The past year was a difficult one for all of us, and it’s taken a toll on many people’s mental health. For children and adolescents in the formative years of their lives, the impacts of 2020 have the potential to be particularly profound.
Even before last year, mental health issues were a significant problem for teens. In a 2018 survey of 13-to-17-year-olds conducted by the Pew Research Center, 70% of respondents said they consider anxiety and depression to be a major problem among their peers in their community. For bullying, drug addiction and drinking alcohol, the rates were 55%, 51% and 45%, respectively.
Then came the unprecedented global health crisis, social unrest and widespread economic difficulties. It’s no wonder many young people are struggling right now.
“My young clients repeatedly communicate that they feel helpless,” explained Samantha Prague, licensed clinical professional counselor at Meridian. “Many have verbalized that they feel a crushing pressure when adults state they are ‘the next generation to fix things,’ when there is little they can control at home, in school or in the larger world as a whole right now.”
Prague, who earned her master’s degree from Northwestern University, specializes in treating patients struggling to overcome trauma and issues with self injury and suicidal behavior.
She is joined at Meridian by her colleague Dr. Divya Gongireddy, a board certified child and adolescent and general psychiatrist. Gongireddy, who completed her residency at the Virginia Commonwealth University Health System, specializes in treating patients with post-traumatic stress, autism spectrum and mood disorders.
Together, Gongireddy and Prague offer children, adolescents and families a comprehensive approach to mental health care.
“We don’t just focus on medicating specific symptoms,” Gongireddy explained. “We seek to learn about and evaluate all aspects of a young person’s world, including physical health, developmental stages and even things like home life, hobbies, school functioning and friendships.”
Prague and Gongireddy recently participated in an interview to discuss child and adolescent mental health issues and Meridian’s approach to delivering care. Read on for the lightly-edited interview below.
What can families do to stay healthy during the pandemic?
DG: For families dealing with children and adolescents in this situation, I think the first step is for parents and caregivers to reflect on their own emotional state and practice self-care for themselves. As they say on airplanes in times of distress, you should put on your own oxygen mask before helping others. A parent’s emotional state will affect how children cope, so if parents take time to process their own feelings, this will model healthy coping skills and positive attitudes for the child.
It’s also important for families to limit media exposure because it is so easy to be overwhelmed by negative news. … Encourage children and teenagers to express emotions in an age-appropriate way. For preschoolers and younger children it could be through playtime or artwork and for older kids through more direct conversations and asking them about their feelings. Everyone is going to feel a range of emotions, … and parents should let them know that they are listening and their feelings are OK. …
Another recommendation is to keep a routine. … Having consistent playtimes, mealtimes, bedtimes, and times for mental and physical breaks—especially if children are learning virtually—can be helpful. Suggest activities that allow them to feel some control over the situation, such as what chores they are responsible for or what kinds of games or activities the family could do together. Knowing what to expect, and what’s expected of them, can help children feel more secure and ease their anxiety.
Apart from the obvious challenges that began last year, are there underlying societal changes that are contributing to mental health issues for young people?
SP: Prior to the pandemic, social comparisons exacerbated by social media and academic achievement played an enormous role in children and teens’ overall functioning. Online trolling, virtual bullying and anxiety regarding things like Snapchat scores have children and teens constantly comparing themselves to others. They are also exposed to a lot of criticism that adults are not privy to. This has put pressure on kids to create public personas of themselves in ways that we as adults have not had to do.
What are the most common mental health issues you’re observing among children and adolescents today?
SP: We are seeing a range of mental health struggles in children and young adults that range from mild anxiety to severe depressive symptoms and everything in between. The pandemic and uncertain political climate has created a lot of instability and isolation for our youth in particular.
Kids and teens should be broadening their world and gaining new experiences in order to build skills, expand social circles and individuate from their families. Unfortunately, this has been interrupted and we are finding that it is harder for children and teens to express themselves and feel connected. As a result, we are seeing greater isolation, bigger emotions or emotional fatigue, racing thoughts and social struggles. This is greatly impacting family relationships, school performance and interests.
What signs, symptoms or behavioral changes should parents and others look out for in the event they’re concerned about the mental health of a young person?
DG: What we look for are changes from a young person’s normal level of functioning. We see changes in mood, for example; they may seem more anxious, tense, melancholy or apathetic. For younger children, we may see more emotional outbursts, temper tantrums or persistent irritability. We may see changes in social interactions as well.
For adolescents, they may be withdrawing from friends and family and spending more time alone in their room. There can also be changes with sleep, appetite and energy level; they may not be doing as well in school as they normally do, or they may start showing disinterest in their usual activities and hobbies.
Are there any notable differences in the way mental health challenges impact males vs. females? Any contrasts in the willingness to seek out care?
DG: Traditionally, it has been explained that females will internalize their emotional distress—which can manifest as depressed mood, low self-esteem or self-injurious behaviors. At the same time, males will externalize their emotional distress, which can manifest as aggression, substance use and other high-risk behaviors.
What we have also seen recently is that there is less stigma surrounding mental health, so young people especially have the language and tools to express themselves and they are are more willing to talk about these issues amongst themselves and with their families. I don’t think the gender differences are as clear-cut anymore, especially in modern-day society with how gender norms and gender roles are changing.
Substance abuse can compound mental health issues, but for young people who are struggling, it can often feel like an escape. What can we do to help deter substance abuse?
SP: Substance use can often be an escape and more importantly a chemical that offers protection from something that is undesired. One of the most important things is to help the person identify what that undesired thing is and find a treatment provider who specializes in youth substance abuse. Family therapy is often a critical component of substance abuse treatment to mend relationships, form trust, recreate boundaries and explore how use started.
Counseling and medication can be an effective approach for treating mental health disorders, but sometimes it’s just not enough. At what point would you recommend inpatient treatment?
DG: Generally, if a child or adolescent is unable to maintain safety, then I would recommend an evaluation for inpatient treatment. If a child or adolescent is having acute suicidal ideations, serious self-harming behavior or suicide attempts, then that is an indication for inpatient treatment. Or if there is significant aggression, violence or threats to harm others, that is also an indication for inpatient treatment.
However, we always try to use the least restrictive form of treatment possible. So, if a child can still be at home safely but just needs extra support, then we have treatment options like intensive group therapy programs or after-school therapy programs.
As a parent or loved one who knows a child or adolescent who is struggling with mental health issues, what can we do to show our support?
SP: Talk to them in an authentic and honest way. Kids and adolescents can smell insincerity and may be used to hiding big feelings and powerful thoughts. It is important to show that you are brave enough and strong enough to help hold those feelings with them. Validate emotions, hold boundaries and collaborate on treatment options so their voices are heard.
What motivated your own decision to dedicate your life to providing mental health care for young people?
SP: In a world of Snapchat filters and Instagram Stories, kids demand honesty and authenticity. In the therapy room it’s just me and the client—all I have is my truth and I think that is something young adults feel safe with; no gimmicks, no special effects and no glamour. Just hard work and feelings. I can’t imagine any other place where I can sit on the floor to talk about politics, families, emotional pain and deep secrets while playing Jenga with my shoes off.
Concerned about child and adolescent mental health issues?
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