Being a teenager can be a challenging time for lots of different reasons. Sometimes we can feel really worried, stressed or sad. Everyone has these feelings sometimes, but when the feelings begin to get in the way of everyday life then our mental health may suffer.

You might have heard of a few different mental health problems. Here are some of the common ones that teenagers can experience:

If you have Attention Deficit Hyperactivity Disorder (ADHD), you may have lots of energy and find it difficult to concentrate. It can be hard to control your speech and actions. ADHD is the most common behavioural disorder in children, and symptoms often become noticeable between the ages of 3–7. We don't know what causes ADHD, but experts think it runs in families. It could also be caused by an imbalance in brain chemicals.

A related condition, ADD (Attention Deficit Disorder) has similar symptoms, but there is less hyperactivity and the main problem is difficulty concentrating.

If you think you are affected by ADHD, talk to someone you like and trust, like a teacher, relative, counsellor or friend. You should also see your GP as they may offer to refer you to CAMHS. There is no test for ADHD so, instead, you'll talk to an expert (maybe a psychiatrist or specialist paediatrician) to find out the best way to help. 

HOW CAN CAMHS HELP ME WITH ADHD?

Behavioural therapy, counselling, family meetings, special educational support and medication can all help children and young people with ADHD. You could be offered psychological therapy on a one-to-one basis. Older children may also be offered group sessions to help with their behaviour.

Anger is an important emotion, and when we are afraid it can help make us feel less vulnerable and able to survive the situation. The important thing is how anger is expressed and dealt with. It is often when anger is ignored or not expressed properly that it can become a problem. If children’s anger is ignored it can build up inside and may lead to them expressing it in disruptive behaviour or turning their frustrations in on themselves.

 

THINGS TO THINK ABOUT

Children tend to feel anger for the same reasons adults do. They may have been annoyed by something in the present and are reacting to that, but it could also be that they’ve been badly treated in the past and are still feeling angry about it, and end up carrying a lot of ‘bottled up’ anger around with them.

Consider the following: 

  • Is the child being bullied? 

  • Are they struggling at school? 

  • Are they unable to express themselves verbally? 

  • Are there any issues at home (e.g. parents very strict, parental conflict)?

  • Have they experienced loss or bereavement?

THINK ABOUT YOURSELF

Everyone knows what it feels like to be angry or to experience someone else’s anger. These experiences will colour our own responses to a child or adolescent who is angry (e.g. if we have experienced anger turning to violence, we may respond fearfully or defensively).

Being aware of our own attitudes to anger is very important in responding helpfully, so that we do not make negative assumptions and make the situation worse.

CAUSES OF AGGRESSION

  • Aggressive responses can be learned by modelling. 

  • Aggressive responses are primitive, and are often used in the absence of alternative strategies.

  • Aggressive behaviours are often an expression of feelings that are difficult to express in other ways.

  • Aggression is quite a stable characteristic; once it becomes an established pattern of coping, it doesn’t often subside with time.

Anxiety is a feeling of fear or panic. Feeling anxious is a normal emotion. Most young people worry about something (e.g. friendships or school work) but, once the difficult situation is over, we usually feel better.

Anxiety can become a problem if these feelings don’t go away or if it stops you from doing the things you would normally do.

Things to think about

It may be helpful to talk to someone you like and trust, such as a teacher, relative, counsellor or a friend. You could also see your GP or School Nurse who may offer to refer you/your child to a service that can help you, such as CAMHS

Many young people experience anxiety at some point in their lives, so it’s quite common. Help may be needed if the anxiety is starting to affect daily life, for example:

  • Worrying a lot.

  • Having problems sleeping.

  • Feeling tired more often.

  • Having difficulty concentrating.

  • Feeling irritable.

  • Avoiding things you used to like to do.

