With teens, while spending more time with and confiding in peers is a normal part of growing up, signs that your teen is experiencing significant stress include:

significantly avoiding parents
abandoning long-time friendships for a new set of peers
expressing excessive hostility toward family members

How You Can You Help?

Proper rest and good nutrition can boost coping skills, as can good parenting. Make time for your kids each day. Whether they need to talk or just be in the same room with you, make yourself available. Don't try to make them talk, even if you know what they're worried about. Sometimes kids just feel better when you spend time with them on fun activities.
Even as kids get older, quality time is important. It's really hard for some people to come home after work, get down on the floor, and play with their kids or just talk to them about their day — especially if they've had a stressful day themselves. But expressing interest shows your kids that they're important to you.
Help your child cope with stress by talking about what may be causing it. Together, you can come up with a few solutions like cutting back on after-school activities, spending more time talking with parents or teachers, developing an exercise regimen, or keeping a journal.
You also can help by anticipating potentially stressful situations and preparing kids for them. For example, let your son or daughter know ahead of time that a doctor's appointment is coming up and talk about what will happen there. Tailor the information to your child's age — younger kids won't need as much advance preparation or details as older kids or teens.
Remember that some level of stress is normal; let your kids know that it's OK to feel angry, scared, lonely, or anxious and that other people share those feelings. Reassurance is important, so remind them that you're confident that they can handle the situation. It can be helpful to work with a licensed mental health professional, such as a psychologist.
References:
American Psychological Association https://www.apa.org/topics/children-teens-stress
Kidshealth.org https://kidshealth.org/en/parents/stress.html

Common Signs of Depression in Childhood and Adolescence

Depression in childhood/adolescence can manifest somewhat differently than it does in adults. Irritability and/or anger are more common signs of depression in children and teens.

When depressed, younger children are more likely to have physical or bodily symptoms, such as aches or pains, restlessness, distress during separation from parents, as they may not have the emotional attunement and/or expressive abilities to talk about their emotions.

Other signs of depression in children and teens can be:

Loss of interest in usual fun activities
Withdrawal from social or usual pleasurable activities
Difficulties with concentration
Running away from home or talking about running away from home
Talking about death or dying, giving away (or talking about giving away) favorite possessions, writing goodbye letters
Sleep increase (or decrease)
Appetite/weight changes (more likely an increase, in depressed teens)
Occasionally, new or recent onset agitation or aggression
Comments indicating hopelessness or low self-worth

Not all of the above-mentioned symptoms have to be present for a diagnosis of depression. Symptoms usually occur on most days, for at least 2 weeks, in order to meet criteria for depression. You can contact your pediatrician to rule out medical reasons first. If depression is suspected, your primary care doctor may be able to provide a recommendation for a mental health professional or you can reach out to the school for a list of local resources.

Reference:

Anxiety and Depression Association in America https://adaa.org/learn-from-us/from-the-experts/blog-posts/consumer/childhood-depression

Signs of Anxiety in Children

Essentially, anxiety in children tends to manifest as negative behaviors that you may have glimpsed briefly in the past but are becoming noticeable, consistent and intense. Over time, these behaviors can become frustrating to parents who feel unable to handle these newly arising attitudes, and don't know how to deal with children that are not responding to punishment, yelling, or to any other methods that were once effective.

Dealing with disorders like anxiety in children is even more tricky than usual because, oftentimes, it may be hard to figure out if your child is suffering from anxiety or from another condition. In children, the symptoms of mental health disorders like anxiety often overlap with symptoms of other disorders, and it can be very easy to mistake anxiety for a learning disability or an attention deficit disorder.

Some symptoms include

Agitation
Restlessness
Inattention, poor focus
Somatic symptoms like headaches or stomach aches
Avoidance
Tantrums
Crying
Refusing to go to school
Meltdowns before school about clothing, hair, shoes, socks
Meltdowns after school about homework
Difficulties with transitions within school, and between school and an activity/sport
Difficulty settling down for bed
Having high expectations for school work, homework and sports performance

If any of these symptoms or behaviors persist, consult with a mental health professional. As childhood anxiety can also be exhausting for you, the parent, be certain to gain support for yourself through a parent support group for children who suffer from anxiety. You could also consider psychological support to offer support and guidance as you work with your child towards decreased anxiety.

