Transcription:

Bill Klaproth: For teenagers, depression, stress, and other influences on their mental and behavioral health have always been a part of consideration of overall health and wellness, so how can we support the mental and behavioral health of teenagers? Let's find out what Dr. Sydney Sawyer, a Pediatrician at Marin Health. This is the Healing Podcast from Moran Health. I'm Bill Klaproth. Dr. Sawyer, always a pleasure to talk with you. Thank you so much for your time. So we are going through unprecedented times here dealing with the COVID-19 crisis, when it comes to the mental health of our teenagers. What are you seeing in dealing with the external and personal challenges that this is presenting?

Dr. Sawyer: Thanks for having me, Bill. Starting out with what you mentioned that we really need to acknowledge that these are extraordinary times for all of us and they're in particular, impacting teens because they are not doing what they're supposed to be doing developmentally. Teens, while they're not a monolithic group, one of the things that they're supposed to be working on is their autonomy and independence. Typically that means more time out of the house, more time with peers, learning about themselves and their identity and establishing that in the world and unfortunately our pandemic, and the shelter in place has really taken away a lot of that freedom. And the ability for kids to work on developing their own independence and a sense of autonomy.

Host: Right. And all of that is appended right now. So what are the signs and symptoms that parents should look for in assessing if mental health issues are surfacing or maybe even getting worse in their teenage child?

Dr. Sawyer: So I think first and foremost, we have to recognize that this is a time where kids are suffering a lot of loss. And this maybe a time when they're suffering more loss than they have ever faced in their lives. It could be loss of milestones like graduation or moving on ceremonies, proms, and celebrations, a summer before college, or even just anticipating summer plans. As we move into the summer, they're not going to be doing things like playing sports or going to the beach with friends so that there are losses involved. There may be more profound losses, family and friends who have been affected by COVID directly and have been sick or even passed away. I think there's also, in addition to the loss, the piece of anxiety about the future, which is unknown, and as adults we like to reassure kids, but the reality is we can't predict exactly how and when we are going to emerge from this pandemic. So there's a lot of anxiety going on as well. And those are normal responses to grieve loss and to have some worries about the future. I think that the question then becomes where do you see the line between experiencing those negative emotions and when it becomes a bigger problem.

Host: So what are the warning signs that this has become a bigger problem?

Dr. Sawyer: Well, I think a lot of it has to do with knowing your kid and seeing a dramatic shift between how they were doing before the pandemic and maybe new symptoms that have arisen. It really depends on a few factors. Some of it has to do with basic temperament, how they've handled challenges in the past, home conditions, what are their relationships with family, like preexisting stressors or mental health issues. So what I would say, I am seeing a lot more teens and families coming in for, and when I say coming in, I mean that I'm seeing by a telehealth are increases in anxiety, depression, even symptoms of obsessive compulsive disorder, school failure, and the symptoms that parents are bringing their kids into see me for are sleep disturbances, sleeping all day long, day and night reversal, refusing to eat or profound weight loss or eating all day, eating junk, not eating healthy meals, weight gain, social disconnection, staying in their rooms all day, and not connecting with their friends. A lot of irritability and even substance abuse, alcohol and drugs. And so what I would say is if you are seeing those kinds of symptoms, you've got to get your kid into the pediatrician so that we can start opening up the conversation and dig in a little bit more and help support these kids who are suffering.

Host: Right. So that's a great list of things a parent needs to watch out for. Can digital devices be included in that list? How do digital devices play into mental or behavioral health? As I've got nothing to do, I'm going to sit on my phone all day. So can you talk about that for a quick second?

Dr. Sawyer: I think it's actually become more complicated terrain because a lot of parents feel like this is the only way that kids have to connect with their friends and or be involved with their school. And so kids are spending so many more hours than they were on their phones, on their screens, and it's a bit of a mixed bag first. For some kids, if they're involved in school, if they're actually showing up and they're doing their schoolwork online, then that's not necessarily a bad thing. And I wouldn't necessarily count that towards their overall screen time in terms of the screen time that they're for pleasure. However, the kids who are on social media all day that are video gaming all day, those kids seem to be suffering more, anecdotally.