Useful Websites and Apps:

·         Young Minds gives free, relevant, practical information about a range of mental health issues in children and young people. It has information about feelings and symptoms, conditions and looking after yourself. See https://youngminds.org.uk/find-help/conditions/anxiety/

Apps (These may not be free to access and may have in-app purchases):

  • Headspace

  • Calm

  • Worry Tree

  • Think Ninja –Mental Health App for 10-18 year olds

  • Chill Panda

Children and Young people with ASD can be more at risk of being bullied compared to their peers due to the following reasons:

  • Young people with ASD are more likely to provide a significant reaction to bullying (can be immediate or after excessive targeting). This can be reinforcement and entertainment for bullies.

  • Some are easily manipulated by their peers and may not even be aware they are being bullied e.g. by being asked to say inappropriate statements by others.

  • Some young people with ASD can tolerate higher levels of ill-treatment from others in exchange for perceived friendship or inclusion in groups.

  • Some young people with ASD may not have the social skills and support networks to counter bullies, thus becoming targets.

  • They may be unaware of the need to ask for assistance; they may think teachers know about all incidents (without them being told) and are thus choosing not to intervene.

You can access further information and support from Bullying UK.

 

Self-harm is when somebody deliberately damages or injures their body. It's usually a way of coping with or expressing difficult feelings, rather than being about wanting to die. However self-harm can result in accidental death. Self-harm behaviours include:

  • Self-cutting

  • Taking an overdose

  • Hitting or bruising

  • Burning

  • Hanging

  • Suffocation

If you have an immediate concern about a child or young person presenting with self-harming behaviour please contact our Urgent Care Team.

REASONS FOR SELF HARM

  • To manage emotional upset.

  • To reduce tension.

  • To distract from emotional pain.

  • A form of escape.

  • An effort to regain control over feelings or problems.

  • To elicit care from others.

  • To identify with a peer group.

  • Self-harm can also be a suicide attempt.

WHAT MAKES A YOUNG PERSON VULNERABLE TO SELF-HARM?

Individual factors: depression, low self-esteem, difficulties with problem solving, impulsivity, drug or alcohol use, bullying.

Family factors: mental health difficulties in the family, parental relationships issues, drug alcohol misuse, a family history of self-harm, abuse, neglect, conflict between young people and carers.

WHEN TO SEEK HELP

This is best done through a GP who may decide to refer you to CAMHS where an assessment would be done and a plan made for support and treatment. If your child goes to hospital for reasons related to self-harm, they should be seen by someone who will talk to them and make a thorough assessment of their mental wellbeing.

The term ‘bereavement’ refers to the whole process of grief and mourning and is associated with a deep sense of loss and sadness. All children will grieve when a person they love dies, although they vary tremendously in how they react. They are more resilient than adults in the face of bereavement, and in general they seem to be less affected in the long term by death than by parental separation. 

A child’s level of resilience depends on a number of factors; including temperament, self-esteem, ability to form new relationships, and having a confiding relationship with a surviving adult. Parent’s reactions to loss will have a major impact on how children cope, and other family members may need reassurance that apparent indifference often occurs, and that grief may resolve more quickly in children than in adults. 

The majority of children who are bereaved will not require specialist mental health services.

THINGS TO THINK ABOUT

All of the many different emotions that children have during bereavement are completely natural and normal. Some of the reactions can be unexpected or surprising and may seem inappropriate to adults (e.g. they may be deeply distressed one minute, then ask if they can go out to play) but this is normal and doesn’t mean that the child doesn’t care or isn’t grieving. 

Adults often try to protect children from things they think will upset or distress them. However, children need to be given information and to be included. They can feel more anxious or lonely if they don’t know what is happening. Bereaved children may have difficulties with other children who may ask difficult questions, or may avoid them because they don’t know what to say or they are worried about getting upset themselves. 

Consider accompanying losses – a house move, for example, may initially have more impact than the death. Remember that children’s needs change over time, they may need to go over the details of the death again at a later stage. 

THINK ABOUT YOURSELF

Talking to a child about the death of someone close may be among the hardest things you have done or will do. It can be exhausting and bewildering and it may also bring back memories of your own. Recognise that conversations may feel uncomfortable or awkward, but try to put these feelings aside and discuss things openly and freely, this will reassure children that these issues are OK to talk about. 