Reference:

Anxiety.org https://www.anxiety.org/causes-and-symptoms-of-anxiety-in-children

Self- Harm

Everyone needs a way to cope with their emotions. People who self-harm have turned to hurting themselves as their coping mechanism to manage their emotions. So, people might self-harm to:

Process their negative feelings
Distract themselves from their negative feelings
Feel something physical, particularly if they are feeling numb
Develop a sense of control over their lives
Punish themselves for things they think they’ve done wrong
Express emotions that they are otherwise embarrassed to show

Types of Self-Injury

Cutting Scratching

Burning Carving words or symbols into the skin

Hitting or punching oneself Piercing the skin with sharp objects such as hairpins

Pulling out hair Picking at existing wounds

Symptoms of Self-Harm

Scars

Fresh cuts, burns, scratches, or bruises

Rubbing an area excessively to create a burn

Having sharp objects on hand

Wearing long sleeves or long pants, even in hot weather

Difficulties with interpersonal relationships

Persistent questions about personal identity

Behavioral and emotional instability, impulsiveness, or unpredictability

Saying that they feel helpless, hopeless, or worthless

How to Help

Teens whose cutting is part of another mental health condition usually need professional help. Sometimes cutting or another symptom leads to a teen's admission to a mental health hospital or clinic. Some teens have more than one hospital stay for self-injury before they feel ready to accept help for cutting or other problems.

Some teens find a way to stop cutting on their own. This might happen if a teen finds a powerful reason to stop (such as realizing how much it hurts a friend), gets needed support, or finds ways to resist the powerful urge to cut. To stop cutting, a person also needs to find new ways to deal with problem situations and regulate emotions that feel overwhelming. This can take time and often requires the help of a mental health professional.

Crisis Text Line can help you deal with self-harm. Text a Crisis Counselor at 741741.

References:

KidsHealth https://kidshealth.org/en/parents/cutting.html

Crisis Text Line https://www.crisistextline.org/topics/self-harm/#pass-741741-on-to-a-friend-8

Eating Disorders in Adolescents

Signs of an Eating Disorder

Extreme weight loss or not making expected developmental weight gain
Frequently skipping meals or refusing to eat
Excessive focus on food
Persistent worry or complaining about being fat
Frequent checking in the mirror for perceived flaws
Using laxatives, diuretics or enemas after eating when they're not needed
Forcing yourself to vomit or exercising too much to keep from gaining weight after bingeing
Repeated episodes of eating abnormally large amounts of food in one sitting
Expressing depression, disgust or guilt about eating habits

Prevention

Encourage healthy-eating habits
Discuss media messages
Foster self-esteem
Share the dangers of dieting and emotional eating
Set a good example

Seeking help for teen eating disorders

If you suspect that your teen has an eating disorder, talk to him or her in a loving and non-confrontational way. Also, schedule a checkup for your teen. The doctor can reinforce healthy messages and look for unusual changes in your teen's body mass index or weight percentiles. The doctor can also talk to your teen about his or her eating habits, exercise routine and body image. If necessary, he or she can refer your teen to a mental health provider.

If your teen is diagnosed with an eating disorder, treatment will likely involve a specific type of family therapy that helps you work with your child to improve his or her eating habits, reach a healthy weight, and manage other symptoms. Sometimes medication is prescribed to treat accompanying mental health conditions, such as depression, anxiety or obsessive-compulsive disorder. In severe cases, hospitalization might be needed.

Whatever the treatment plan, remember that early intervention can help speed recovery.

