The natural progression of this situation of the teen in the pizza shop is that he may pull away.  Eventually he may find more interesting company than dad.    

I hear in your question that you want better.  I’m sharing this scenario to help you to think of what other factors are in your behavior, (intentional and unintentional) which might be contributing to your children distancing themselves from you.  I wish you success, whatever you do, don’t stop trying.  Kids need us, and want us, with changing intensity throughout our lives.  As you keep trying to engage you are sending the message that you will always be open to relationship with them.

Helpful links:

http://fathers.com/wp39/wp-content/uploads/2015/01/Five-Tips-for-Dads-Who-Travel.pdf

https://www.artofmanliness.com/articles/how-to-be-a-better-dad-when-you-travel-for-business/

healthaffiliatesmaine.com

Luanne Starr Rhoades, LCPC, LADC, CCS is a professional counselor and the Outpatient Therapy Director at Health Affiliates Maine, a mental health and substance abuse treatment agency serving adults, adolescents, children and families. For more information or if you or someone you know needs help, call us at 877-888-4304 or visit our website www.healthaffiliatesmaine.com and click on “Referrals.”

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Struggling with Sexual Identity

My husband and I suspect our daughter (age 15) is a lesbian. Is it best for us to broach the subject with her or best to wait until she is ready to talk with us?

This article originally appeared in Macaroni Kid on March 21, 2019 by Luanne Starr Rhoades, LCPC, LADC, CCS; Health Affiliates Maine

Question: My husband and I suspect our daughter (age 15) is a lesbian. We’ve actually suspected so for a few years now and the high school years have made it more clear to us. She has not said anything directly to us, or to anyone that we know of. We want to fully support her as best we can. Is it best for us to broach the subject with her or best to wait until she is ready to talk with us? I don’t want her to feel pressured to come out but I also want her to know we are in her corner. 

Answer: I like your last sentence.  This is probably what she needs to hear from you, that you are in her corner. Struggling with sexual identity is difficult. All of us thrive when we are authentic to who we are, however, it can be the hardest thing to talk to loved ones about. Big questions like: Will they be hurt? Will they disown me? Will I bring shame to the family? Will they expect me to change? You, however, seem to hit all the right notes of accepting and caring.  

By your words and actions you can continue to let her know:

  • you care about her  
  • you love her just as she is
  • you are open to conversations on all subjects 
  • you are willing to learn about differences
  • you want to support her

Your daughter will talk about it when she is ready. She may be in a state of questioning herself. Some individuals have reported being “outed” by someone before they were ready, and this had been damaging. You can demonstrate your acceptance and support by such things as attending events involving the gay community, inviting your gay friends to your home, or perhaps watching movies that depict gay characters. Many parents have gone down this road before you and can provide valuable information. Investigate organizations that focus on these issues like The Family Acceptance Project, PFLAG, and other online and community resources.  

Note to all parents: As parents, we hold a vision in our heads as to who our children are, what they will be, and what their future relationships will look like. Sometimes the picture in our head does not match the current reality. This can cause distress. It is important for you to allow yourself time to work through this and get support if you need it. Individual or family counseling can help. Always stay focused on loving your child, no matter what. The goal is for us to nurture and raise, what I think of as good humans; which are healthy, independent, adults who care about themselves, each other and the world.

Luanne Starr Rhoades, LCPC, LADC, CCS is a professional counselor and the Outpatient Therapy Director at Health Affiliates Maine, a mental health and substance abuse treatment agency serving adults, adolescents, children and families. For more information or if you or someone you know needs help, call us at 877-888-4304 or visit our website www.healthaffiliatesmaine.com and click on “Referrals.”

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Teen Suicide: It’s Not Just Drama

Adolescence is a time of change, change that is often frightening and confusing for teens. Their bodies are changing. Their minds, too, are changing, but they are not yet ready for all of the decisions they face.

This article originally appeared in Macaroni Kid on March 5, 2019 by Mary A. Gagnon, LMFT; Health Affiliates Maine

“She’s such a drama queen.”

“All he wants is attention.”

“They’re not serious.”

These words—and others like them—lead to the dangerous belief that a teen who is talking about suicide should be dismissed or, even worse, purposely ignored. Those beliefs can sometimes lead to tragic results.

Adolescence is a time of change, change that is often frightening and confusing for teens. Their bodies are changing. Their minds, too, are changing, but they are not yet ready for all of the decisions they face. It’s important to understand this because teens often act without thinking and have little experience in managing their emotions. These are two risk factors for suicide. Other risk factors—mental health issues, poor coping/social skills, perfectionism, unrealistic parental expectations, family conflict, abuse, and more—heighten the risk for teens already struggling to learn how to become adults. 

