Archived information about adolescence, mental health, and our practice.

Britt H. Rathbone, LCSW-C was named a top therapist for Adolescents and a top therapist for Group Therapy in the July 2009 edition of Washingtonian Magazine. Mr. Rathbone has been named in the Washingtonian Magazine list every time it has been published, and is the only adolescent therapist to be consistently named.

Washingtonian Magazine asked 1,500 psychiatrists, psychologists, clinical social workers, therapists, and counselors who they would call if a family member needed help, and then tallied the results for the “Top Therapists” list.

“It is an honor to be recognized in this way by my professional colleagues” says Rathbone.

Mr. Rathbone, a clinical social worker, is the director of Rathbone & Associates, a leading provider of adolescent psychotherapy in the Washington metropolitan area.

Studies show that bullying may affect up to half of children in school. Bullying is not an acceptable part of growing up. It is a serious problem for both the bullies and the bullied. Studies show that bullying victims as well as bullies themselves were more likely to have suicidal thoughts.

If you think your child is being bullied talk with your child and the school. Let your child know you are there to support him or her. Teach strategies for assertiveness and ignoring. Make the school aware of your concerns. Many schools are implementing anti-bullying initiatives and are very responsive when they become aware that someone is being victimized.

If your child is bullying others, work with them on managing frustration and anger, and developing empathy. Model nonviolent problem-solving in your own life.

By immediately intervening with bullies, their victims, and the school environment adults are in a position to make a significant improvement in the mental health of teens.

A recent survey of almost 10,000 college students found that 27.1% reported having been diagnosed with a mental health condition at some point in their lives. Almost one in five reported a diagnosed depression, and one in eight reported a diagnosed anxiety disorder. 15.7% were diagnosed with a mental health condition in the previous twelve months.

28.7% reported that their use of the internet, computer or TV was excessive, and 41.8% felt it had negatively impacted their academic performance. [1]

We have found that college students often find themselves with limited or difficult to access mental health resources when away from home. Establishing a connection with a therapist is an important part of the process of adjusting to college for many young people with mental health histories. Parents can assist their young adult children by identifying resources and helping to set an initial appointment if necessary.

After a decline in adolescent suicide rates from 1990-2003 the suicide rate among 10-24 year olds increased again this year. The 8% increase was the largest single year increase in 15 years.

The increases since 2004 correlate with the FDA black box warning on SSRIs (selective serotonin reuptake inhibitors). Since the black box warnings were instituted in 2004, there has been a 20% decrease in the numbers of these prescriptions for young people. One possible reason for the increase in suicide is that some youth may have been inadvertently discouraged from psychopharmacological treatment and may not be getting treated for depression at all.

While not all young people with psychiatric issues need medication, some do, and effective follow up care can be a critical way to detect and manage suicidal thoughts in adolescents using SSRIs. Psychotherapy provides this essential monitoring in addition to effectively teaching new skills and methods for managing mood problems.

Robert D. Gibbons, C. Hendricks Brown, Kwan Hur, Sue M. Marcus, Dulal K. Bhaumik, Joëlle A. Erkens, Ron M.C. Herings, and J. John Mann, Early Evidence on the Effects of Regulators’ Suicidality Warnings on SSRI Prescriptions and Suicide in Children and Adolescents, Am J Psychiatry, Sep 2007; 164: 1356 - 1363.

Talk Therapy Offsets Suicide Risk Associated With Antidepressant Medication For Adolescents

A recent study finds that the combination of cognitive behavioral talk therapy (CBT) and the use of antidepressant medication (fluoxetine) leads to the best treatment response, and the talk therapy appeared to correlate with less suicidal ideation or action. The following chart shows treatment responses:

While all treatments had a similar outcome after 36 weeks, the adolescents who received the CBT alone or the combination treatment had less suicidal behavior:

The Treatment for Adolescents With Depression Study (TADS) Long-term Effectiveness and Safety Outcomes, Arch Gen Psychiatry. 2007;64:1132-1143

Individuals with either bipolar I or bipolar II disorder who received intensive psychotherapy had higher recovery rates than those who received short-term therapy or no therapy at all [1]. The type of therapy didn't matter (family focused therapy, interpersonal therapy, social rhythm therapy, or cognitive behavioral therapy) but the intensity and frequency of therapy did. Individuals with bipolar disorder who received either weekly or biweekly therapy over a nine-month period were more likely to recover from a depressive episode, recover more quickly, and have fewer symptoms.

While medication is an integral element of the treatment of bipolar disorder, psychotherapy is an important component of the overall treatment plan.

[1] Miklowitz, DJ, Otto, MW, Frank, E, et. al., Psychosocial Treatments for Bipolar Depression, Archives of General Psychiatry, 64:419-427, 2007

Teenagers are increasingly abusing narcotics such as Vicodin and OxyContin, and these narcotics are second only to alcohol and marijuana in terms of prevalence.

Almost 1 in 10 high school seniors acknowledged abusing these prescription drugs in the last year. Additionally, almost 7% of high school seniors report abusing over the counter cough and cold medications in the past year, and abuse of stimulant medication, commonly prescribed for ADHD continues.