Do what you can to support the child, but don’t expect too much of yourself and talk to someone if you need support. 

We all feel low or down at times, but if your negative emotions last a long time or feel very severe, you may have depression. Depression is a mood disorder where you feel very down all the time. Depression can happen as a reaction to something (like abuse, bullying or family breakdown) but it can also run in families.

Depression often develops alongside anxiety. It's not the same as 'manic depression', which is another term for Bipolar Disorder.

Depression is one of the most common types of mental illness. Although it's hard to feel optimistic when you're depressed, there is lots of support available to help you feel better.

WHEN DO I NEED TO GET HELP?

Take the first step – depression can affect anyone, and you deserve help to feel better. Talk to someone you like and trust, like a teacher, relative, counsellor or friend. You should also see your GP. They may offer to refer you to CAMHS, another expert or a psychiatrist who can help you. 

HOW CAN CAMHS HELP ME?

Depression can be treated with medication, therapy or a combination of both. You may be offered Cognitive Behaviour Therapy (CBT) to help you manage your thoughts and feelings. 

HOW CAN I HELP MYSELF?

  • Let someone know how you are feeling.
  • Exercise can help relieve symptoms.
  • See the bottom of this page for some other resources you might want to look at for advice and support.

 

In trying to understand why a child may not be eating enough, ask yourself the following: 

  • Have they recently experienced bereavement or divorce? 
  • Have they experienced any trauma? 
  • Have they been bullied; called 'fat' or other things? 
  • Do they come from a family where there is an unusual emphasis on eating? 
  • Do they come from a home where there is poor role modelling? 
  • Are the changed eating behaviours happening is certain situations? 
  • What, if any, appear to be the adverse effects of their eating behaviour on the people around them?
  • What, if any, appear to be the benefits (to them) of their behaviour in terms of the effect on others?

THINK ABOUT YOURSELF

Attempting to respond helpfully to a child or adolescent who is not eating can evoke very strong feelings in the helper; from feelings of helplessness to intense frustration.

On the other hand, successful attempts in situations where others appear to be failing can make the helper feel very important or even indispensable. Such feelings can make a helper feel good about themselves but may result in them becoming over-involved. There is such a thing as being too well ‘tuned in’ to what a child or young person is experiencing in relation to their attitude to eating. When this happens there is a danger that the helper loses their ability to stand back and make good decisions which are in the best interests of the child.

WHAT NOT TO DO:

  • Don’t react angrily to a child/adolescent who won’t eat. 
  • Don’t punish a child/adolescent for not eating. 
  • Don’t act in such a way that suggests that you are anxious or panicky – remain calm. 
  • Don’t try to force them to eat.
  • Don’t get into conversation about how "fat" or "thin" people are, or about whether this is a "good" or "bad" thing.
  • Don’t talk about your own difficulties with eating or drinking. 

Self esteem is a way a person feels about themselves. A person with low self esteem generally feels worthless and that they have little to contribute. The development of feelings of self esteem start very early in life. Praise and encouragement from parents or important people in the early years boosts the positive feelings children have about themselves and encourages them to go on achieving. Achievement itself is not enough – love, praise and encouragement are essential elements in helping children develop positive self esteem. All children go through periods of low self esteem, which includes lacking in confidence. This is mainly due to a lack of affirming, positive feed-back from others.

THINGS TO THINK ABOUT

  • What the child has recently been through (e.g. low school grades, being bullied, a family crisis such as parental split).

  • When the child seems more confident, or less confident and what factors are affecting this (e.g. are they more, or less confident with certain people).

  • How you and other workers are relating to the child and how this may affect their feelings of self esteem.

THINK ABOUT YOURSELF

Your own feelings will have a direct influence on the way you approach the child. It’s important to be aware that your own experiences can colour your views and dictate your actions. It’s important that your actions are taken as a direct result of attempting to help the child not as a means of managing your own emotions. Be aware that if you have feelings of negative self-worth, it is possible the child will mirror you. 

CHILDREN WITH LOW SELF ESTEEM

  • Tend to avoid new and different situations. 

