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Interviewer: So what is the difference between typical adolescent behavior for children in junior high and high school, and problematic behavior? And what can parents do on their own? And when should you seek professional help?

Jessica Holzbauer is a licensed clinical social worker and Manager of the Teenscope and Kidstar programs at Huntsman Mental ÐÇ¿Õ´«Ã½ Institute. Let's first start out with how should parents think about typical behavior versus problematic adolescent behavior.

Understanding Individuation and Developmental Changes in Adolescence

Jessica: I love this question, and this is a question that parents ask all the time. So in adolescence, we know that the developmental process is for adolescents to individuate. So what does that mean? Individuation means that kids are becoming their own person, which in and of itself can cause significant tension with parents. And so what we really look at is overall functioning in three domains when it comes to adolescent behavior.

The first we look at is school. Are kids attending school? How are their grades? Are they having problems at school with their behavior?

We look at home behavior. How are they doing with their family? Have they pulled away? Are they engaged? Are they contributing members of the household?

And then we look at social behavior as well, and what we look at is do they have friends. Has their friend group changed? Are they still engaged in the same activities that they've always engaged in or have they pulled back?

So what we really, really look at is, are the changes that we know to be part of individuation really within the context of what we would consider normal, if you will.

Normal vs. Problematic Behavior in Adolescents: What Parents Need to Know

Interviewer: So help me understand that a little bit more because it sounds to me like the behaviors you look at . . . Of course if they're working on their individuation, they might get a whole new group of friends, and that's not problematic.

Jessica: So it depends, right? And that's often my assessment as a therapist. But let me put it this way. So adolescence is tough, right? Adolescence is really hard, and so we know that for a number of reasons, adolescents should be more moody, for example. Their sleep schedule should be different than what it was when they were 11, or 12 years old. Their interests should change. They're developing socially, they are developing sexually, and so their behavior is going to be different.

And so what's really important is that parents look at behavior within the context of developmentally what's appropriate. So if your child, your 16-year-old is moody, they wake up, they're grouchy, they're irritable . . .

Interviewer: That sounds appropriate.

Jessica: Yes, I'm sorry to say. Yes, it is.

Interviewer: Unfortunately, yeah.

Jessica: It is, right? They used to think that you were fantastic and that you had the answer to everything, and now you don't know anything about anything. That's normal.

Interviewer: Pushing boundaries is probably another normal thing . . .

Jessica: Absolutely.

Interviewer: . . . which parents might not necessarily like because that can feel like it's going against them all of a sudden now.

Recognizing Mood Swings and Other Common Adolescent Behaviors

Jessica: Absolutely. Kids are trying to figure out what their limits are for themselves and what is appropriate in their household. So these things that can be real sources of tension for parents are actually developmentally appropriate.

Where we get concerned is if these behaviors or feelings, if you will, last for long periods of time, so I'm talking weeks and months rather than days, and they get in the way of kids being successful at home, at school, or socially. That's when we get really concerned.

Interviewer: So bumps in the road, not as concerning. Roadblocks, concerning.

Jessica: That's a great way of putting it. Absolutely.

Interviewer: All right. So mood swings that last a couple of days or pushing the boundaries that last a couple of days, and then kind of levels out again, and then might happen again, that's okay?

Jessica: Absolutely. For example, a lot of teens become very self-conscious about their appearance, right? And so we know that adolescents are very judgmental of one another and very judgmental of their outward appearance. There's a lot of stock that's put into outward appearance. That's normal.

So if you have a 15-year-old who's maybe spending half an hour in the morning doing elaborate makeup, that's pretty normal. However, if that is getting in the way of your child going out and having friends because they're too self-conscious, maybe they're staying at home, maybe they never feel like they look good enough, maybe they're wearing clothes that hide their bodies, that would be caused for concern.

Interviewer: Okay. And being super critical of themselves once in a while is okay, but if it's a chronic thing, if it's happening over and over again, or it's really severe, that would be concerning.

Parents Should Approach Their Child's Behavior With Curiosity and Without Judgment

Jessica: Absolutely. And I think the best thing that parents can do if they do have a concern is to really just inquire, because maybe their son or daughter or their child is making a flippant comment, or maybe they're just trying to push some buttons. What's really important is parents in the most non-judgmental way actually ask. They ask with curiosity, and they ask without judgment.

Interviewer: Okay. What are considered, then, some problematic behaviors, some specific things that parents might see that are going to be concerning?

Jessica: Yeah, I would say low moods, so that means irritability, maybe difficulty getting out of bed, maybe hygiene declines, and that lasts a couple of weeks, that would be a cause for concern.

Aggression or running away, for example, because the irritability reaches a fever point, that would be cause for concern. Maybe avoiding going to school, maybe no longer helping out around the house because they just simply don't have the energy, that would be cause for concern.

One thing that is a real hot-button issue for parents as well is developing sexual orientation and sexuality. And so we know that it's developmentally appropriate for kids to explore that part of themselves. However, if they are engaging in high-risk sexual behavior, maybe with multiple partners or maybe engaging in behavior that's contrary to their values, that would be a huge cause for concern.

I think any prolonged isolation from family would also be cause for concern. I mean, most teens don't want to sit with their family on a Friday night and watch the newest Disney movie. That's not what they want to do. That's okay. But if we're talking days on end where kids want nothing to do with their family, that would be cause for concern.