Teens often report obtaining the narcotics from their family medicine cabinets, and cough and cold medications are easily available at drug stores. Parents of teens should consider disposing of medications that are no longer being used and maintaining a healthy vigilance about their teen's behavior and possessions.

Click here to read the full report on current adolescent substance abuse trends.

We recently conducted a client satisfaction survey to evaluate the helpfulness of therapy, the level of improvement since beginning therapy, and satisfaction with therapy. We are pleased to report that our clients consistently reported satisfaction in all areas with all of our therapists. The comments included:

While with the results of the survey are impressive, we continually look for fresh and new ways to better serve our clients. Please let us know if you have any suggestions or additional feedback. We will continue to offer the highest quality mental health services for adolescents and families.

We are very pleased to offer a DBT skills group this fall. DBT (Dialectical Behavioral Therapy) is a highly effective therapy for a variety of difficult to treat mental health conditions. The DBT skills group teaches:

Interpersonal Effectiveness: Skills for getting along better with others and having better relationships.

DBT was originally developed to help individuals with Borderline Personality Disorder, and has been proven effective with other conditions as well. DBT is especially useful for people who engage in cutting, suicide attempts, disordered eating, and other self destructive behaviors.

Data shows that almost half (47%) of the people who began drinking by age 13 developed alcoholism later in their lives. Adults who started drinking after age 21 only had a 9% risk of alcoholism later in their lives. The risk for alcohol dependency declines as the age of first use goes up:

Additionally, research has shown that alcoholism in adults is associated with "visuospatial, executive, psychomotor and memory decrements; smaller brain volume and a host of work-related and health problems"[1]

We know that there is rapid growth in the adolescent brain. Alcohol use may be a significant interfering factor in normal brain development.

Given the high risk for alcoholism and the high stakes for interfering with brain growth during adolescence, we must clearly communicate to our teens that alcohol use is very dangerous. Teens look to significant adults in their lives for guidance, often through modeling. It's important to be consistently clear with teens that we disapprove of adolescent alcohol use.

A recent Maryland State Department of Education report indicated that bullying reaches a peak in middle school and declines during the high school years. 12 year olds were the most frequent victims of bullying, and 13 year olds tended to bully the most. And while the report indicates that only 1.4 incidents per 1000 students were reported, it also acknowledges that many bullying incidents are not reported so this is an under representation of the problem.

Public and private schools have implemented many programs to combat bullying with mixed results. If you are concerned about bullying with an adolescent in your life, consider visiting the website bullies2buddies for an innovative and useful approach to this problem. A free download of a step by step manual is available online.

Frequent victims of bullying may also need a personalized approach to stopping the behavior, and a consultation with a therapist may help.

We have noticed and studies have confirmed that illicit prescription drug use is increasing among teenagers. This is occurring as the abuse of other drugs is declining.

Many teens obtain these drugs by taking them from legitimate prescriptions written for parents or friends, while others purchase them through the internet or from friends.

The National Institute on Drug Abuse surveys teens annually, and they found that almost 10% of high school seniors have used Vicodin, and 5% have tried OxyContin. These numbers have increased over the last few years.

Parents should be alert to the presence of pills if they notice a change in their teen's behavior. If you are concerned about the behavior of a teenager you know, and suspect prescription drug abuse, please call the office for treatment options and resources.

A 2004 survey conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA) found that 9% of adolescents ages 12-17, or over two million teenagers, had a major depressive episode in the previous year.

The teenagers who experienced major depression were also much more likely to have used drugs, alcohol and cigarettes than teens that did not experience depression.

Symptoms to look for in major depression include irritability, loss of pleasure in previously enjoyed activities, changes in sleeping or eating habits, difficulty concentrating, and a lack of energy. Click here for a full list of diagnostic criteria.

Despite the fact that less than half of depressed teens receive help for the depression, it is very treatable. Contact your pediatrician, counselor or therapist if you have concerns about a teen you know.

Cognitive Behavioral Psychotherapy and Medication is Best for Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) responds better to a combination of medication and psychotherapy than to medication alone. Two recent studies [1,2] show that of the people who were treated with medication alone, approximately 80% relapsed. Those who were treated with a combination of therapy and medication relapsed at rates between 10% and 46%, depending on the study.

OCD occurs in about 3% of people in this country. The symptoms often become more obvious during adolescence. OCD is characterized by intrusive and distressing thoughts, or obsessions, accompanied by strong urges to perform certain behaviors, or compulsions. This combination of symptoms can be embarrassing and confusing to adolescents.

Cognitive behavioral psychotherapy aims to change the thinking patterns and behaviors that contribute to OCD.

[1] Biondi, M and Picardi, A. Increased maintenance of obsessive-compulsive disorder remission after integrated serotonergic treatment and cognitive psychotherapy compared with medication alone. Psychotherapy and Psychosomatics, 74:123-128, 2005.

[2] Cognitive-Behavior Therapy, Sertraline, and Their Combination for Children and Adolescents With Obsessive-Compulsive Disorder: The Pediatric OCD Treatment Study (POTS) Randomized Controlled Trial. The Pediatric OCD Treatment Study (POTS) Team. JAMA. 2004;292:1969-1976.