  • Tend to put themselves down – “I’m stupid” or “I won’t be able to do that” (before they’ve tried).

  • Are generally unable to deal well with failure. 

  • Feel their efforts are never quite as good as others.

  • Tend to compare themselves to peers in a negative way. 

Most of us have little rituals that we perform that make us feel more comfortable or to help remember things; for example, we may check windows are shut or close doors before bed. Whilst these rituals comfort and reassure us, sometimes they can become intrusive, annoying or even disturbing if the compulsion to carry out a ritual is so strong that we can’t settle until we have completed it in a certain way. This is when we might call our habits or rituals obsessions or compulsions. 

Repetitive intrusive thoughts or impulses are often referred to as obsessions. Compulsions usually refer to actions/behaviours that a person feels they are driven to perform by their obsessive thoughts. Obsessive thoughts and compulsive rituals can be distressing to children and adolescents if they start to take over their normal lives. They tend to be more common in children when another family member has a similar problem and they are more likely to experience these difficulties when they are under stress or during significant life changes. 

HOW TO RECOGNISE WHEN SOMEONE MIGHT BE STRUGGLING:

  • Are they taking much longer to complete normal tasks, such as getting dressed? 

  • Are they taking longer to complete work at school?

  • Are they anxious about putting things in a certain order? 

  • Do they show or describe an excessive fear of dirt and germs? 

  • Do they appear to be continually repeating particular behaviours, like touching things such as light switches or door handles? 

  • Do they become very upset by disorder and mess? 

  • Do they complain of thinking about certain things like words or numbers all the time? 

  • Are they showing excessive concern about order and symmetry? 

Most of us have little rituals that we perform that make us feel more comfortable or to help remember things; for example, we may check windows are shut or close doors before bed. Whilst these rituals comfort and reassure us, sometimes they can become intrusive, annoying or even disturbing if the compulsion to carry out a ritual is so strong that we can’t settle until we have completed it in a certain way. This is when we might call our habits or rituals obsessions or compulsions. 

Repetitive intrusive thoughts or impulses are often referred to as obsessions. Compulsions usually refer to actions/behaviours that a person feels they are driven to perform by their obsessive thoughts. Obsessive thoughts and compulsive rituals can be distressing to children and adolescents if they start to take over their normal lives. They tend to be more common in children when another family member has a similar problem and they are more likely to experience these difficulties when they are under stress or during significant life changes. 

HOW TO RECOGNISE WHEN SOMEONE MIGHT BE STRUGGLING:

  • Are they taking much longer to complete normal tasks, such as getting dressed? 

  • Are they taking longer to complete work at school?

  • Are they anxious about putting things in a certain order? 

  • Do they show or describe an excessive fear of dirt and germs? 

  • Do they appear to be continually repeating particular behaviours, like touching things such as light switches or door handles? 

  • Do they become very upset by disorder and mess? 

  • Do they complain of thinking about certain things like words or numbers all the time? 

  • Are they showing excessive concern about order and symmetry? 

Most of us can think about certain things that make us anxious. Many of these are understandable. Most of us can also think of one less rational thing that makes us anxious.

Phobias are similar to these irrational fears we all possess, the difference being that a phobia makes the sufferer feel extreme anxiety, even terror, at the thought of coming in contact with their feared thing or situation. The stronger the feeling of anxiety, the more likely we are to avoid the thing or situation.

Young children tend to learn to feel anxious from parents or significant others. Adolescents can develop fears and anxieties from their own thinking. One of the most common is social anxiety/phobia. When these fears and anxieties get out of control and the child/adolescent’s avoidance behaviours start to seriously interrupt their enjoyment of life, or their normal activities, this can be termed 'phobia' and usually requires some intervention.

THINGS TO THINK ABOUT

  • Has the phobia been learned or picked up from another person? It is important to consider whether a family member is helping maintain a phobia by their own fear, or by their fear of the child's anxiety or discomfort.

  • Has the child/adolescent had a direct experience that has scared them? This type of phobia can also develop because they have witnessed or heard something.

