Clues Your Teen May Be Facing a Mental Health Challenge

Feb. 8, 2022 — Leonard noticed some concerning changes in his daughter Tina that started soon after her 16th birthday.

“Basically, she almost completely stopped talking to my wife and me,” says Leonard, who asked not to be named to protect his family’s privacy. “Anything we asked her, she answered with one word, like ‘nothing,’ or ‘whatever,’ or with a shrug.”

Leonard, an IT project manager at a bank, and his wife, a customer service representative, had been working from home during the COVID-19 pandemic through most of 2020.

“We had actually drawn a lot closer during the lockdown, eating family dinners together and going on walks,” he says.

But, he says, Tina changed once she returned to school in 2021 with a new “‘hybrid” structure, which happened around the time of her birthday. She holed up in her room after school and started biting her nails — something she hadn’t done since she was 7. She barely ate anything at dinner.

“We could tell she wasn’t sleeping much at night because her light was on at all hours, and she’d come down to breakfast looking exhausted,” Leonard says. “We thought she might be worried about something, but she denied that anything was wrong.”

Although Leonard was “disappointed” that his daughter was so distant, he wasn’t alarmed.

“We figured it was normal teenage stuff,” he says. “I wasn’t super fuzzy with my parents when I was 16. My wife’s friends said, ‘It’ll pass, it’s just a teenage phase.’”

But then Leonard and his wife saw Tina’s report card. She had failed her classes.

“We realized this wasn’t just ‘normal teenage stuff,’” Leonard says.

Leonard’s story is not unique, according to a new survey conducted by GeneSight Mental Health Monitor from Myriad Genetics. The researchers surveyed 323 U.S. parents of children ages 16 to 24 and 641 teens and young adults age 16 to 24. The survey was conducted in August and September 2021. The margin of error in survey results for the total base population is +/- 3%.

The researchers found that only half of parents were “very” or “completely” confident that they could tell the difference between normal adolescent challenges and a mental health condition, and over a third (35%) were only “somewhat” confident. Almost half of parents (47%) thought their child would not be fully comfortable talking to them about their mental health struggles.

“As many parents of teens know, your kids may stop confiding in you. Yet, the [survey] shows how vital mental health conversations are,” Mark Pollack, MD, chief medical officer for mental health at Myriad Genetics, says in a press release. “If you suspect your child’s mental health is suffering, talk to them and talk to a health care professional about your concerns.”

Red Flags and Clues

Debbie Thomas, EdD, a Louisville, KY-based child and adolescent psychiatric clinical nurse specialist, says parents can look out for certain clues that their child might be struggling with mental health issues and the red flags showing these issues have reached crisis level.

“A lot of things parents should tune into are in major domains of functioning — school, family, friends, activities, and grades,” Thomas says. “Is your child having fun, or do they just seem kind of ‘blah?’ Is your child acting out or ‘acting in’ — meaning, being sullen or withdrawn? Have you seen changes in appetite, sleep, energy level, motivation, or joy?”

These can all be warning signs that trouble is afoot.

The survey showed that almost a third of parents believed that “worry” and “anxiety” were the same thing, but they are actually different, Thomas says.

“Worry can be a component of anxiety, but oftentimes, worry is incidental and transient,” she says.

For example, a youngster can be worried about a biology test, but when the test is done, the worry disappears. Anxiety, on the other hand, is often felt in the body. It can take the form of headaches, stomachaches, nausea, or sleep disturbances. It is more pervasive and can be a mental health problem.

Similarly, there is a difference between “just feeling down” or “having the blues” versus being depressed. A state of “blues” — feeling sad, hopeless, worthless, apathetic, or not feeling pleasure in usually enjoyable activities — that lasts for 2 weeks or more can be depression.

Questions to consider are whether the child’s mood is persistent or momentary. Did something happen that they are upset about, or is there an ongoing problem? How pervasive is it? How has it affected the most important domains of life?

Talk to Your Kids

Kids want their parents to talk to them, and over half (51%) are willing to share their mental health struggles with their parents, according to the survey. A fifth of the young respondents said they would be willing to share their struggles with other family members, and 38% said they would be willing to talk to friends.

Initiating conversations is very important, says Thomas, who is professor emeritus and former director of the graduate psychiatric nursing progam at the University of Louisville School of Nursing.

“Don’t just look at the kids’ behaviors, look at the feelings behind those behaviors,” she says.

For example, if a child throws something at the wall, ask what they are feeling. Are they frustrated? Angry? If so, about what?

Thomas advises parents to talk to their children if they see something is amiss.

“But don’t just ask, ‘What’s wrong?’ That sets up the likely response of ‘Nothing’s wrong,’” she says.

Instead, ask more specific questions. “’Is something worrying you? Are you having problems at school or with friends? Are you in any type of trouble?’”

And be proactive in initiating these conversations.

“I advise not waiting to see if the mood lasts for 2 weeks,” Thomas says. “I recommend having open conversations with kids and listening to what kids have to say.”

And don’t be afraid to ask specific questions, and listen carefully between the lines. For example, if your child says something like, “I don’t want to be here anymore,” try to clarify what this means.