A recent study found that teenagers who felt that they were too fat or too skinny were more than twice as likely to think about or attempt suicide than teenagers who did not have negative feelings about their weight. Teens who did not think negatively about their weight, were less likely to consider suicide, even if they really were overweight or underweight.[1]

Our society is ever more focused on appearance, and teenagers are especially vulnerable to being self-critical and self-conscious. While we often think of girls being more at risk for body image issues, boys too are focusing on developing their bodies based on unrealistic images from the media.

This research underscores the influence of our perceptions, however inaccurate, on our moods. Anger, anxiety and depression can be overwhelming, and are often the result of misperceptions. Therapy can be a useful tool for teaching teens to think more realistically and feel better.

[1] Danice K. Eaton, PhD; Richard Lowry, MD; Nancy D. Brener, PhD; Deborah A. Galuska, PhD; Alex E. Crosby, MD. Associations of Body Mass Index and Perceived Weight With Suicide Ideation and Suicide Attempts Among US High School Students. Archives of Pediatrics and Adolescent Medicine, 2005;159:513-519

We have recently observed an increase in adolescents talking about and participating in gambling. Betting on professional sports events and playing poker are common examples. Sometimes, significant amounts of money are involved.

Gambling can be a serious issue. A 2004 study found that adolescent gamblers were more likely to abuse or be dependent on alcohol or other drugs, and were more likely to be depressed. This study pointed out that adolescent gambling, like adolescent substance abuse, often involves a social component, which may contribute to its appeal. The study indicated that gambling during adolescence may have an influence on psychiatric functioning in adulthood [1]

Parents should make efforts to provide adolescents with safe and healthy social activities, some of which may include taking safe risks. While it’s important to watch for signs of depression and drug and alcohol use among teens, it’s also important to be aware of the risk factors for these issues.

[1] Maciejewski, PK, and Potenza, MN. Psychiatric Correlates of Gambling in Adolescents and Young Adults Grouped by Age at Gambling Onset. Archives of General Psychiatry, 61:1116-1122, 2004

People who think about the things they are grateful for in their lives sleep better, feel better, and are in better physical health.

A recent study showed that people who kept a "gratitude journal" in which they listed things they were grateful for on a daily or weekly basis reported the most benefits. Benefits of gratefulness include an overall sense of well-being, better social skills, and less emphasis on materialism. [1]

In addition, people who were grateful were more likely to achieve their academic goals, and were more optimistic about the near future.

Training our adolescents through example to be grateful appears to be a significant strategy for maintaining good mental health. Teenagers are under a lot of pressure and providing them with techniques to offset the stress of daily life may help prevent mental health problems.

Eating Family Meals Together Associated With Enhanced Well-Being Among Adolescents

Recent research has shown that more frequent family meals with adolescents are associated with lower levels of depression, lower likelihood of alcohol, marijuana and cigarette use, and, among girls, higher GPA and less likelihood of suicidal thoughts or action [1].

It can be difficult to eat together in today's families. Work, sports and social demands all make it difficult to sit down for dinner together. Yet, this research echoes previous studies that have shown that spending time together at critical times (meals, bedtime, transition periods) has a positive effect on adolescents. And it is also consistent with research that shows that teens with mental health concerns are less likely to eat with the family (see Teen Involvement in Family Activity.)

We have more influence over our teens than it seems, and making sure we commit to spending time together at critical points during the day may be a significant factor in improved decision making and mental health among adolescents.

[1] Eisenberg ME, Olsen RE, Neumark-Sztainer D, Story M, and Bearinger LH. Correlations Between Family Meals and Psychosocial Well-Being Among Adolescents. Archives of Pediatric and Adolescent Medicine, 158:792-796, 2004

A new study performed by the National Institute of Mental Health found that the benefits of certain medications to treat adolescent depression outweighed the risks, but did urge practitioners to monitor teens carefully for suicidal thoughts when taking Prozac.

The study suggested that teens who were in therapy while taking medication had a lower risk of self harm than those that only were taking the medication. The study also showed that the greatest improvement was among the participants who received both medication and cognitive behavioral therapy. Those who received therapy alone and medication alone also showed improvement, but not at same level.

Depression is treatable. Contact your pediatrician or a therapist if you have concerns about an adolescent in your life.

Smoking reduces life span and quitting smoking can extend life. For more information, click on www.surgeongeneral.gov/library.

A recent study found that in the summer after high school graduation, 40% of males and 30% of females were drinking alcohol heavily. The heavy drinkers were more likely to perceive that their parents were less strict about alcohol use, and were more likely to have close friends who were also heavy drinkers. Graduated seniors who drank less heavily were more likely to feel that their parents kept track of their whereabouts and behavior, and that their parents didn't approve of heavy drinking. [1]

Parents often feel helpless and powerless with their older teenagers. This research indicates that even when parents can't directly control their young adult children's behavior, their attitude about alcohol does have an impact on their children's choices.