Reference:

Mayo Clinic https://www.mayoclinic.org/healthy-lifestyle/tween-and-teen-health/in-depth/teen-eating-disorders/art-20044635

Suicide Prevention

While the warning signs in children can be subtle, learning potential red flags plays a crucial role in intervention. While suicidal behavior is often associated with symptoms of depression, you might also notice the following changes in your child:

Changes in sleeping habits (too much, too little, insomnia, or night wakings)

Changes in eating habits (overeating or eating too little)
Withdrawing from family and friends (social isolation)
Psychosomatic symptoms: headaches, stomachaches, other aches and pains that can’t be explained

Changes at school: It’s perfectly normal for kids to experience ups and downs during the learning process, but a pattern of negative change can be a red flag that a child needs help.

Other signs include:

Drop in academic performance
Decreased interaction with teachers and kids at school
Lack of interest in school
School refusal
Loss of interest in normal daily activities (playing, sports, extracurricular activities)
Preoccupation with death: It’s natural for kids to think about death at times, particularly when they are coping with loss or hear about tragic events in the news. Preoccupation with death, researching ways to die, and/or talking about their own death can be red flags.
Feelings of hopelessness
Some children give away their favorite possessions or tell parents, siblings, or friends who should get their favorite possessions.
Writing or drawing about death or suicide
Significant changes in mood

In addition to the warning signs that a child might experience, there are also certain factors that can elevate the risk.

Previous suicide attempt Experiencing a loss

Chronic bullying Family history of suicide or suicide attempts

Violence or witnessing violence Access to firearms

Impulsivity Acute rejection

Feeling like a burden

It’s essential to seek an evaluation by a licensed mental health practitioner who specializes in working with children. If you’re not sure where to access help, schedule an immediate appointment with your child’s pediatrician, and indicate that you have concerns about your child’s mental health and potentially suicidal behavior.

If you have an immediate concern, Call 201-262-HELP (4357) which is Bergen County’s Designated Psychiatric Emergency Screening Program. The purpose of 262-HELP is to provide emergency mental health services to residents of Bergen County.

Reference:

PSYCOM https://www.psycom.net/children-and-suicide

Substance abuse

Chances are your teen's mood swings can be attributed to the racing and changing hormones that come with adolescence. In other words, teen mood swings are normal. You'll want to pay attention, though, if your teenage son or daughter is experiencing mood swings along with changes in behavior or appearance, such as:

Losing interest in activities they once enjoyed
Dropping old friends for a new group
Acting despondent, aggressive or angry
Sleeping more than usual
Breaking rules
Exhibiting physical changes like sudden weight loss, frequent nosebleeds, bloody or watery eyes, or shakes and tremors

Changes in appetite or sleep patterns
Deterioration of physical appearance
Withdrawal from social or important activities
Unexplained need for money or secretive about spending habits
Sudden change in friends or locations
Increased interpersonal or legal problems
Change in personality or attitude
Neglecting responsibilities

If you suspect or know that your teen is experimenting with or misusing drugs:

Talk to him or her. You can never intervene too early. Casual drug use can turn into excessive use or addiction and cause accidents, legal trouble and health problems.
Encourage honesty. Speak calmly and express that you are coming from a place of concern. Share specific details to back up your suspicion. Verify any claims he or she makes.
Focus on the behavior, not the person. Emphasize that drug use is dangerous but that doesn't mean your teen is a bad person.
Check in regularly. Spend more time with your teen, know your teen's whereabouts, and ask questions after he or she returns home.
Get professional help. If you think your teen is involved in significant drug use, contact a doctor, counselor or other health care provider for help.

SAMHSA’s National Helpline, 1-800-662-HELP (4357), (also known as the Treatment Referral Routing Service) or TTY: 1-800-487-4889 is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations. Callers can also order free publications and other information.

Resources:

PsychCentral https://psychcentral.com/lib/symptoms-of-teen-substance-abuse/

Hazeldon Betty Ford https://www.hazeldenbettyford.org/

Substance Abuse and Mental Health Administration https://www.samhsa.gov/find-help/national-helpline

Mayo Clinic https://www.mayoclinic.org/healthy-lifestyle/tween-and-teen-health/in-depth/teen-drug-abuse/art-20045921

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