  • Is the child/adolescent stressed and experiencing anxiety symptoms? (e.g. from exams, parental separation). They may incorrectly connect feelings of anxiety with an object or situation that they are in. 

  • Is embarrassment or fear of getting into a panic increasing their avoidance behaviour? 

  • How much is the fear interfering with their normal daily life?

THINK ABOUT YOURSELF

Remember that a phobia is an irrational fear and is very personal to the sufferer. Try and avoid your own personal experience of fear influencing how you react to the child/adolescent.

If you have experienced a phobia yourself, this can be useful in helping them, however, your own embarrassment or frustration with yourself about your fears can make you annoyed with their lack of courage, motivation or progress. A child/adolescent can pick up on your feelings which can get in the way of your interventions being helpful. 

Psychosis can be a symptom of serious mental illness like Bipolar Disorder or Schizophrenia. It can also be related to stress, depression or drugs and alcohol. In a psychotic episode, a person loses touch with reality as other people see it. They might hear voices, see or feel things that aren't there, feel paranoid or believe things that don't rationally make sense.

Although it can be scary, psychosis is treatable. Some people have one episode of psychosis and never have another one, while others might need ongoing treatment. Other people might notice some symptoms before you do, because psychosis can make you feel like things are normal when they're not. 

WHAT ARE SOME OF THE SYMPTOMS?

  • Hallucinations; where you see, feel, smell or hear things that aren't there.
  • Delusions; where you 'just know' things that seem unreal to other people.
  • Feeling that you're being followed or your life is in danger.
  • Muddled thinking and difficulty concentrating.
  • A feeling that you're being controlled by something outside yourself.
  • Feeling like time speeds up or slows down.

Just because you experience one or more of these symptoms, it doesn’t mean you’re definitely affected by psychosis. It’s important to talk to your GP to get a full diagnosis.

Getting help

TAKE THE FIRST STEP

Talk to someone straight away and ask for help. Choose someone you like and trust, like a teacher, relative, counsellor or friend. You should also see your GP. They may offer to refer you to CAMHS, another expert, or a psychiatrist who can help.

HOW CAN CAMHS HELP ME?

Psychosis is usually treated using medications called anti-psychotics or neuroleptics. You may also be offered Cognitive Behaviour Therapy (CBT) or counselling to help you get over the experience of psychosis. If you have been diagnosed with Schizophrenia or Bipolar, your treatment will depend on your needs.

HOW CAN I HELP MYSELF?

Talk to someone you trust like a parent, teacher, relative or friend.

Reactions to a traumatic experience can differ greatly from person to person. It is important to understand that just because a child/adolescent has experienced a traumatic event, this does not mean that they will inevitably suffer severe emotional consequences as a result.

Factors that influence how much children react to a traumatic event include; the age of the child and their ability to understand the event, the nature of the event, how quickly they can return to a normal lifestyle, their support network and the people around them.

Experiencing or witnessing a traumatic event can make a child think that the world around them is no longer a safe and predictable place; this can be very frightening. Specific reactions can differ greatly but often seem to consist of a contradictory cycle of trying to avoid reminders, but at the same time re-experiencing the event in many ways over and over (nightmares, re-enacting).

Young children may regress to an earlier developmental stage. School children may become moody, blame themselves, become angry and aggressive, or with-drawn. Adolescents may also become angry and upset, withdraw from friends and social activities. Their sleep and eating patterns may also change. 

Coping with trauma is a complex challenge, and reactions to an event can therefore be very different and unpredictable. 

SIGNS OF POST-TRAUMATIC STRESS DISORDER (PTSD)

Exposure to a traumatic event can be followed by signs of PTSD:

  • Re-experiencing ‘flashbacks’ of the event; like watching an action-replay, which is distressing and frightening. 
  • Non-specific effects such as withdrawal or regression. 
  • Increased arousal (e.g. night terrors, being easily startled). 
  • New fears (e.g. of the dark, or separation).
  • Symptoms present for at least 1 month. 

