Identifying psychiatric and behavioral problems in teens

Your teen is moody. He's not doing well in school. He wants to be left alone. Does he have a learning disability? Depression? Or maybe he's just a normal teen?

Pinpointing a diagnosis of psychiatric and behavioral problems in teens can be tricky, even for experts in mental health. The human brain is still developing during adolescence, and as any parent of a teen can attest, mood and behavior can fluctuate wildly at this age.

“Teens are by nature secretive and it is sometimes very hard to figure out what is normal and what is not about teen behavior,” says Norma Clarke, MD, medical director of the Adolescent Treatment Program at The Menninger Clinic in Houston. “Also, teens can behave very well in a psychologist's or counselor's office, which makes it harder to arrive at a diagnosis.”

That's the first challenge, Dr. Clarke adds, because an accurate diagnosis is an essential step in treating mental illness. For teens struggling with psychiatric or behavioral disorders it can mean the difference between progressing in treatment or remaining stuck in their current situation and often unhealthy pattern.

By adolescence, many teens in treatment for behavioral or psychiatric issues have received multiple diagnoses—ranging from ADHD to bipolar disorder. Mood swings and irritability are a common symptom of many disorders, but, depending on the diagnosis, treatment can be drastically different, including the medication and therapy prescribed. When individuals don't respond to treatment that is not suited for them, they feel like failures.

“They feel that they are broken for life,” Dr. Clarke says. “They feel hopeless and think there is something so wrong with them. It affects their self-esteem and their ability to make friends and become the best they can be.”

Many parents of teens struggling with psychiatric or behavioral disorders feel helpless because they can't help their child, Dr. Clarke adds.

Menninger recently launched its Adolescent Assessment Program to provide troubled teens and their parents with more clarity around the problems and issues confronting teens. An accurate diagnosis is one aspect of this clarification. While brief, the two-week evaluation is intense and allows the patient, parents and treatment team to get to the heart of the matter. The Program fits the needs of teens and families who aren't making progress in their treatment and who desire a second opinion.

During their two week assessment at Menninger, patients meet with members of the evaluation team, which includes a psychiatrist, psychologist, internist, social worker, rehabilitation specialist, addictions counselor, nursing and senior staff specialists. The treatment team considers patient and family history, parent and patient reports, psychological testing, past treatment records and observations during the patient's stay. The Program also uses neuropsychiatric diagnostic tools including magnetic resonance imaging (MRI), to pinpoint the possible causes of behavioral and psychiatric problems in patients and rule out an underlying medical condition, such as a brain injury.

Patients participate in individual, group and family therapies and learn about coping strategies. Mental health professionals also review medications and other prescribed interventions.

Close to the end of the assessment period, team members share their findings during a conference and discuss the patient's diagnoses and treatment goals. Following this conference, the team shares these findings with the adolescent and the parents and involves them in discussing options for next steps in the treatment process and ways to support the teen academically and socially. Patients may continue treatment at Menninger or other programs if indicated.

Armed with answers, teens and parents can make decisions about future treatment methods, schooling and life. With their newfound clarity, they also regain hope.

“Once they are pointed in the right direction, teens can make positive strides toward recovery and learn how to lead successful lives,” Dr. Clarke says.

The Menninger Clinic is an international specialty psychiatric center, providing treatment, research and education. Founded in 1925 in Kansas, Menninger relocated to Houston in 2003 and is affiliated with Baylor College of Medicine and The Methodist Hospital. For 17 consecutive years, Menninger has been named among the leading psychiatric hospitals in U.S.News & World Report's annual ranking of America's Best Hospitals.