“Does this mean you don’t want to be in this room right now because you’re upset? In this school? Or is this how you feel about life?” Thomas says.

Youngsters often express suicidal thoughts passively rather than saying directly, “I want to be dead” or “I want to kill myself.”

She says it is a “myth” that asking about self-harm or suicide will “put ideas” into the person’s head.

“Actually, it’s more like taking the lid off a pot boiling on the stove and letting some steam out before the pot boils over. It releases some of the pressure that the kid might be holding internally,” Thomas says. “Talking will do nothing but help the situation.”

“I’ve Talked to Her. Now What?”

Talking to children is an important first step, but it’s just that: a first step. Depending on how the conversation or conversations go, you may need to seek professional help for your child.

Over 75% of young respondents in the survey said that their mental health challenges had started before they turned 18. But only half of parents sought treatment for their child’s mental health challenges, and nearly three-quarters of youngsters who did not get help said they wished their parents had done so.

Many said they would not have suffered so much during their teenage years had their parents gotten them help. They also said they would have been better equipped to handle their problems, they would have been better prepared for adulthood, and they would not still be dealing with the same issues now.

Paula, a paralegal based on the West Coast, began to notice disturbing behaviors in her son Kevin when he was in preschool.

“He became anxious in ways that were not typical of other kids in his class or children of family members and friends,” says Paula, who also asked not to be named to protect her family’s privacy. “He had trouble sitting still. He had a lot of temper tantrums. He got kicked out of several preschools, but we were told that all of his problems were behavioral.”

Paula tried talking to Kevin, but “he didn’t have the vocabulary to express what was going on for him. He was just a little boy,” she recounted. Fortunately, Paula has a close relative who is a therapist.

“I grew up in a family where therapy was normalized and not stigmatized, and so I was attuned to the possibility that acting out behavior might be the sign of a mental health problem such as anxiety, and not just ‘bad behavior,’ which is what turned out to be the case.”

Kevin, now 15, was eventually diagnosed with severe anxiety disorder.

What Kids Face Today

Thomas says the stressors of the pandemic have pushed both parents and youngsters to the max.

“It is often difficult for parents to focus on their kids’ mental health struggles when so many parents are having struggles of their own,” she says.

Bullying is major stressor for youngsters. “I’ve seen bullying take on a life of its own as social media has mushroomed — not only Facebook, but now there’s Instagram, Snapchat, and many other platforms. I’ve seen virtual bullying escalate, and now that kids are back in school, there are also the traditional forms of bullying — physical, verbal, and social.”

She says many parents overlook the impact of “social bullying,” which can take place in person or in virtual settings.

“It may not take the form of ‘I’m going to beat you up or kill you’ but rather, ‘Don’t bother showing up at the party or football game Friday night, we don’t want to see you there.’ The person will be scared of the ridicule or of being ostracized,” Thomas says.

Virtual bullying includes exclusion, creating rumors, taunting, and encouraging others to bully the person. Or there a few friends in the same WhatsApp group and they suddenly drop one friend from the group.

Parents should be aware of what their children — both younger kids and teenagers — are doing online, Thomas says.

“Kids are online so much of the time these days, especially since the beginning of the pandemic. Sometimes they say they’re playing video games, sometimes chatting with friends, but sometimes they’re involved in things that can be scary or unsafe — even physically, and certainly mentally and emotionally,” she says.

“COVID has disrupted kids’ routines and depleted a lot of resources. Kids are left to deal with the complex challenges that have always faced adolescents, plus all of the new complications that COVID has brought — often, greater family stress, financial stress, isolation, and uncertainty,” Thomas says.

Leonard said that he and his wife spoke to Tina together.

“We told her how much we loved her and that we understood this is a really hard time, and we were there for her,” he says.

Tina burst out crying and admitted she was “nervous all the time” about getting COVID-19 now that she was back at school. She was upset that she had put on a few pounds during the lockdown and some of the kids at school were making fun of her and calling her “Tubby Tina.”

“She told us, ‘I walk around feeling like a gremlin is eating me up from the inside all the time,’” Leonard says. “She was relieved that we weren’t angry about her grades. She agreed that if we would find her a therapist, she would go.”

Leonard and his wife called their primary care doctor, who referred them to a mental health center with a team of psychiatrists, psychiatric nurse practitioners, and other mental health practitioners. Tina started therapy with a compassionate social worker.

“We didn’t know if she would need medication, but right now, therapy seems to be helping her. She’s more communicative and friendly and seems happier,” he says.

Trust Your Gut

“I think the best advice given to me, and the advice I would give other parents, is to trust your gut,” says Paula. “You know your kid. You know when they need something.”

Today, Paula says she and Kevin attend therapy weekly.

“We go to family sessions, Kevin goes to individual counseling and group therapy, and we have a provider who prescribes his medication,” she says. “We and his providers are always monitoring his symptoms of anxiety and treating them as they arise.”


Contacting one’s primary care doctor or pediatrician, as Leonard did, is often a good starting point. They can point you in the direction of mental health help for your child. Other resources, many of which offer referrals, education, online support groups, and peer-to-peer help, are listed below.

National Alliance on Mental Illness (NAMI)

Depression and Bipolar Support Alliance (DBSA)

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