THINGS TO THINK ABOUT

Many children and adolescents will experience or witness a potentially traumatic event at some point. This does not automatically mean that they will suffer serious emotional consequences. However, it is not unnatural to feel afraid and stressed after a traumatic event, and often these reactions don’t last very long. 

"Truancy" refers to young people who avoid attending school without their carer’s knowledge, whereas "school refusal" is when a child or young person starts to miss school frequently because of vague illnesses or symptoms. 

Many children will experience transitory difficulties attending school. Difficulties with peer relationships and issues with learning are often triggers for young people not wanting to attend school or finding ways to avoid it. Good communication between home and school is extremely important. This will enable information to be shared regarding issues that may be impacting on the young person both in and out of school. Schools and families can use resources open to them such as school counsellors, pastoral support, behavioural services, education psychologists and multi-agency teams to support young people to access school and reduce distress .

If this does not effect change or the young person is showing increased distress, either your GP, school or the MAT can refer to CAMHS.

School refusal can present for two main reasons: 

  • Firstly, that the child or young person has a phobic reaction either to the general school situation or to a particular situation or thing within the school. 

  • Secondly, where the child or young person displays a fear of attending school but the main source of the worry is leaving home or separating from family. 

Although, on the surface, the two appear distinct, a single cause of the young person’s anxieties can be difficult to establish.

SCHOOL REFUSAL SYMPTOMS

  • The symptoms the young person complains about are similar to those associated with worry (e.g. stomach aches, diarrhoea, nausea, headaches, fatigue, dizziness, vague and general aches and pains, etc). 

  • The child/young person shows extreme determination not to attend school, for example reluctance to get dressed, to leave the house or enter the school premises. 

  • The child/young person appears to be anxious or agitated on the mornings of school attendance. 

  • The child/young person may have difficulties settling to sleep on school nights. 

  • The symptoms appear to settle fairly quickly after getting into school. 

  • These symptoms are worse the night before starting a new school week, after school holidays, and are less obvious during weekends and holidays. 

  • A child/young person who has a genuine fear of attending school often wants to be on their own at home or outside of school.

THINK ABOUT YOURSELF

If you have displayed school refusal or separation anxiety yourself, it is important to separate your own feelings and experiences from those of the young person you are trying to help. While it can be useful to empathise with the strength of feelings that the young person may be having, your own experiences can sometimes inhibit you from helping them to the best of your ability.

Being aware of the need to be firm and encouraging in spite of your own feelings is important. If you realise that you may be over-identifying with the child’s problem or family’s dilemma, you may not be the right person to offer the most effective help and encouragement.

THINGS TO THINK ABOUT

In trying to understand why a child or young person may be displaying school refusal or truancy, ask yourself the following: 

Could this be a specific fear or anxiety around a particular subject or activity that they feel they are failing in or likely to become embarrassed by, for example reading, maths, physical education? This is probably the easiest cause to tackle, but more often than not there are other anxieties involved.

If it is an adolescent, are they worried about not keeping up with their peers? Or are they worried about teasing, embarrassment or lack of confidence?

Do they appear to be scared to leave their home or worried about separating from their family? In this situation, the parents are often very caring and protective of the young person. It is important to consider the attitudes of parents towards their non-attendance, for example; are the parents unable to be firm, are they anxious themselves, or are they accepting the young person's excuses too readily?

SIGNIFICANT LIFE CHANGES/STRESSORS

Consider whether there have been any significant life changes/stresses affecting the child/young person: 

  • Has there been significant loss or bereavement such as parental separation, the death of a close family member or friend, a change of school or move of  house? 

  • Are they struggling academically in one or more of their subjects? 

  • Are they confident and socially integrated with strong friendships and alliances? 

  • Are they different from the majority of other young people (for example; from a different ethnic or religious group)? 

  • Do they have an obvious or hidden disability? 

  • Are they suffering from a physical illness? 

  • Could they be a victim of bullying, teasing or another form of abuse? 

It is important to bear in mind that some physical illnesses can present vague and intermittent symptoms; therefore it is important to ensure that the child has a medical examination if there is any doubt about what is causing their symptoms.