[1] Read, JP, Mitchell, RE and Brand, NH. Do Parents Still Matter? Parents and Peer Influences on Alcohol Involvement Among Recent High School Graduates. Psychology of Addictive Behaviors, 18:19-30, 2004

A recent study found a relationship between smoking and panic attacks in teenagers. Over three thousand young people aged 14 to 24 were interviewed, and it was found that smokers were more likely to report having had a panic attack or panic disorder. Four years later, researchers reinterviewed over twenty five hundred of the original participants in the study, and found that smokers, even those who were not dependent on nicotine, were more likely to have developed a panic disorder since the initial study [1].

Panic is a form of anxiety, and young people with anxiety often report that cigarettes help them relax. It is important that they be aware that this relaxation is an illusion, probably due more to the deep breathing associated with smoking than the nicotine. In fact, nicotine is a stimulant and can worsen anxiety symptoms. More effective anxiety relief can come from learning about deep breathing and other anxiety management techniques.

[1] Stein, MB, et al. Smoking Increases Risk of Panic: Findings From a Prospective Community Study. Archives of General Psychiatry, 60:692-700, 2003.

The FDA has reported that there has been an excess level of suicidality among youngsters with major depressive disorder who have taken certain widely used antidepressant medications. These medications include Celexa, Prozac, Paxil, Zoloft, Effexor, and Serzone. This is based on a preliminary review, and additional information, analysis and discussion are encouraged. If you are concerned about the effect of these medications on your child, please contact the prescribing physician.

School Suspension

Adolescents who are suspended from school spend the day at home as a punishment for behavior at school. In fact, many students should receive in school suspension rather than be out of school. According to the American Academy of Pediatrics, out of school suspension "may exacerbate academic deterioration, and when students are provided with no immediate educational alternative, (may exacerbate) student alienation, delinquency, crime, and substance abuse may ensue." [1]

If your teen is suspended from school, advocate for an in school suspension. The student then has an opportunity to make up work and will not inadvertently be rewarded for misbehavior by essentially being given a day off. And if your teen is receiving special education, be sure the school does not suspend him or her for more than the 10 days legally permitted.

If out of school suspension can't be avoided, consider a community program to continue the education process while he or she is removed from the school. SHARP is a good example of such a program.

Our teens are entitled to a free and appropriate education, and they do not receive this when they are not attending school.

Female Athlete Triad

Athletics are a critical part of adolescent development, and should be encouraged for health, mental health and social benefits. It's important to be alert to specific medical concerns that can develop in females who participate regularly in sports, especially those sports that emphasize leanness such as ballet and gymnastics, endurance as in long distance running or swimming, or weight classification. These concerns are disordered eating, menstrual dysfunction, and decreased bone mineral density.

Female adolescent athletes are often trying to lose weight, and some use vomiting, laxatives, or excessive exercise to achieve this goal. Menstrual dysfunction is more common in athletes than in the general population, and may result in decreased bone mineral density, which may predispose them to osteoporosis.

The American Academy of Pediatrics recommends that exercise be encouraged in adolescent girls, but that we be alert to the female athlete triad and provide education and treatment where appropriate.

A recent study monitored relapse rates among adolescents treated on an outpatient basis for substance abuse. It was found that 66% reported a relapse in the six months following treatment. Adolescents identified social pressure, withdrawal syndromes, and negative mood as factors in relapse. The study concludes that depression may be associated with relapse among substance abusers, and recommends more intensive treatment to address mental health factors [1].

We see many adolescents in psychotherapy who are also being treated in substance abuse treatment programs elsewhere. We see a clear correlation between substance abuse and depression and anxiety disorders. If these issues are not addressed as part of the substance abuse treatment, the risk of relapse is higher. And for adolescents with mood issues, proper treatment may reduce the risk of substance abuse. The factors associated with drug and alcohol abuse are complex, and treating them often requires a treatment plan coordinated among several providers to be effective.

[1] Maisto SA, Pollock NK, et al. Rapid Relapse Generally Follows Treatment For Substance Abuse Disorders Among Adolescents. Addictive Behaviors, 28:381-386, 2003

Parents often wonder what, if any, impact they have on their adolescents. A recent study found that teenagers who perceived that their parents were monitoring them and were aware of their activities drank alcohol less. And less alcohol use was associated with less externalizing behavior such as delinquency and aggression [1].

It’s important to keep our eyes and ears open as parents. Let your teenager know that you are monitoring his or her behavior, and remember that although peer influences play a major role in adolescent substance abuse, parents have impact as well.

[1] Bray JH, Getz JG, & Adams G. Gender, perceived parental monitoring, and behavioral adjustment: Influences on adolescent alcohol use. American Journal of Orthopsychiatry, 72:392-400, 2002.

It seems teenagers are always playing video or computer games. Many parents express concern that the amount of time playing games is a problem, or that school performance is declining while time spent playing videogames is increasing. How can you tell if your teen is addicted to videogames? Consider the following symptoms [1]:

Parents should set limits with video and computer games as they do with other behaviors. Establishing clear expectations for school performance and family involvement will also allow parents to recognize when game playing is becoming a problem. If teens persist in excessive play, consider calling the guidance counselor or a therapist experienced in working with adolescents.

