Thriving Kids: A Parenting Podcast From the Child Mind Institute

 Hello and welcome to the questions and answers edition of the Thriving Kids Podcast from the Child Mind Institute. I'm your host, Dr. Dave Anderson. Last week I spoke to Dr. Lisa Damour about adolescent mental health. Why healthy teen development often feels disruptive at home. How to tell the difference between helpful and unhelpful coping and why strong relationships with caring adults are the single most powerful factor in teen wellbeing.

This week I'll be answering your questions about parenting teens from handling pushback on therapy and setting limits around social media to keeping connection through mood swings, privacy battles, and shifting motivations. Let's get into it.

So for our Thriving Kids Podcast q and a episode, today we're answering questions about teenagers. Our first question for this episode is, my teenager refuses therapy. How do I actually get them to engage? We get this question a lot because commonly when parents say to teens, I'd like you to go to therapy, a teenager sees it as criticism, and we have to acknowledge that the way that teenagers enter therapy is often different than the way that adults enter therapy.

We want it to be closer to the adult model. Lots of adults will say, okay, I really feel like I could use a therapist. Let me look at what my insurance covers. Let me see what kinds of therapists my friends are seeing. I'm gonna go and try to pick somebody who I feel is supportive and can help me with an issue that I'm trying to work on.

For teenagers, we'd love that to be the model. Whenever a parent says to us, Hey, my teenager said I'd really like to get some therapy to help with, you know, the fact that I'm feeling sad or the fact that I'm feeling anxious or something that was really rough that happened to me like, we are overjoyed.

That means that stigma was low enough that the teenager could just ask for help and hopefully we can meet them where they're at. But if a teenager's refusing therapy, the most common thing that we'll say to parents is one of two things. Either if you can get them to my office for a single visit. I will try to engage them in a process called motivational interviewing, or sometimes I will try to coach parents on how they can engage in motivational interviewing themselves.

And the basic breakdown for this is that we try to figure out what the teen's goals are, and even if the teen's goals are things like I want to get my parent off my back and I want my teachers to stop telling me that I'm messing up in school. We can say to a teenager, I agree with you. I want to get your parents off your back.

I want to get your teachers off your back. I want to help you to feel like people aren't annoying you as much, and like you can make space for more of the things that you want to do. And frequently what we're trying to do is say like, look, the goals of therapy are aligned with your goals. We would like to make it easier for you to interact with your parents.

We'd like to make it easier for you to interact with teachers. We'd like to make it so you feel more successful in many of the things that are going on in life. And so if we can get a parent to talk to their teen and say, what do you think would be the goal when the teen can say, this is my goal, and the parent can say, look, I think the therapist is a great person to talk to about this.

They might be able to help you and coach you toward that goal. You know, this really works. Another thing we do hear from teenagers, just a second note on this, is that teens will talk about the stigma. They'll say, I don't wanna go to a therapist 'cause I don't want them to label me or tell me what's wrong with me.

What I'll often say back to parents is in adolescence, you know, therapists function more like coaches than necessarily being interested in being diagnosticians. All we wanna do is figure out what the teen might be having difficulty with across school, uh, you know, family or social settings, and then figure out how we can help give suggestions, guidance, and counsel that helps 'em to get what they would like.

And that's really also a kind of, you know. Common thing that goes alongside treatment in the sense that if a teen is depressed, the frontline treatment is to get them behaviorally activated. And also looking at the thoughts that maintain either their beliefs about themselves or their lack of optimism about the future.

If a teen is anxious. Again, our treatment is about getting them into the world and confronting the situations that make them anxious, and also targeting the thoughts that might be like false alarm bells in their lives. So no matter what, that kind of coaching really is a facet that teens find useful about therapy, and we can kind of market it to them that way.

Our next question is a tough one. I found a vape in my son's room. I can't ignore it, but I don't wanna scare him into hiding more things from me. How do I approach this conversation? When the question of how to prevent substance, alcohol, nicotine, uh, vape use comes up with parents. My most common answer is that there are three messages that come out of the research around substance and substance abuse and drug abuse prevention, um, with teens.

Uh, the first message is we tell teens we don't want them to use, and we also tell them that. In that same line on that first message of not wanting them to use, we do not want them, especially to be using at home. We are gonna do everything we can to prevent them from using drugs or alcohol in the home.

