The holidays are finally here. Which means the new year is right around the corner. This means that very soon, we all get to put 2020 behind us, and look forward to a better 2021. We don’t need to reiterate why everyone is excited to turn the page. We know every one of you is tired of hearing the word “unprecedented.” You don’t want to read one more email that begins with the phrase “In these challenging times.” Or one that ends with, “When this is all over, we’ll get together.”

We promise not to say any of those things in this article.

What we want to talk about is your teenager’s mental health, and how the past ten months may or may not have affected it.

This is an important topic for two reasons:

1. The isolation, stress, and disruption related to the pandemic can exacerbate or trigger the onset of mental health and alcohol/substance use disorders.
2. Mental health and psychiatric disorders can appear as early as age 6, with mood and substance use disorders often appearing in early- or mid-adolescence.

That’s why we urge parents to use the winter holidays as a time to closely observe, connect to, and check in with their teens, for the purpose of assessing their mental and emotional health. We know many families have been cooped up together for ten months. Parents reading this may think something like this:

“I see my kid every day all day because I work from home and they do virtual school. If they had a mental health disorder or were using drugs, I’m sure I’d know about it.”

Granted, this may be true. However, we want to point something out: it’s possible that you and your teen are on COVID autopilot.

Settling in to the (Temporary) New Normal

Back in March when all this started, it was novel. None of us had ever lived through a pandemic, dealt with shelter-in-place orders, or been restricted from gathering indoors with groups of people. It was all a total shock to the system. Most of us were hyper-aware of how our kids handled the whole thing. We read articles (written by people like us) warning about the mental health dangers of the pandemic. The isolation and the loss of social contact would take its toll, the experts warned. Missing key life events like graduations and birthday parties combined with the absence of extracurricular activities all meant our teens were going through tough times.

That’s why we all listened. We watched our kids for signs of trouble. We did our best to create routines that fostered a sense of normalcy. We adapted. Many of us found a new normal – a pandemic normal – and then we soldiered on. We made it through the end of school, figured out how to manage summer, then started a new school year – all under circumstances dictated by the pandemic. And now here we are at the holidays.

But while all this was happening, something else may have happened: we may have started to tune things out in order to cope. Think of it like this: we circled the wagons, established what we thought were the healthiest routines we could, and then we stuck to them. We circled the wagons to keep the stress of the pandemic at bay, and we stuck to our routines for the same reason.

Take a Step Back

There’s a catch to doing that, though. People change. You change. Your kids change. People can change a lot in ten months. And yes, in ten months, the first symptoms of a mental health or substance use disorder may appear for the first time.

In light of that, here are two questions to consider: while our attention was focused outward, figuratively, toward the pandemic, did we miss changes happening inside ourselves? Did we miss changes that may have happened in our teens?

Let’s go back to the discussion of when mental health disorders may first appear. This is called the age of onset.  Research shows the following average age of onset for various attentional, behavioral, emotional, and mood disorders:

Impulse Control and Conduct Disorders

• Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder: 7-9
• Oppositional Defiance Disorder: 7-9
• Intermittent Explosive Disorder: 13-21
• Disruptive Mood Dysregulation Disorder: 6-10

Anxiety Disorders

• Phobias and Separation Disorders: 7-14
• Panic, Generalized Anxiety, and Post-Traumatic Stress Disorder: 15 and up.

Mood Disorders

• Early Onset Depression: 14-19
• Early Onset Bipolar Disorder: 14-17

Psychotic Disorders

• Schizophrenia: 15-35
• Other psychotic disorders: 24

[Note: Onset of psychotic disorders in children and adolescents is rare. Research shows they typically appear in early adulthood.]

Alcohol and Substance Use Disorders

(from The Journal of the American Medical Association)

• Early onset alcohol use disorders: 14
• Early onset substance use disorders: 14

If you have kids in those age ranges, then this is important information for you to know and understand. Once you do that, it’s equally important to be honest with yourself. It’s possible you may have missed the onset of a mental health or alcohol/substance use disorder over the past ten months – and the stress of the pandemic increases those chances.

What You Can Do

There’s another thing to consider: your child may not want to say anything about what’s going with them. They may not want to rock the boat. They may not want to draw undue attention to themselves. It’s possible they think you’re the one under excess stress, and they don’t want to add to it. It’s also possible that, since they’re still children (even your adolescents) they don’t understand what’s going on with them. They may not have words to describe their emotions, which means they can’t talk about them and ask for help.

It also means any changes may manifest in new behaviors. In order to identify these behaviors and determine whether they indicate an underlying issue, we suggest that over the winter break – when there’s no Zoom school and you have (hopefully) a few days off work – you schedule a time to sit down and talk to your teen about how they’re handling the pandemic.

What to Watch For

In addition, during this downtime, we suggest you watch your teen closely.

We know you may have shared space with them most days for the past ten months, but over the break, we want you to slow down and really see them – and watch for any changes you may have missed when your attention was elsewhere, like on work or the pandemic, for instance.

Here’s our list of changes to watch for, offered with the caveat that you need to adapt all these to the context of the pandemic. Over the past few months, has your teen:

1. Stopped doing activities they used to love
2. Withdrawn from friends or family
3. Displayed or discussed feelings of hopelessness or sadness
4. Shown increased levels of irritability, anxiety, or anger
5. Significantly changed their sleeping or eating patterns
6. Had difficulty maintaining attention or concentration
7. Neglected their appearance or personal hygiene
8. Engaged in reckless or risky behavior
9. Complained of chronic physical ailments like headaches or digestive issues

When you’re looking for the signs on this list, or listening for them during your check-in conversation, remember that any or all the signs above – when they occur alone or in small clusters – can be typical adolescent behavior. Minor irritability is no big deal. Changes in appearance, sleeping patterns, or new friends are not always things to be concerned about – especially during a stressful time like the past ten months of the pandemic.

It’s when these signs persist that you need to pay attention.

How to Follow up on Warning Signs

If you do identify any of the warning signs listed above, the key is to ask your teen follow-up questions. For each symptom, ask the following:

1. When did this start?
2. How often do you experience this?
3. When it happens, how long does it last, and how intense is it?

In general, if the symptoms of a mental illness occur daily and persist for more than two weeks, it’s time to consider seeking a thorough mental health evaluation or assessment conducted by a licensed mental health professional.

Move Forward Together

We understand that the way teenagers communicate – or any kids for that matter – can be frustrating. From the adult perspective, kids make mountains out of molehills and molehills out of mountains. A social hiccup with a friend group might be the literal end of the world omg, while a score of 57 on an open-book quiz that takes their grade from a B to a C is literally like nothing, I can make it up, don’t freak out.

That’s why the three follow-up questions we list above are important. What sounds like a big deal could turn out to be nothing – but you won’t know if you don’t ask the questions and do some digging. And what sounds like nothing at first could be a big deal – but you won’t know unless you ask the questions and get to the heart of the matter.

Your winter break check-in, therefore, can serve multiple purposes.

It’s a mental health check-in: if you determine your child needs a professional evaluation, then you can take the necessary next step and schedule one. If there’s no sign of mental health issues, then you’ve done your due diligence, and you now know what to watch for and how to check in – which are good tools to have in the parenting toolbox.

It’s a way to refresh lines of communication that may have gotten stale during the pandemic: you may learn new things about your child, because they have changed over the past ten months – they’re still growing, and that means change.

Finally, it’s a way to get back on the same page and get ready for the new year: you and your teen can reach your own new normal and commit to making 2021 an amazing year, despite any obstacles that come your way.