[1] Tejeiro RA and Bersabe-Moran RM. Measuring Problem Video Game Playing In Adolescents. Addiction, 97:1601-1606, 2002

We all know the stereotype of teenagers that are uninterested in participating in family activities. And it may be healthy and developmentally appropriate for teens to pull away from the family to a degree. It’s important nonetheless to keep teens active in family activities.

A recent study found that adolescents who complained of depression and anxiety and who were seeing a therapist were less likely to eat meals with the family, participate in family celebrations, conversations, and other activities. These same teens reported that they felt less supported, loved and accepted by the family. [1]

It’s hard to determine if the lack of family involvement leads to the mood problems or if the mood problems contribute to less participation in family activity, but it is clear that we must attempt to include teens whenever possible, and reach out to them when necessary. Teens can be difficult to live with, and may not show a lot of appreciation, but we must make every effort to include them in family life.

[1] Moreno J, Ruiz MT, and Pascual E. Doing Things Together: Adolescent Health and Family Rituals. Journal of Epidemiology and Community Health, 56:89-94, 2002.

An annual survey of 44,000 8^th through 12^th graders has shown the first decline in adolescent drug use since the mid-nineties. And cigarette use among eighth graders is at half the level of 1996. But while these numbers are moving in the right direction, the amount of alcohol, drug and cigarette use among teens is still high.

The decline in the numbers is encouraging, but we must continue to be alert to the real possibility of drug and alcohol use among teens. Substance abuse impacts family relations, academic performance, and mood, and can be treated if properly identified.

The suicide of a teenager is a tragic and often preventable occurrence. Teenagers who have repeatedly thought about suicide, or who have attempted suicide are considered at-risk, and there are over three million of these adolescents in the US. Over a third of these at-risk teens attempted suicide last year. The early identification and treatment of at-risk youth is the key to preventing suicidal behavior, yet only 35% of at-risk teens received the mental health treatment they needed.

The use of drugs has been linked to an increased risk for suicide. The percent of youth at-risk for suicide was:

It is thought that teens that do not receive appropriate mental health care often “self-medicate” with alcohol and other drugs. Adolescent depression is a serious condition, with potentially life threatening symptoms. It is treatable, but we must be alert to those teens that are at-risk, and direct them to the appropriate mental health services.

Many of the teens we treat are reporting increased anxiety associated with the recent sniper shootings. Schools have been in “Code Blue” almost every day, and the news reports have been saturated with the latest information. Youngsters with anxiety disorders may see their symptoms flare up during times like these, and we must be alert to teens who need an opportunity to talk. Reassuring teens of the low risk, unprecedented law enforcement response, and need to maintain daily routines while staying alert and being aware of our surroundings may help to balance the media’s response to the shootings.

The events of the past year have shattered the sense of safety most children and adolescents experienced prior to the September 11 terrorist attacks. Being available to listen to and support our teenagers can help them cope with the violence and unpredictability that have characterized these recent events. Use the resources available to you through schools, religious organizations, friends and the community to help your adolescents manage the uncertainty of the situation. But more than ever, it is family that matters most during these disturbing and difficult times.

OCTOBER 22, 2002 UPDATE: Based on the most recently revealed statements threatening children, parents should take every precaution to ensure the safety of their teenagers. Until the sniper is apprehended, we all must be extra vigilant and teach our children to be cautious.

Teen behavior often tests the limits of what is acceptable, and often results in societal changes or fashion trends. Many parents worry about tattoos and piercing. Anyone who spent time at the pool or beach with teens this summer has noticed the prevalence of tattoos on young people. Is there a risk? We know that concerns have been raised about the risk of Hepatitis C and unsanitary tattoo and piercing equipment. But what about other risks?

A recent study of 484 twelve to twenty-two year olds found that 13% of teens report having a tattoo, and 27% report having body piercings somewhere besides their earlobes. Females were more likely than males to have either tattoos or body piercings.

Teens with body piercings or tattoos were found to be more likely to engage in high-risk behavior such as suicidal behavior, drug use, sexual activity, and eating disorders, and they engaged in these behaviors more often than their peers without tattoos and piercings [1].

It is clear that every teen with a tattoo or piercing is not at risk, but we should be alert to the possibility that this behavior may indicate other issues. Being alert to all the signs that a teen may be struggling helps us identify those youngsters that will benefit from counseling.

[1] Riffenburgh RH, Roberts TA, and Myhre EB. Tattoos and Body Piercings as Indicators of Adolescent Risk-Taking Behaviors. Pediatrics, 109:1021-1027, 2002

We are pleased to report the feedback from our latest client satisfaction survey. Teens and parents have overwhelmingly rated us at the highest levels:

We are very proud of these ratings. And we will continue to strive to bring the very best outpatient mental health care to the teens we treat. Thank you for these outstanding ratings!

Many adolescents, and even parents, regard marijuana as a harmless drug. In fact, marijuana abuse does cause a variety of problems and is widely used among adolescents. Of all adolescent admissions to inpatient substance abuse treatment facilities, about 60% are for marijuana use. And half of those admissions are referred through the criminal justice system [1]. About 85% of high school seniors report that marijuana is easy to obtain [2] and the average age of first use for marijuana is 12.75 [3]. It is clear to mental health providers who work with adolescents that marijuana is often abused, and can result in school performance problems, irritability, depression, conflict within the family and a change of friends. Marijuana is psychologically addicting, and adolescent abuse of marijuana can be a sign of more serious mental health issues.