That's the first thing is that we're trying to tell them, look, your brain is still developing. It is not a smart idea for you to use. 'cause lots of teens come back to that first principle and say, but you drink alcohol with dinner, or, I've seen you doing X. And the answer is, you know, it's not like it's necessarily that healthy sometimes when adults are doing this.

Some adults can use alcohol or other things to enhance experiences. Some adults, of course, have difficulty with things and struggle with addiction, but at the end of the day, when your brain is developing, we would like to keep you away from these particular things. That's your first point. Your second point when talking to teens and trying to prevent drug and alcohol abuse is to say to them, if you get into trouble, I wanna make sure you understand that I am a realist.

You may be in situations outside of the home where drugs and alcohol are present, and you might get into trouble. It might be about, you know, you having a drink or you using something and not realizing what its effect was. I want you to know that I'm here if you do get into trouble. That's kind of the second point that we want to emphasize for kids is we want to emphasize that we don't want them to use, but we also are realists.

And if they do use and they get into trouble, we, we wanna be honest about that. Third point is that we want them to reach out to us if they get into trouble, and that the consequence that we might impose is going to be less, uh, if they reach out to us than if we have to find out some other way. And I cannot tell you how many times this has helped to ensure a teen or their friend's safety is this notion that we don't want them to use.

At the same time, we wanna be realistic about the risks and the peer pressures they're gonna face. And we always want them to know that we want them to still reach out to us, even if they've made a mistake, even if they've done something that might result in a consequence for us. So to the parent who asks about the vape in their son's room, you're not ignoring it.

You're going to tell your son that you found that vape. You're gonna tell them it's off limits within your home. And that. You cannot allow them to use, and you think that this is a bad idea for their developing brain, but you're also going to open up the other facets of the conversation that outside your home, you know, they're gonna come in contact with this stuff.

You know, that's part and parcel of the teen experience, and you wanna make sure that A, they're making smart decisions around this and have an open line of communication with you or other supportive adults in their life about how to make smart decisions. And then beyond that, if they make decisions that perhaps put them or their friends in danger, you're here.

Call you and the consequence will always be less. Our next question for this teen Q and a episode is, school motivation is all over the place. One week my daughter talks about college. The next, she says she doesn't care at all. How do I encourage her to think about the future without every talk turning into a lecture inherent in this question is what goes up and down in kind of teens response to their own successes and failures.

It's that. During this stage of development, you're trying lots of new things. You're trying to invest in school, but at the same time, what you're finding is that you might be succeeding or you might be failing, and especially when you're in a stage of development that's characterized by a little bit more emotional volatility, when you succeed, you're like, you know what?

I'm going to college. I'm doing great stuff. I'm probably gonna succeed in this whole field. I'm gonna be a scientist, or I'm gonna be an English lit major, or I'm gonna be amazing as a student of history. And then the next time where you get a kind of a bad grade, that level of emotional volatility in teenager hood and in adolescence says, well, I shouldn't have been caring about this at all.

School's terrible. They're not teaching me anything I can use for life, and I shouldn't even be thinking about higher education. The key for us is we want to cut through the noise and be a centering presence. So instead of reacting to the extremes that a teen can vacillate between, which is very, very common, we wanna kind of stay right in the middle.

So. Teenager says, I can't wait to go to college. You know, that kind of thing. We stay a step behind them and we say, yeah, you know, like I, I really love how you're engaging with school and I'd love to help you in thinking about the steps that might get you to college and put you in the best position to get into the college that you would like to go to.

If the next week they say, you know what? School's terrible. I want to drop out. I wish I didn't have to go to school. School is worthless for life. You know, my common approach with that, with a teen is just to say, wow. I'm just wondering like what might have happened this week that caused you to feel this way?

And you know, sometimes teens will say, well, nothing. You know, I've always known this. At that point I just kind of let it ride and maybe I'll help them to engage in some distracting or coping activities that help them pendulum to swing a little bit back towards center. And that's how I can be a centering force.

I don't need to question their ideas. I don't need to say, well, you don't understand. Schools should matter to you. It's your ticket to x. I just try to suppress that lecture, you know, uh, aspect that comes along with being an adult and wanting to pass on our wisdom to teens and instead honor where they are.