Host: So online socializing is probably a good thing, but too much online potentially could be bad.

Dr. Sawyer: That's right. And the way that kids are engaging also matters. And I will bring up a delicate topic, which is that this entire teenagers are involving themselves in romantic relationships or sexual relationships, which adds a lot of stress to parents because kids are sending photos of themselves. They are engaging in sexual relationships online or via texting. And that is not how most parents want their kids online.

Host: Yeah, I wouldn't think so. So if a parent recognizes any of these behaviors or sees them partaking in some of the things you were just talking about, what is a parent to do? Give us some tips for parents.

Dr. Sawyer: So again, I would say I think a little bit of how parents approach this depends on their preexisting relationship with their kids. You know, if, if they've had a pretty connected relationship. I really promote parents sitting down and, and empathizing with respect and starting with empathy, acknowledging how hard all of this is, the losses of the anxiety, the fear of the unknown, you know, not glossing over the reality of our circumstances and being reassuring where you can. I think that coming to teenagers from a respectful place and from a really honest place, you're going to get a respectful response. We all know that, you know, when we come at our partner's, friends, especially our teens with nagging, complaining, shaming, that just doesn't work. So starting the conversation from a more elevated place from a place of empathy can be really effective. If you don't have a relationship where that feels like you can jump in, that's where sometimes your pediatrician or a mental health professional can be really helpful in supporting that conversation and opening those doors to better communication.

Host: I love what you said there. I think that's so great. Start the conversation with empathy. I didn't expect you to say that. So I think that's really, really good advice for somebody. And then you said, you know, approach it from a respectful, honest place. And if you approach it that way, you're going to get that type of respect and honesty back. And that's really what you're after is trying to get to that place of respect and honesty and empathy. I think that's so great. Cause you said nagging, complaining, shaming, that's not going to work. So, and then you said if a parent feels okay, what I'm doing isn't enough, then it is time to reach out to your pediatrician.

Dr. Sawyer: Yeah, absolutely. You know, I think pediatricians are starting to, we're really on the front lines with the behavioral and mental health issues that are arising. And in a lot of cases we can help families with appropriate mental health referrals.

Host: And you can do this virtually, right?

Dr. Sawyer: Absolutely. We are seeing the majority of our behavioral and mental health appointments via telehealth.

Host: And then if they want to do that, who should they call?

Dr. Sawyer: And they just call our office and they schedule a video appointment. It's very easy.

Host: And then lastly, Dr. Sawyer and thank you for your time. Considering what we're going through now and considering the mental health of teenagers, could this be a benefit, in a way? Teaching them valuable coping skills that they might be able to use later on in their lives?

Dr. Sawyer: I absolutely think so. I mean, we can acknowledge that this is a time of tremendous toxic stress, but when a group of people, when a society, when the planet is under this kind of stress, we also see human capacity for resiliency and creative solutions. And you know, when you think about what really makes humans feel good, it's we're prosocial. So it's about connecting and it's also about our accomplishments. And if teens are able to come through this saying, you know what? I stayed connected with my friends, or I got, I became more connected to my parents and my family, or I accomplished these things, in spite of these difficult circumstances, they can come out of this difficult time with a sense of I can get through something really hard and be okay. And I think that's an incredible lesson that I hope a lot of our kids will come out of this with.

Host: That is an incredible lesson and that would be a great skill to learn and a benefit out of all this craziness we're going through and you just dropped another great line on us. I love how you said we humans are pro-social. That's so good. I love that. That is a great line. Everybody tweet that out right now. That's so good. Dr. Sawyer, I always love talking with you, always very informative and thank you so much for your time. We appreciate it.

Dr. Sawyer: Oh, likewise, Bill, thank you so much. I really appreciate it.

Host: That's Dr. Sydney Sawyer. And for more information, please visit my Marinhealth.org. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is the Healing Podcast brought to you by Marin Health. I'm Bill Klaproth. Thanks for listening.