NotesTeens5 min read
When your child is struggling: how to know it is time
Adolescence is supposed to include moodiness, privacy, and the sense that you have become deeply embarrassing. The question is not whether your teenager is difficult. It is whether something has changed in a way that persists.
Look for change, duration, and reach
Change: this is different from how they have been, not just different from how you would like them to be.
Duration: it has lasted weeks rather than days, and does not lift when circumstances improve.
Reach: it is showing up in more than one place — home and school, or friendships and sleep and appetite. A bad patch in one domain is usually a bad patch. Three domains is a pattern.
Signs worth acting on now, not later
Withdrawal from friendships they used to value. Loss of interest in things that reliably mattered. Sleep that has inverted. A significant drop in school engagement. Self-harm of any kind. Talk about not wanting to be here, however lightly delivered.
That last one is never something to wait out. Ask directly, stay close, and call or text 988 if you are worried about their safety.
How to raise it without triggering a shutdown
Lead with observation, not diagnosis: "You've been having a hard time getting up, and you haven't seen Maya in a month. I'm not in trouble with you. I just want you to have somewhere to put it."
Offer choice — two or three clinicians, and permission to say no to any of them after one meeting. Autonomy is the currency at this age, and giving some away buys engagement.
Then be clear about privacy: what they say is largely theirs, with the standard safety exceptions, and I explain those to both of you at the start.
The parent's part
Sessions include parents at the edges rather than at the center. You will get direction and involvement, but not transcripts, because a teenager who believes the room is monitored will use it as a waiting area.
Worth Keeping
Three things to take away
- Change, duration, and reach across domains matter more than intensity.
- Any talk of not wanting to be alive is acted on immediately, not observed.
- Giving a teen real choice over the clinician improves engagement more than anything you say.
If you are unsure whether this crosses the line, that is a good reason to ask rather than to wait another term.
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