From anxiety and depression to stress and social media, many teens are struggling. Tufts experts share tips for how to help through prevention and treatment
No matter where you look, headlines paint a picture of teenagers in distress.
More than 20% of teens have seriously considered suicide, says the American Psychological Association. Suicide is the second leading cause of death for children ages 10-14, according to the National Institute of Mental Health. And teen girls, in particular, “are experiencing record high levels of violence, sadness, and suicide risk,” says the Centers for Disease Control and Prevention.
“The teenage years are no walk in the park for any parent because there's so much that comes up during that time, from decision-making about access to social media to dating privileges to their academic future,” says clinical psychologist Alice Connors-Kellgren, assistant professor at Tufts University School of Medicine and director of the Child Trauma Clinic at Tufts Medical Center. “Even if your child is pretty perfect, it can be really stressful.”
Connors-Kellgren says the families of her teenage patients have a lot of questions. Is my teen depressed? Why is my high schooler so anxious? How do I get my kid to open up? How can we help our teenager with social anxiety? How can we tell if they’re being bullied?
“It’s all about having open communication and allowing for time. Boys and girls talk differently, and sometimes we, as a society, are more open to talking about feelings with girls than with boys. I hope we can change that,” says child psychiatrist Neha Sharma, associate professor at the School of Medicine and director of the Child and Adolescent Psychiatry Clinic at Tufts Medical Center. “Extend an invitation to talk and then pause to allow them to process that before they come back. If they don't take our offer right away, we tend to assume they don’t want to talk. But parents need to keep coming back, not in a nagging way, but in an ‘I'm still here and listening’ kind of way.”
Parents and other adults can support young people by teaching them about tapping into their life purpose and self-agency, and pursuing goals such as helping others, says Henry Brzycki, AG03, co-president of The Brzycki Group and The Center for the Self in Schools.
While each teenager’s circumstances and needs are different, these experts with ties to Tufts describe behavioral red flags to watch for and share proven strategies that parents and caregivers can use to help boost their teens’ mental health through prevention and treatment.
For Anxiety, Assess the Problem
If you’re concerned about your child, Sharma suggests starting with the basics. Are they eating, bathing, and otherwise taking care of themselves? How is their self-esteem? How are they doing socially, and do they talk about friends or lack thereof? How are they doing academically, and not just with grades, but with completing tasks and managing assignments? Are they relating to the family as they normally do? Are they spending excessive amounts of time on screens?
If you see a negative turn in any of those facets of life, Sharma suggests, dig a little bit and check in with your teen.
Watch for anxiety clues like avoidance, she says, especially if it’s something they didn’t avoid previously, like discussing a particular topic or going to an extracurricular activity. Pay attention to sleep disruptions and appetite changes, as both can signal an increase in anxiety. Another sign of anxiety can be increased irritability or edginess.
Low mood and low energy are often signs of depression, as are big changes in your teen's appetite or sleep habits, Connors-Kellgren says.
Parents can help teens cope with some challenges simply by listening to their concerns and offering a reassuring presence, the clinicians say. Community and family support are the main protective factors of teen mental health, Sharma says, and a sense of belonging, whether through a sport, faith community, school, or other group, is vital to fight off the negative messages bombarding today’s teenagers.
“All kids, regardless of age, want to know that there's someone who wants to hear them and their perspective. The dinner table is a great place to just talk about the day,” she says. “Teens need a lot of reassurance. They feel out of control and understandably scared about the uncertainty of the future. Teach them the idea that uncertainties are okay, and as long as we're in it together, we can navigate it.”
It’s more of a growth mindset, or a belief that the situation can be improved through learning and hard work. But if families can hold onto that narrative, it could help everybody's mental health, she says.
Help Them Find Their Purpose
Helping young people understand the concept of life purpose, or what gives their life meaning, can be transformative, says Brzycki, who earned a master’s degree in education from Tufts Graduate School of Arts and Sciences and a Ph.D. from The Pennsylvania State University. “It’s often a connection to a greater good or to other people's wellbeing, and we’ve found that children as young as 10 can have a strong inner sense of what that is.”
Brzycki, who has 40 years of experience in education and psychology, says the idea of life purpose is used both as a prevention tool and an intervention tool, especially with young people who have eating disorders, substance use disorders, or suicidal thoughts. He says teens really want to be engaged and discuss these kinds of meaningful issues in their lives.
“It's moving to see it work, too. When young people realize that they are important, and their parents recognize they have importance beyond doing chores or getting good grades, they see that they have a larger role to play in life and in society, and it lights their fire. It motivates them,” Brzycki says.
