Common Mental Health and Behavioral Challenges

Many teens struggle with mental health and behavioral issues.  Among the most common diagnoses given to struggling teens are anxiety disorders, depression, bipolar disorder, attention deficit/hyperactivity disorder (ADHD), conduct disorder, eating disorders, post-traumatic stress disorder, and substance abuse.  It can be extremely difficult to accurately diagnose a child or teenager, as symptoms of different disorders may overlap, and different youths who have the same diagnosis may present different symptoms.  Nevertheless, the National Mental Health Information Center, an arm of the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, has summarized prevalence data for these major diagnoses:

Anxiety Disorders
Teens with anxiety disorders experience excessive fear, worry, or uneasiness. Anxiety disorders are among the most common of childhood disorders.  As many as 13 of every 100 young people have an anxiety disorder which causes significant distress and impairment in social, educational, or occupational functioning. Anxiety disorders include:

• Phobias, which are unrealistic and overwhelming fears of objects or situations.
• Generalized anxiety disorder, which involves a pattern of excessive, unrealistic worry that cannot be attributed to any recent experience.
• Panic disorder, which includes terrifying “panic attacks” accompanied by physical symptoms, such as a rapid heartbeat and dizziness.
• Obsessive-compulsive disorder, characterized by a pattern of repeated thoughts and behaviors, such as counting or hand washing.
• Post-traumatic stress disorder, which is typified by flashbacks, nightmares, hypervigilance, an exaggerated startle response, and other symptoms following a distressing event, such as abuse, witnessing violence, or exposure to other traumas such as war or a natural disaster.

Major Depression
Studies show that approximately 10 to 15 percent of adolescents may experience major depression. The disorder is marked by changes in:

• Emotions — sadness, irritability, guilt, worthlessness, hopelessness
• Motivation — apathy, fatigue, loss of interest in pleasurable activities, decline in quality of schoolwork
• Physical well-being — changes in appetite or sleeping patterns, physical complaints such as headache and stomachache
• Thoughts — distorted cognitions, negative cognitive schemata (an organized pattern of thinking that focuses on negative interpretations of events)

Bipolar Disorder
While mood swings are normal in adolescence, some teens experience extraordinary highs (mania) and lows (depression), symptoms of bipolar disorder (sometimes called manic depression). Typically periods of moderate mood occur in between the extreme highs and lows. During manic phases, adolescents may talk nonstop, need very little sleep, and show unusually poor judgment.  Bipolar disorder can recur throughout life and usually begins in late adolescence and early adulthood.

Attention-deficit/Hyperactivity Disorder (ADHD)
Teens who have ADHD—predominantly inattentive type may have difficulty consistently sustaining focus on tedious, boring tasks, organizing their schoolwork, following directions, and completing tasks.  Those who have ADHD—predominantly hyperactive type may be fidgety, always on the go, impulsive, and risk taking.  Those who have ADHD—combined type have both sets of symptoms.  Attention-deficit/hyperactivity disorder occurs in up to five of every 100 minors.

Oppositional Defiant Disorder
Teens who have been diagnosed with Oppositional Defiant Disorder (ODD) typically engage in an ongoing pattern of uncooperative, defiant, and hostile behavior toward authority figures that seriously interferes with the teen’s day-to-day functioning.  Symptoms of ODD may include: frequent temper tantrums; excessive arguing with adults; active defiance and refusal to comply with adult requests and rules; deliberate attempts to annoy or upset people; blaming others for one’s own mistakes or misbehavior; often being touchy or easily annoyed by others; frequent anger and resentment; mean and hateful talking when upset; and seeking revenge.  The symptoms are usually seen in multiple settings, but are generally more noticeable at home or at school.  Five to fifteen percent of all school age children meet the criteria for ODD.  ODD is sometimes a precursor to conduct disorder.  In contrast to teens with conduct disorder, the behavior of teens with ODD does not involve serious violations of others’ rights.  It does, however, impair the teen’s family, academic, and social functioning.

Conduct Disorder
Teens diagnosed with conduct disorder repeatedly violate the basic rights of others and the rules of society, acting out their feelings or impulses in destructive ways. The behaviors they engage in include fire setting, breaking and entering, stealing things of nontrivial value (such as a car), and vandalism.  Estimates of the number of minors with this disorder vary, ranging from one to four of every 100 children 9 to 17 years of age.

Eating Disorders
Adolescents who do not recognize they are underweight and who are intensely afraid of gaining weight may have an eating disorder which can be life threatening.  Those with anorexia nervosa, for example, severely restrict their calorie intake and experience significant weight loss.  Anorexia affects one in every 100 to 200 adolescent girls and a much smaller number of boys.

Adolescents with bulimia nervosa eat huge amounts of food in one sitting and then purge in order to prevent weight gain.  Purging may entail self-induced vomiting, excessive laxative use, taking enemas, or exercising obsessively.  Reported rates of bulimia vary from one to three of every 100 young people.  Many adolescents compulsively overeat in order to self soothe.  Their obesity jeopardizes their physical health and incurs social opprobrium.

Substance Abuse and Dependence
Substance use and dependence puts millions of adolescents at increased risk for alcohol-related and drug-related traffic accidents, risky sexual practices, poor academic performance, and juvenile delinquency.  Substance abuse is any pattern of substance use that results in repeated adverse social consequences related to drug taking, for example, interpersonal conflicts, failure to meet work, family, or school obligations, or legal problems.  Substance dependence, commonly known as addiction, is characterized by physiological and behavioral symptoms related to substance use.  These symptoms include the need for increasing amounts of the substance to maintain desired effects, withdrawal if drug-taking ceases, and a great deal of time spent in activities related to substance use.

Many teens who have academic, behavioral, and emotional challenges self medicate with alcohol and other substances.  The substance abuse and other challenges then exacerbate each other.  About half of America’s teenagers have tried an illicit drug by the time they finish high school.

Frederic Reamer Ph.D. Bio

Dr. Reamer is a professor in the Graduate Social Work Program at Rhode Island College.

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