Regardless of your position on marijuana use, recognize that adolescents and young adults do not always use even legal substances safely. The potential for abuse is great. Do not ignore signs that your teenager may be using marijuana or other drugs. Talk to a therapist experienced in detecting and treating adolescent substance abuse.

[2] National Survey Results on Drug Use from the Monitoring the Future Study, 1975-1995, L. Johnston, J. Bachman, and P. O'Malley; HHS, National Institute on Drug Abuse; Washington, D.C.: USGPO, 1996 (Table 12, p. 88 and Table 13, p. 89).

[3] Edwards, R.W "Drug Use Among 8th Grade Students is Increasing," International Journal of Addiction, 28(14): 1613-20, 1993.

Vacations can be exciting family experiences, but can be trying at times for teenagers and parents alike. Conflicting ideas of what constitutes the perfect vacation, differences of opinion about how to divide the time when sightseeing, and a teens desire for independence all contribute to tension. The key is compromise. Getting input from family members while planning vacations may help keep the conflict to a minimum. Teens are especially sensitive to being treated with respect, and simply including them in the planning can go a long way towards minimizing conflict. Teenagers are learning to negotiate the world with less input from parents. It is useful to allow teens to have some independent time while on vacation. Setting aside free time for adolescents in the family may help the time spent together to be more enjoyable and relaxing.

Electronics have become smaller and more ubiquitous. Many teens find that listening to a CD player or playing a hand held video game makes the hours go by faster while waiting for a flight or riding in the car. Allowing everyone his or her own diversions when you are together for extended periods help keep the tension level down. This is not to say you should not set limits. Having a CD player on all day or at the dinner table may drive you nuts. Talk it out with your teen in advance so they understand your expectations.

Allowing your teen to bring a friend along on vacation may also help make the trip easier. Peers are everything for teens, and being away from friends for a week or two can seem like an eternity. By bringing a friend along, your teenager may participate in the vacation with more enthusiasm.

A 2000 national survey of more than 25,000 teenagers aged 12 to 17 found that adolescents who participate in team sports are less likely to use cigarettes, alcohol and other drugs than teenagers who do not participate in team sports. Teens who participate in team sports are also more likely to disapprove of peer use of cigarettes, alcohol and marijuana. [1]

Cigarettes

Alcohol

Marijuana

Other Illicit Drugs

Team Sport

10.5%

15.5%

5.7%

3.7%

No Team Sport

18.1%

17.8%

9.6%

5.9%

We routinely recommend athletic activity for adolescents with depression or anxiety, as research shows that it helps improve mood and lower anxiety levels. We also know that team sports help improve social skills. This study further supports the importance of positive peer interaction and athletic activity for adolescents.

Encourage your teen to find a sport he or she enjoys. Parents can help by modeling responsible alcohol use and abstinence from other drugs as well as involvement in athletics. Teens want to be successful. If they don’t experience success in appropriate activities, they are more likely to find “success” in unhealthy activities with substance abusing peers. Talk, encourage and support your teen!

Human adolescence is unique. We take so long to grow up. Other species have a shorter adolescence and mature much more quickly. While apes mature in about twelve years, humans take eighteen to twenty years, sometimes more. Anthropologists at University College in London have discovered that species that predated Homo sapiens did not have the extended adolescence of today. They speculate that as the brain became larger, humans needed more time for learning, and the extended adolescent period gives us this time.

In fact, we now know that adolescents are still learning as their brains continue to develop. Much of adolescent behavior can be understood in the context of neurological immaturity. We have the opportunity to teach throughout adolescence. What we teach our teens about problem solving, managing emotions and social functioning among other things has a meaningful impact on their brain development. We are patient and encouraging when a child is learning to walk, yet we can be critical and punitive when a teenager is learning more complex human functions. Recognizing that teens have developing brains and that they are still learning gives us the framework for providing the support and encouragement they need, even when they make mistakes.

There are numerous therapies and approaches to managing the mental health concerns of teenagers. It can be difficult to sort through the maze of providers and therapy techniques. It is widely understood among therapists that a key to successful treatment is a good fit between therapist and client. Some researchers suggest that it may be the most important factor, even more significant than treatment approach and therapist experience.

While looking for a therapist, trust your feelings. Find a professional who connects well with both the adolescent and the parents. Look for a therapist who demonstrates warmth, empathy, caring, acceptance, and encouragement. And make sure that all involved family members feel comfortable with the choice. Therapy can be hard work, but can result in significant progress if the relationship with the therapist is a good one.

