An Overview of Adolescent Mental Health

Abstract

The journey to adulthood includes a number of challenges. Often called “the tasks of adolescence,” they include the achievement of biological and sexual maturation, the development of personal identity, the development of intimate sexual relationships with an appropriate peer, and the establishment of independence and autonomy. It is no surprise that the road may be rocky.

It is critically important for clinicians who provide care for adolescents to be able to sort out what are “normal” behaviors for this age group, what are problems that are caused by life situations, and what are problems that have a diagnosis and need professional intervention.

Up to a third of teens feel overwhelmed or sad. And it is estimated that 25% will have an anxiety disorder during their teen years and 12.5% will have an episode of depression. The prevalence of ADHD is 11%. Thirty-five percent of high school seniors reported drinking some alcohol in the past month, 21% reported using marijuana, and 11% reported smoking cigarettes.

Many of these problems are transitory and are resolved by the beginning of adulthood, with few long-term consequences. And most teens are doing well—the most recent CDC data show that close to 83% of teens are in excellent or very good health and another 15% are in good health.

This chapter discusses each of the most common mental health conditions that teens experience, as well as likely causes of related worrisome behaviors. It also provides information on each, including prevalence and the most effective interventions.

Appendix

Chart 1.1 GAD-7

Chart 1.2 SCARED . Screening for Childhood Anxiety-Related Disorders (SCARED) . Below is the SCARED-5. If the score for this assessment is ≥3, use the full SCARED questionnaire: ww.psychiatry.pitt.edu/sites/default/files/Documents/assessments/SCARED%20Child.pdf

Chart 1.3 PHQ-9 modified for adolescents (PHQ-A)

Chart 1.4 Teen behavior checklist (updated as per DSM-5)

Inattentive Behaviors

Check the column that best describes the teen’s behavior over the past 6 months

	Never or rarely	Sometimes	Often	Very often
1. Fails to give close attention to details or makes careless mistakes in school work, at work, or during other activities (e.g., overlooks or misses details, work is inaccurate)
2. Has difficulty sustaining attention to tasks or activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading)
3. Does not seem to listen when spoken to directly (e.g.., mind seems elsewhere, even in the absence of any obvious distraction)
4. Does not follow through on instructions and fails to finish school work, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily distracted)
5. Has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks, difficulty keeping materials and belongings in order, has poor time management, fails to meet deadlines)
6. Avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers)
7. Loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, phones). Sometimes loses completed homework
8. Is easily distracted by extraneous stimuli (for older adolescents, may include unrelated thoughts)
9. Is forgetful in daily activities (e.g., doing chores, running errands; for older adolescents and adults, returning calls paying bills)
Total

Hyperactive/Impulsive Behaviors

	Never or rarely	Sometimes	Often	Very often
10. Fidgets with hands or feet or squirms in seat
11. Leaves seat in classroom or in other situations in which remaining seated is expected (e.g., leaves his or her place in the classroom, in the office or other workplace, or in other situations that require remaining in place)
12. Frequently feels restlessness
13. Has difficulty engaging in leisure activities or doing fun things quietly
14. Is “on the go” or acts as if “driven by a motor” (e.g., is unable to be or uncomfortable being still for an extended time, as in restaurants, meetings; may be experienced by others as being restless or difficult to keep up with)
15. Talks excessively [ends hyperactivity ]
16. Blurts out an answer before questions have been completed (e.g., completes people’s sentences, cannot wait for turn in conversation)
17. Has difficulty awaiting turn (e.g., while waiting in line)
18. Interrupts or intrudes on others (e.g., butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission; may intrude into or take over what others are doing) [ends impulsivity ]
Total

1. Do these behaviors cause significant difficulties?
2. Home: yes ___ no___ School: yes ___ no ___
3. Scoring: Add each of the columns in the Inattentive ADHD set. Combine totals for “Often” and “Very Often.” Do the same for the hyperactive/impulsive behaviors. See article for next step
4. [Content from DSM-5. Structure created by author]