This week, school sucks. And so if they're gonna be in that place, I'm gonna ask them if they wanna talk about it and tell me about why that is. And if they don't wanna talk about it, I'm gonna help 'em ride it out. Because my bet is that they're not gonna stay in this extreme place forever. And as long as I don't get them even more entrenched in that place by somehow invalidating it or telling them it's a terrible idea to have, which is what gets teens, like really feeling like they should dig in their heels, then maybe I can help them to center themselves and come back to the middle on school.

Next question is, privacy is such a battle in our house, phones, bedrooms, journals, doors. My team keeps saying I don't trust them, but I feel like I can't just back off completely. What's fair here? This is one of those questions where it's kind of a, a answer that's dependent on each household and what you feel comfortable with, as well as what your teen's history is.

I commonly will say to parents at the beginning of adolescence that it's really important to explicitly lay out kind of the social contract of adolescence so that you can establish where trust is gonna come from and then. Give the teen the benefit of the doubt in a sense of like being innocent until proven guilty, at least at the outset of adolescence.

And so we'll go through with parents and say, look, talk to your teen about what you expect about their presence online, about their behavior with devices, about what you expect them to be doing on social media and in chats with friends. And if any of those words caused fear to strike into your heart.

Get to know those worlds. Ask your team to help you to get to know those worlds, make that something you explore together. But the idea is that you wanna set up. Those things that are rules in the virtual world, you wanna set up. What causes you to feel a sense of trust about privacy in your own home? If their bedroom door is gonna be closed, if you're gonna give them, you know, the solitude they might desire, you know, we get this kind of classic picture of a teen, you know, in their bedroom listening to music and you know, maybe working on homework and maybe otherwise processing the experiences of Loves Lost.

During adolescence or whatever it might be. But we're saying to them, if I'm gonna give you that space in your room, or if I'm gonna give you some privacy with say someone you're romantically interested in, or if I'm gonna let your friends come over and you guys get together by yourselves, here's what I expect within my house.

Uh, here's what I expect in terms of drugs and alcohol. Here's how I expect you to conduct yourself, you know, in relationships, in accordance with the values of our household. And again, we emphasize. I'm gonna start off by telling you these things and I'm gonna hope that I can trust you to make smart decisions.

If you give me a reason to believe that, you know, you're not necessarily abiding by the kinds of guidelines that we've set out that might lead to consequences or that might lead to temporary periods where I can't give you the same level of privacy you're looking for, whether that's. If a teen violates something on social media or in texts or in their communication, maybe that means they don't have access to their phone or that their phone access is monitored for a time.

But what I'm always going back and forth with parents is that adolescence is a time when we wanna honor the bids for agency. The bids for independence. But if you see your teen violate one of those boundaries that you've set up within your house or online, it's a good idea to then pull boundaries back into place for a limited period of time and be very explicit about how the teen re earns your trust around those things.

Some parents will say, well, what if they have proven themselves time and again to be untrustworthy? Like for example, they're using drugs in the house. Frequently, or they are repeatedly trying to engage in behaviors with their friends that I would consider unsafe. Or, uh, you know, for parents who might give their teen access to vehicles they're behaving unsafely or making unsafe decisions about the car, or they're writing things on chats online that are racist, uh, you know, are incredibly inappropriate or could be screenshot and sent to their school.

Those can be situations where I'd say to parents, you might need a mediator to get that trust back into place. And that might be a time to use a school counselor, a therapist who have access to that, uh, a coach, trusted adults in the community, member of your faith community, somebody who can mediate those conversations and talk about building that trust.

'cause at the end of the day, teens want independence and they will get it one way or the other. It's just a question of whether or not we can be kind of on that journey with them. The next question is anxiety for my kid shows up as avoiding things like not trying out for the team, backing out of hard classes, skipping anything that feels scary.

How do I help them face fears without pushing too hard? This is a question about a, a common concept in psychology called accommodation, and it's that when parents see their kid feeling anxious, it can be really difficult to know how much you can nudge your kid into those anxious situations, especially when you might not know exactly how to coach them through.

And we see these processes, we think of them as vicious. Cycles of accommodation, it's that a parent sees their child's distressed, wants to relieve the distress for their child, and the way that that distress gets relieved is by not making them do the thing that is causing 'em anxiety. But then you see this ever widening withdrawal from the world in the sense that a kid who is anxious for some of the situations listed in this question, like not trying out for the team or backing out of hard classes or skipping anything that feels scary is likely to feel socially anxious.