Interviewer: Some other problematic behaviors, I think, that probably go without saying, but probably are worth saying, substance abuse, self-harm, those sorts of things, I'd imagine are always red flags.

Jessica: Thank you. I deal in that realm, and so for me, that's a given. Thank you so much for asking that. Yeah, absolutely, suicide ideation, self-harm, substance abuse. We know that kids will want to experiment and learn more about substances, much to most parents' chagrin. However, substance abuse is a huge cause for concern.

And the reason being . . . well, one reason is that the inhibitions are decreased, and we know that adolescents have a terrible time regulating their emotions and their behaviors. And so when we couple that with mood-altering substances, it really can be a recipe for very high-risk behavior.

Interviewer: When you talk to parents, what's the biggest challenge that you see them face when it's determining the difference between problematic versus not problematic?

Jessica: Yeah, parents really have a hard time with this because we all adapt to the new norm, right? And so if their child has been kind of irritable, kind of low energy, surly for a period of time, we just adapt to that as a family.

And so I think sometimes it can be difficult for families to kind of pull back and look at the big picture and really look at, "When did this start? How long has it been going on? Has it gotten better or worse?" I think that can be really difficult.

And then I also think, too, that the tension between parents and adolescents is real. And so a parent might be concerned, but their child is saying, "No, everything's fine. Everything's fine. Everything is fine." So there can be a significant difference of opinion as well.

And so I think parents can have a hard time knowing what's really true. Is their assessment true or is their child's assessment true? And usually, the truth is somewhere in the middle.

Interviewer: Yeah, that's an interesting point, the truth is somewhere in the middle. Do you tell parents generally if you are uncomfortable with something or if you are like, "Oh, I really believe strongly, or I don't know that this is quite right," that they act on that then?

Jessica: Absolutely. I would much rather a parent be wrong and check that out with either a mental health professional or their pediatrician than be right and not take that action.

Interviewer: Yeah. And that brings up a great point, too. What's the first step? Sometimes accessing the health system can be challenging, right?

Jessica: It can.

When to Seek Professional Help for Your Child's Problematic Behavior

Interviewer: Especially when you just need an answer or two, so you go to the internet instead. So how could you actually get some reliable information if you just have a question or two?

Jessica: Yeah, I think a good place to start is actually with the child's school, with the school psychologist or school counselor, because they are also seeing your child in school as well, and so may have a different perspective. So that's a really good place to start.

I also think that parents are experts on their kids, and so I think reaching out to other parents and maybe parents who have had a couple of kids go through adolescence can also be a wealth of knowledge. And then up from that, certainly the pediatrician, and then a licensed clinical therapist as well.

Interviewer: And if a parent wants to go and get help beyond that, what does that look like? Does it start with just the parent seeking out the information from maybe a licensed clinical social worker? Should they go to the school and talk to the school psychologist without letting their child know at first? Should they involve the child? What's that process?

Jessica: Yeah, when it just comes to educating oneself, I think it's okay to ask whatever source is a reliable source, whether it's the school counselor or it's the pediatrician, or maybe it's the parent down the street who's been through this a couple of times.

I think, however, our mental health is our mental health, and so I think if a parent wants to intervene with their child's mental health, it's really important that they talk to them about it, and they say, "Hey, I could be wrong, and I know adolescence is hard, and so I'd like to make an appointment for you to go speak to a therapist."

Most kids are not going to be happy if they get driven to a therapist's office and dropped off and now are expected to talk about their feelings and thoughts. So this needs to be an open conversation that parents are having with their children.

Interviewer: And I don't know, it seems like it'd be difficult for me to do that. Maybe for a lot of parents, it's not. But if there is, a parent that they're not exactly sure how to have that conversation because perhaps their parents never modeled that type of communication before, what resources do you suggest for them to have that initial conversation and do it well?

Jessica: The American Academy of Pediatrics has some wonderful resources on their website about how to talk to kids about mental health. And I think that although adolescents can be really difficult, at the end of the day, they are humans, they are people, and if we can just go into a conversation with adolescents also as humans, as people, and even say, "I don't know how to have this conversation with you, and so I am likely not going to do it well, so I'm just going to throw it out there. I have some concerns. I don't even know how to talk to you about this. Can we figure out a way to talk about this?" I think being radically genuine goes a long way with adolescence.

Interviewer: Beyond that initial conversation, if a parent feels that after that conversation something else needs to happen, what would that next step be? Would it be a licensed clinical social worker? Would it be still the pediatrician now with the child along? What's next?

Jessica: Yeah, I think if the parent has really sussed out that it seems to be a mental health issue, I think the next best step is getting in with a therapist. Whether it's a licensed clinical social worker, whether it's a psychologist, whether it's a marriage and family therapist, that's the next step.

But we know there's a mental health crisis in the United States, and so finding a provider can be really difficult. So a good holdover as well is to ask the school counselor if they could also meet with their child as well.

We know that schools are also overwhelmed, but I think trying to make several inroads to get some support and help will pay off in the long run because the wait with any one entity might be pretty egregious.

Interviewer: Any final thoughts for a parent listening to this that you would like to communicate to them?

Jessica: Oh, boy. It does get better. It does, and I think that most parents who have adolescents are going through something similar. And it always strikes me when we start to talk about mental health, how many people have experienced the same thing.

And so I would say resist the stigma, resist looking like the family that has it all figured out, and just talk to friends, talk to other parents who have been through it, who can provide support, validation, and advice. You are not alone in this.