Alix McDonald is 17 years old, and the future weighs heavily on her mind. A high school senior in Chicago, she was “stressed a lot” in the fall about “whether or not to apply to college,” especially during a pandemic.
What comforted her was “talking through pros and cons with my mom and dad” — without feeling as if her parents had an agenda. “They didn’t push me,” said Alix, who has both attention deficit hyperactivity disorder and a lesser-known learning difference called slow processing speed, and has long grappled with school-based anxiety. “They asked questions about what I wanted.”
Alix, like young people across the country, is wrestling with feelings of apprehension and uncertainty about what the next year will bring, made all the more intense in the pandemic. For parents, it has become harder to assess if their teenagers are doing OK. “Alix spends a huge amount of time alone in her room,” said her mother, Veronique McDonald, a real estate broker. “We try to implement something fun to get her to join us.”
In the pandemic, many of the traditional measures that indicate whether a teen is thriving have been rendered irrelevant. Does my child attend school and stay engaged? Is my child participating in team sports or joining activities in our community? Is my child getting enough sleep with these early morning practices? Why is my child always alone?
Jennifer Hartstein, an adolescent psychologist in New York who specializes in anxiety and depression, said that in the absence of “age-old markers” of wellness, “we have to pivot and look at kids differently.” Slow down and ask kids how they are doing, Dr. Hartstein advised.
She added: “A parent’s biggest strength is knowing when you need to get help for your kids and for yourself.”
Focus on social and emotional skills.
As families prepare for post-pandemic life, there is an opportunity to reframe discussions of what it means to be doing well. Skills such as self-compassion, resilience and distress tolerance are strong indicators of how a kid is doing.
Rheeda Walker, a professor of psychology at the University of Houston and the author of “The Unapologetic Guide to Black Mental Health,” said that resilience “isn’t about how many times we get knocked down” but rather, finding the factors that help us get back up. “What allows someone to tap into their strength when they need it most?” she asked. “Is it their family? Their faith?”
Dr. Walker encourages people to assess how they feel each day. “I talk in the Black community about psychological fortitude,” she said, explaining that it means asking: “What is my rating on a zero to 10 basis to achieve my goals today and manage my life? If I am at a 2, what is keeping me from getting to a 6?” Parents can teach teens to practice this strategy when kids are struggling to meet their own daily challenges, even if the goal is merely to leave the house and interact with peers.
She also noted that it is important to look for shifts in behavior, shifts in mood, anything that indicates a change in your child’s patterns — this is a signal for parents to investigate what lies underneath.
Pay attention to mental health.
When I was growing up in the ’80s, my doctor listened to my heart and lungs, checked my blood counts and monitored my growth. I checked all the boxes for “healthy.” Yet I had an undiagnosed anxiety disorder throughout childhood that made my launch into college agonizing.
“We as pediatricians have come a long way in our awareness of mental health,” said Dr. Sharon Robinson, a pediatrician in Evanston, Ill., who is raising two teenagers, ages 14 and 17. Anxiety is the most common adolescent mental health disorder, she said, and in her practice, they routinely screen all patients for depression starting at age 12.
When a child’s survey triggers a positive response for depression, Dr. Robinson first meets privately with the patient to ask clarifying questions and assess their risk level for self harm and suicidal ideation before inviting parents back into the room. With mild to moderate depression, which account for the majority of cases, Dr. Robinson discusses therapeutic strategies with the family and provides a referral to talk therapy.
In severe situations, such as when a child indicates suicidal thoughts or has made a suicide plan, “we urgently refer those children to a psychiatrist or even to the emergency room for assessment,” she said, and they also create a safety plan and schedule a follow-up visit.
Help young people rebuild their independence.
Psychologists and pediatricians recommend that parents return to focusing on the milestones that they helped their kids develop in early childhood — eating, sleeping, separating from parents. Adults can scaffold the basics, providing support, structure and encouragement as young people rebuild in-person socialization into their lives, and then step back and allow them to stand on their own.
Research published in June of 2020 by the Centers for Disease Control and Prevention showed that 18- to 24-year-olds reported the highest rate of struggles with mental health, substance abuse and suicidal ideation, as compared to older adults.
According to Ali Mattu, a clinical psychologist in Northern California and creator of the popular YouTube channel The Psych Show, teens and young adults are having a harder time psychologically than older generations because Covid has represented a bigger proportion of their lifetimes, and “the effects are greater.”
He explained that the adolescent brain is wired to quickly make associations, and during the pandemic, some young people have learned to be hypervigilant, because we’ve trained them to associate going places with risk of a major disease. Since our brains don’t finish developing until our mid-20s, he said, young people are quick to act on their emotions. For some, that means “anxious avoidance,” which can manifest as a reluctance to leave home. For others, it means “overconfident approach,” which accounts for teens and young adults who throng to parties, unmasked.
Dr. Mattu said the best thing parents can do for teens and young adults who are withdrawing is to help them develop four key skills. The first is “the ability to do things alone, like run an errand or do what needs to be done to get through their day,” based on the expectations of their family and culture. Second is “the ability to ask for help, to be vulnerable and ask for support,” such as by emailing a teacher on their own or reaching out to a counselor or parent.
Third is “the ability to support their peers, because teens are really focused on their relationships with each other,” explained Dr. Mattu, and often, a peer is the first one to know when someone is struggling. And the fourth skill is “finding a connection to a larger community,” such as a club, an organization, a fandom, a religious group — anything that creates meaning and purpose.
As young people take steps to re-enter the world, sometimes things will go wrong. The growth happens when they navigate their distress and try again instead of avoiding similar situations. Recently, my teenager asked me to drive her to meet a friend in downtown Chicago. “You can do this on your own,” I said. When she never arrived, her friend called us. Our daughter had entered the right street address in Google Maps — in the wrong city.
By the time we contacted her, she was lost on the highway, hysterical and terrified. “I just want to come home,” she cried. Our best friends, who live close to where she was, offered to drive out to meet her. My daughter swallowed her pride and accepted their help.
A week later, my daughter took a deep breath and got back on the highway to meet another friend. “This is you, being resilient,” I told her, as she headed out alone. “I couldn’t be prouder.”
Carrie Goldman (@CarrieMGoldman) is an author, speaker and the social-emotional learning curriculum director for the Pop Culture Hero Coalition. She is currently working on a memoir.