They're likely to have anxiety about performance or academic performance, whether or not they can demonstrate, you know. Their level of intellect in classes. And so commonly what we'll say to parents is we can give you some tools and you know, there are models of anxiety treatment that are entirely parent mediated in undermining accommodation.

Like Ellie Leibovitz's model up at Yale, uh, called space where. This is a model for anxiety treatment where we never have to meet the child in order to actually treat anxiety. 'cause it's fully focused around parent coaching and helping to undermine cycles of accommodation. But sometimes, especially as kids get older, it might be helpful for the kid to consult with a counselor or a therapist around these types of anxieties.

And the way that we focus on it is we make a list. With a kid of all the things that cause them anxiety and our focus in making this list, and it's called an exposure hierarchy, is that we take the things that are most anxiety provoking. Like for example, you know, going to prom stag might cause social anxiety in almost anyone.

For a kid who has social anxiety, that might be a 10 outta 10 on the anxiety scale or you know, something like, uh, taking an AP class the kid doesn't feel like they're ready for might be a little bit difficult for them or deal a bit difficult for their anxiety. What we wanna focus on is how do we break this down into small steps in a ladder, and we're looking for kind of the middle steps in that ladder.

Helping a kid to say, I'm not just gonna do the things that feel comfortable. I'm gonna work to get a little bit more comfortable, feeling uncomfortable, test myself. Gather some data on this and come back and, you know, work up towards some of these situations that might be most anxiety provoking. So when we talk about skipping things that feel scary, we might say to a kid what feels a little bit less scary than say that situation.

Okay, can we try that this week? So we might get a kid to, for example, and I'll go to like social anxiety examples that I have with patients. Uh. I have patients who say it's really anxiety provoking for me to invite a friend to hang out after school. And I'll say, okay, how about we invite a friend to hang out during a free period at school, or if we have a chance to walk off campus in high school for lunch?

You ask that friend where they're going and ask if you can come with and you guys get Taco Bell together. Or if you're really anxious to even ask a friend, how can we join a club that. Already gets you contact with peers. Then we'll focus on what exposures we can do within that club. But so much of this is trying to find that sweet spot where you're getting a little bit more comfortable, being uncomfortable, challenging yourself, and then realizing it's not as scary, or that you might actually be more successful than you thought.

Our next question, third to last one here on this episode is social media is our biggest fight right now. Every time I try to set limits, it turns into a blowup. Is there any way to have rules around it without constant battles? This is one of the biggest debates that we see across the kind of sphe, uh, at the moment where, you know, we have, uh, messaging for parents around what age is appropriate for kids to get on social media.

We have messaging to parents about the risks of social media, whether it's cyber bullying, or whether it's certain content they might see, or whether it's the time spent that pushes out other developmentally appropriate tasks, or whether it's the phenomenon of bed rot and how that might affect the teenager's involvement in other activities.

There is a lot of stress going to social media. What Dr. Lisa Damour said on our our previous week's podcast here about teens, I think is really important. And for those of you who listened, it was in the last two minutes that Dr. Damour and I talked about this. But the thing is, we wanna map the risks associated with social media, uh, and at the same time understand that what the research shows us is that social media has put one factor in the context of many in, uh, determining teens wellness and mental health.

And frequently we have the conversation only about social media and not about all of those other factors. So what Dr. Timor even said in, in the podcast episode is that the single most important factor in a teen's life is a relationship with a supportive adult that they feel like they can go to, that they can talk with, that they can kind of like talk through struggles with.

That's one of the single most important factors in teen wellness. Beyond that we'll often go through with parents and teens. Is the teen, you know, getting enough sleep, is their kind of, are their screen habits interfering with that? Uh, are they eating regularly? Are they hydrating? Are they moving their body regularly?

Are they getting face-to-face time with peers? Are they getting face-to-face time with family? Are they invested in their schoolwork? Are they completing their homework? Do they have at least one extracurricular activity that they're involved in? And when we start asking those questions and going through that checklist, frequently what we can see is there are factors to optimize about the teen's life and about their wellness.

Time spent on social media may fade a little bit more into the background in that sense. And then what we can come back to is we can say, look, once we've checked off those boxes that are most important for a teen's development, and once we've said, okay, here is the amount of access or time I'm willing to allow my team to have to social media.