Symptoms of depression are fairly common among adolescents; about 30% of teenagers report having some symptoms of depression when surveyed, with 9% having symptoms of moderate to severe depression. But what are the factors that indicate that this is serious problem? A recent longitudinal study found that most teenagers who have just a few symptoms of depression seem to do fine and are at low risk for clinical depression, but that those with more symptoms should be monitored closely. Some of the factors that correlated with persistent depression were school suspension, weaker family relationships, fair or poor general health, and female gender.[1]

It’s important to take all depressive symptomatology seriously, and being alert to adolescents with more symptoms and risk factors may help identify those who might benefit from treatment. Depression is a treatable condition, and teachers, guidance counselors, coaches, parents and even friends are in an excellent position to observe and identify those teens in need.

1. Rushton Jerry, Forcier Michelle, and Schectman Robin (2002) Epidemiology of Depressive Symptoms in the National Longitudinal Study of Adolescent Health. J. Am. Acad. Child Adolesc. Psychiatry, 41:2:199-205

(Posted February 2002)

There is no shortage of information about Attention Deficit Hyperactivity Disorder (ADHD). It is one of the most studied psychiatric conditions of childhood. Yet there is still controversy about whether it really exists. Some of the confusion is a result of overdiagnosed or misdiagnosis. While ADHD has very clear symptoms and must exist in all areas of a child’s life for an extended time period beginning by age seven, there are many conditions that mimic ADHD. Misidentification of these other conditions as ADHD leads to ineffective treatment. For example, a teen might have trouble with certain teachers and act up in class. This could be due to frustration resulting from an unidentified learning disability, irritability associated with depression or another mood disorder, or anxiety about a certain type of assignment or classroom management style. Or it could be that the teen has a food allergy, is in a bad mood when tired, or is energized by friends in the class. There are many possible reasons for behavior that initially looks like ADHD. And there are many adolescents who do have ADHD but have another mental health condition that complicates treatment.

When we see ADHD-like behavior in our clients, we thoroughly evaluate it. This includes talking with parents, the client, and when appropriate and with permission, teachers and other involved medical professionals. By looking carefully at the behavior, we can help determine the true origin of the behavior, and then recommend the best approach to address it.

Please visit our links page to learn more about ADHD. Proper and professional evaluation by a nonbiased professional is one key to successful treatment.

We are pleased to announce the creation of our speaker’s bureau. Our therapists offer presentations to parents, educators, therapists and teens on a variety of issues associated with adolescence. We tailor our presentations to the specific needs of our audience and our speakers are engaging, dynamic and interactive. We work with adolescents day in and day out, and our audiences overwhelmingly report that our presentations are informative, lively and current.

If your group is looking for a dynamic speaker to address adolescent issues to a professional or lay audience, please call or email us for a rate sheet and list of topics. We would be happy to create a program to meet your needs.

The question we hear most often from parents these days is, "How are teens reacting to the recent tragic world events?" The answer is, "it depends." It varies depending on the coping ability of the adolescent, the amount of support they experience in their family and among their friends, their previous state of mind, and the amount of stress on their plate. We see teens who are ready to enlist, and others who feel violence is not the answer. It's important to remember that teenagers are still trying to sort out their place in the world, and don't always fully understand the implications of their statements or actions.

We are impressed with the overall high level of awareness and sensibility of the teens we treat. They tend not to panic and they aren't particularly reactionary. It's worth noting this is the first threatening world event that most of today's adolescents have experienced. Of course there are some teens that are struggling more than others, but they are handling it remarkably well by talking about their feelings, debating responses with one another and getting support from friends and family.

It's important for all of us to talk and express feelings and reactions when traumatic events occur. Letting our teenagers express themselves will help them get through these tough times.

Adolescents are chronically sleep deprived. Teens often are the last to go to sleep in the house, and have to wake up early to get to school on time. While local school systems periodically look at the issue of having high schools start later in the morning, no changes have yet been made. Before electric lights were invented, our ancestors typically slept nine hours a night, and when all cues related to the time of day are removed in studies, adults will sleep approximately ten hours a night. Yet teens are often sleeping six or seven hours a night, far less than the nine hours they need. Sleep deprivation is associated with irritability, depression, anxiety, memory deficits and other problems. Getting enough sleep can lead to a stronger immune system and better concentration at school.

Parents can support their teens by keeping the lights bright in the house in the morning, providing access to high protein, complex carbohydrate breakfasts, encouraging regular exercise, and creating a home environment conducive to unwinding from the stress of the day. Understand if your teen isn't tired until late at night, the hormonal shift that occurs during adolescence impacts the circadian rhythm and they often don't feel tired until after 11:00.

Most teens enjoyed their summers, finally feeling a relief from the stress of homework, tests, and for some, the terrible experience of being victimized by bullies. For a variety of reasons, some teens are targeted by bullies, and the impact on self-esteem and confidence can be great. The typical advice we give teens-ignore it, don't fight back-often doesn't work; the bullying continues. Or it may take a full school year of responding differently to the bullying before the bully gives up and moves on to another victim.

Schools need to approach this problem from two directions; supporting and protecting the victims and working with the victimizers, and taking a zero tolerance stance on bullying. School systems that have made a decision to tackle this issue have seen improvement, yet our local school systems have not taken a serious system wide approach to this problem. We should be vocal about the impact of bullying on our kids, and the need for the school system to address the problem effectively. Perhaps with appropriate programming at the school level, many more students can enjoy being at school this year.