Address Social Anxiety and Bullying
Connors-Kellgren and Sharma report an increase in social anxiety among the teenagers they see after the COVID-19 pandemic. They also point out that social media has transformed teens’ lives, moving more of their interactions into the virtual realm and creating a new arena for harmful judgments and bullying.
How can parents help teens with social anxiety navigate this reality?
“The important thing to do is ask, why is the child shrinking in social situations? Why are they minimizing themselves? And it often has to do with their sense of self-worth or self-esteem,” says Brzycki. “They feel like they're being judged, being assessed, or put in a particular role or box in which they don't feel comfortable.”
He encourages parents, caregivers, and educators to talk to teens about why they may be afraid to express themselves in a peer group, community group, or similar situation. What role, if any, would they like to play? What strengths do they have that they would like to express?
Somewhat similar to the concept of life purpose, teens also benefit from the concept of life dreams, whether a situational set of dreams or big-picture dreams, Brzycki says. “You can teach a young person to understand that at every moment, they can be in touch with their dreams and what they want in that particular situation or for their life. They have control over their future. And that gives them a sense of agency.”
When people sacrifice their dreams, he adds, resignation and sadness set in and their sense of self-worth plummets.
Connors-Kellgren says self-worth and self-esteem also come into play with teens who have been bullied. “When I work with families whose teens have experienced bullying, I focus on two things: rebuilding the teen's self-esteem and ability to cope with interpersonal stressors and supporting the family in advocating for and managing the source of the bullying," says Connors-Kellgren.
If you are concerned about bullying, you may want to talk with staff at your child’s school about how they address it, she says. You may also need to put limits on your teens' social media use to reduce their exposure to harmful interactions.
Help Your Teen Manage Stress
When it comes to stress, sometimes your teen won’t have much control over how much comes in their direction. But you can help them have more control over their response to the stress.
Take, for example, high schoolers who are stressed about getting into college and trying to fill their applications with extracurriculars and activities. Connors-Kellgren talks to teens in this situation about prioritization.
“Teens need to sleep 8-10 hours a night, they need three meals a day, and they have to go to school. With those needs met, what are the things they really want to prioritize after that?” she says. “If they have a lot of homework, can they finish the project but save the reading for another night? Can they choose one sport instead of two? Help them think about what feels important to them in addition to what’s important based on the demands of college applications.”
She also talks to teens about healthy stressors and a healthy stress response. Examples of healthy stressors include final exams or a championship game. During those times, parents can help teens prioritize things like sleep, nutrition, and movement. That foundation may help them be able to practice time management or make room for relaxation exercises, so they don’t feel so overwhelmed.
Connors-Kellgren also cautions that sometimes stress about productivity comes from parents. And she acknowledges that it can be hard not to push kids, especially when you see their peers doing more. But she encourages parents to take some of the pressure off when they can, and she advocates for building rest into the family schedule.
Connors-Kellgren says parents and teens can try anxiety-reducing strategies such as relaxation or breathing techniques, challenging the automatic thoughts teens may have about their anxieties, and reducing negativity in self-talk. There are a number of online resources with guidance, she says, such as the Calm and Headspace apps for relaxation tools, and Calm’s tool to improve self-talk.
Consider Professional Help
When mental health concerns seem like more than you can handle on your own, Connors-Kellgren and Sharma suggest reaching out for professional help, whether from a school counselor, your child’s pediatrician, or a therapist.
Many families have questions about using medication to treat a teenager’s anxiety. Connors-Kellgren and Sharma stress that the decision to try medication depends on the specific circumstances of the child and their family. But in general, if someone’s anxiety starts to become disruptive—if they’re breaking down in tears every night over homework, refusing to go to school, or reporting a lot of physical symptoms—then it might be time to speak with a pediatrician or therapist to explore options for medication, Connors-Kellgren says.
If you’re concerned that your child may be considering harming themself, make sure they know about the federal suicide and mental health crisis hotline, 988. Launched in 2022 after the child mental health crisis was recognized during the COVID-19 pandemic, it’s a resource for anyone in a state of crisis. In addition, the Trevor Project offers crisis counseling aimed specifically at LGBTQ+ youth.
Although the challenges today’s adolescents face are serious, parents can make a positive difference, Connors-Kellgren says.
“It can often feel like our children are suffering and there's nothing we can do about it,” she says. “But in my practice, I have seen so many kids in adolescence get better through therapy and medication. If we can catch some of these mental health disorders when someone is a child or an adolescent, our interventions are so much more meaningful. I feel very hopeful working with kids and adolescents.”