As adults, it’s easy to brush off a teen’s behavior as “dramatic” or “attention-seeking.” So how can we tell the difference between a teen having a bad day and a teen who needs more support? Look for some of these signs:

  • Threatening to hurt or kill themselves
  • Making plans to kill themselves
  • Expressing hopelessness about the future
  • Displaying extreme distress or emotionality (more than is typical for a person their age or for the teen in general)
  • Increase in agitation, irritability, anger (more than is typical, or an extreme change)
  • Withdrawal from activities they used to enjoy

What can you do if you suspect that an adolescent is thinking about suicide? First, you show them you care. Ask them how they’re doing. Ask them what’s going on in their lives, who their friends are, how their academics are going, how they’re feeling. And if they tell you, listen. Teens know if you’re not being sincere, so don’t make it an interrogation—make it a curious, genuine inquiry. Second, you ask the question—Are you thinking about suicide? Yes, it’s direct, and yes, it’s scary. However, it’s the only way to get the answers you need, and the consequences of not asking could be dire. Don’t worry—you won’t put the idea in their heads. That’s a myth. And third, you get them help. If they say yes, you make sure to connect them with a mental health or medical professional right away, and do not leave them alone. If they say no, it’s still a good idea to help them connect to a mental health professional because even if they aren’t planning to take their own lives, chances are good that they could use some extra support.

One of the major factors in preventing suicide is the presence of caring adults in the lives of teens. Truly, adults can make the difference for adolescents considering suicide. Be the difference. Show you care.

*Credit to the Maine Suicide Prevention Program (www.namimaine.org) for information regarding signs and risk factors for suicide.

Mary Gagnon is a Licensed Marriage and Family Therapist and the Training and Clinical Development Specialist for Health Affiliates Maine.  Mary has worked in private practice as well as a variety of community mental health settings throughout her career.  Her most recent work at Health Affiliates Maine includes oversight of clinicians in private practice and development and facilitation of trainings for schools and conferences throughout the state.  She is also trained to provide Suicide Prevention Awareness sessions for the Maine Suicide Prevention Program.

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Parents of teens understand there is a certain degree of moodiness that comes with the age. After all, it is a perfectly normal developmental stage for teens to grow away from their parents and want to try out all kinds of independence. 

Sometimes for parents, this moodiness can look dark and scary. Just remember that emotionally, there is a push and pull happening inside young people. They are attracted to the changes that come with getting older, but apprehensive of their growing independence. 

In most cases, the highs and lows, moodiness, and (sometimes) surliness are normal for a teen. But how do you know if what you are seeing is within the range of normal development? When does a parent need to be concerned that teenage moodiness might be a sign of a bigger problem?

Teenage “red flags” that can signal to parents it’s time to reach out for help:

  • Lack of interest in activities that usually bring enjoyment
  • Withdrawal from family and friends 
  • Isolating
  • Changes in their normal appetite and sleep habits
  • Seemingly tired all the time with difficulty concentrating
  • Not seeming to care about things which are usually important to them
  • Failing at school and/or school refusal
  • References to drugs and alcohol, drug paraphernalia
  • Unusually reckless behavior
  • Changes in friends or their normal crowd stops coming around
  • References or threats of suicide
  • Unusually dark depressed mood (can include absorption in music and art with references to death, blood, rage, etc.)
  • Cutting self
  • Unexplained pain or stomach problems
  • Unusual lack of self-care

Other behaviors and feelings that can signal deeper problems:

  • Fear and anxiety and generally overwhelmed by life
  • An unusual episode of elevated mood and speech followed by a depressed mood
  • Behaviors such as unusual drumming, tapping, interrupting, and pressured speech can indicate other mood disorders, which should be addressed with the primary care provider

Contributing factors which can predispose some teens to problems with moodiness:

  • History of traumatic adverse childhood events (abuse, neglect, sexual trauma, etc.)
  • Divorce
  • Family history of depression and/or addiction
  • Death or loss of a loved one
  • Incarceration of a parent
  • Bullying (cyber or otherwise)

The key for parents is to evaluate what is unusual for your teen and if these behaviors are prolonged or causing problems at home or at school. If your child is exhibiting multiple “red flags” from the checklist above, it might indicate it is worth talking to your doctor and a counselor.

Luanne Starr Rhoades, LCPC, LADC, CCS is a licensed counselor with Health Affiliates Maine

This information is not a substitute for a doctor’s or counselor’s advice.

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