Summer is a great opportunity for teens to work or volunteer and gain valuable experience. We have been amazed at the variety of sites teens have worked. It seems that there is something available for almost any interest if teens are willing to consider internships, volunteering, and full or part time employment. Many teens tell us that they have discovered previously unknown interests, and that they have clarified their thinking about careers by experiencing first hand what the work is like. And earning some money gives adolescents the opportunity to learn how to develop good money habits.

While many internships and summer jobs end when school starts, some teens decide to stay on through the school year. A study by NIMH found that working part time can be healthy for adolescents, but warned that working more than twenty hours per week was associated with a variety of problems, including increased risk for substance abuse and emotional difficulties.[1]

As always, parents help their teens balance the benefits and risks of working. Family involvement when appropriate and possible is one of the greatest protective factors for teens.

[1] Resnick M.D. et al. Protecting adolescents from harm. Findings from the National Longitudinal Study on Adolescent Health. Journal of the American Medical Association 1997;278:823-832

MDMA or "Ecstasy", a hallucinogenic amphetamine, continues to gain popularity among teens. Approximately one in twenty eighth graders and at least one in ten high school seniors report having used ecstasy.¹ Usually taken in pill form, ecstasy causes users to feel intense pleasure and self-confidence, as well as closeness with others and a heightened sense of empathy. Side effects can include depression, anxiety, sleep problems, and teeth clenching, which is why some users carry pacifiers. Ecstasy has been shown to immediately damage the brains of rats and primates in research, and some of this damage appears to be permanent. Other research indicates that this damage may result in long-term memory loss.² Unfortunately, these effects are not widely recognized by teens, and many of the teens we treat tell us that they believe ecstasy is harmless.

Teens are bombarded with opportunities to use alcohol, drugs and cigarettes on a daily basis. Teens tell us that the easiest place to obtain illegal substances is within the "Drug Free School Zones." Parents must do their part by keeping the lines of communication open with their kids. And if parents notice a sudden change in their teen's friends and behavior, they should consider the likelihood that drug use may be involved. Good resources for concerned parents are available on our links page, or contact us if you want more information.

1. LD Johnston, PM O'Malley, JG Bachman. (Dec. 2000). "Ecstasy" use rises sharply among teens in 2000; use of many other drugs steady, but significant declines are reported for some. University of Michigan News and Information Services: Ann Arbor, MI. Available: www.monitoringthefuture.org
2. Fischer, C.; Hatzidimitriou, G.; Wlos, J.; Katz, J.; and Ricaurte, G. Reorganization of ascending 5-HT axon projections in animals previously exposed to recreational drug 3,4-methelenedioxymetham-phetamine (MDMA, "Ecstasy"). Journal of Neuroscience 15:5476-5485, 1995.

Rathbone & Associates recently conducted a client satisfaction survey. Please take a moment to review the findings and see how your peers ranked us. We value your feedback, and appreciate the overwhelmingly positive responses.

We are very proud of these top ratings and thank our clients for their continued confidence in us.

Client satisfaction is our #1 priority, and we constantly look for ways to improve upon our services. Please don't hesitate to let us know your suggestions and feedback on an ongoing basis.

Research over the past ten years indicates that exposure to the media can lead to increased violent and aggressive behavior, increased high-risk behaviors, including alcohol and tobacco use, and accelerated onset of sexual activity among adolescents[1]. It seems that teens are spending more and more time watching TV, on the Internet, or playing videogames. The social isolation that is associated with some of these activities is an additional concern.

What can be done to combat the impact the media has on teens? Adults must stay involved in their teen’s lives and be aware of the violence and sexuality that they are being exposed to daily. Maintaining open communication within the family is the first step towards mitigating this impact. Parents can encourage and support age-appropriate activity with others and avoid using TV and computers as babysitters for their teens. If the television must be on, watch TV with teens, then discuss the content of the shows together. The mood and concerns of vulnerable teens are often reflected in their musical preferences, so discuss music lyrics when possible. Given the ubiquity of the media in all our lives, it is impossible to avoid exposure to these messages, but if we keep the lines of communication open, we may be able to avoid the risks associated with them.

[1] Villani, Susan (2001), Impact of Media on Children and Adolescents: A 10-Year Review of the Research, Journal Of The American Academy Of Child & Adolescent Psychiatry; 40:392-401

(Posted May 2001)

The recent school shootings in California underscore the importance of every child feeling accepted and included in the community. Too many adolescents are isolated, rejected, and considered "outcasts" by their peers.

Adults can do something for these teens. Watch carefully and support these vulnerable kids. Often, teens don't fit in at their school, but they may find a good fit in a youth group or non-school related activity. Many teens have told us how hard it is to turn things around socially in an environment where they are ostracized. Yet, many of those same teens rave about the benefits of scouting, religious youth groups, community service organizations, or even working at a part time job.

The goal is to find an arena where success and acceptance can be cultivated. If the school environment is not accepting, balancing it with positive after school experiences can help. Teens have too much potential to let them suffer with rejection.

For more information on teens, visit our links page. If you have any ideas or thoughts about this issue, send us an email.