Then the next thing is embarking on digital literacy together and saying, how can we. Uh, you know, educate ourselves. Easiest way, by the way, and I know this is a very academic recommendation, is to read the former surgeon General Murthy's advisory on social media that came out a few years ago that really mapped a lot of the research related risks for teens and the things we want them to be aware of.

But a lot of times we'll say to parents, you don't have to know everything. You can be the conduit with your teen to give them information on the things that make you worried about social media. You can be the person who sets boundaries around the time they spend. And then beyond that, we wanna be curious about.

Their world and what it looks like on social media and continue to focus on how to get them to critically think about their consumption of social media. You know, pending those boundaries so that as they grow up and they move out of your household, they can more critically think about their interaction with screens as a whole, because social media's, but one in a number of phenomena that will present themselves over the course of your teen's life.

Our second to last question, my teen is moody all the time. And constantly pushing limits. I know some of that is normal, but how do I know when it's something I should be more worried about? This is a great question for us to be able to map when teens might need help from a therapist or might need some level of mental health care.

It is absolutely true that teens, as they move into that kind of zone of development, will move from something where at an earlier stage of development, they may have been interested in their parents' advice. Interested in their parents' guidance, uh, excited about their parents' interests, taking their cues from a parent, and then all of a sudden they're noticing that they want much more to understand what their peers are interested in, what their peers are giving them as guidance.

And they might be a lot more annoyed at your shtick 'cause they've been hearing it for. 13 years or more. And at this point the messaging is tired. They know what you care about and they're just kind of annoyed to hear you remind them of the tasks they have to do, the household responsibilities they're failing at, or the ways that you deserve to be talked to with more respect as their parent.

All of that is to say. The moodiness is definitely a part of the developmental stage. What we wanna think about with teens and what I often try to center parents around is that survey research shows that even though teens say it's awkward as heck to have tons of conversations during adolescence with their parents.

They desperately care about a few things, that their parents care about them, that their parents are curious about what's going on in their life, and that parents are the first points of contact for some of those most important conversations about sex, consent, safety, sexuality, uh, spirituality, um, you know, any number of things, uh, digital life and, and digital safety, drugs and alcohol.

Teens say it is so awkward, but still. They, they rate parents as being the first source of information they want to hear, uh, about on these kind of tough topics. So what we're commonly thinking about with parents is if your teen is getting more moody, uh, we're gonna focus on the ways that. Parents and teens connect and can maybe spend some time together that isn't about reminding the teen of the to-do list or, uh, reminding them they've gotta do their homework or reminding them of their household responsibilities, but trying to find some we call attachment rituals or things that you as a parent do.

Maybe it's breakfast every Sunday. Maybe it's the fact that you both enjoy watching a certain sport or a certain type of movie. Or maybe it's that you just like quiet walks in the morning to school where both of you get to Dunkin Donuts, iced coffee, whatever it is, you're looking for those rituals. That open up space for them to kind of talk to you about their life and feel like you're there for them, not just for your to-do list as a parent.

Beyond that, when we talk about when to be concerned about your teen, frequently we'll say is they might be moody, but if their mood really shifts. To extremes. You see them getting very, very angry or seeming very sad or withdrawn, or they suddenly lose interest in things that they once loved, where they're sleeping or eating.

Patterns really change or they start saying a lot of negative things about themselves. Those are real key signs that a teen is struggling with their mental health, maybe struggling with depression, maybe struggling with some of the precursors of. Really critical issues like suicidality, and those are the moments to say to a teen, I'm really concerned about you.

I'm really concerned about what's going on. If you can't talk to me, can I connect you with someone who you can talk to about this? Because I just wanna make sure you're safe and I just wanna make sure you're healthy, even if I'm not the person who can help you be that way. Our last question. Friends seem to be their whole world right now, and family feels like an afterthought.

How do I respect that independence but still stay connected? So this question relates to a lot of the other answers in this podcast q and a episode, because it is so representative. Of these tensions that happen during adolescence where you've got a teen who's really pushing toward new experiences and the importance of their peer relationships and trying to define kind of who they are, independent of their family.

You also want them to remember their family. And commonly we also see across development stages that whereas in adolescence, you may see this dip in teens, you know, rating of the importance of their family. That goes back up in later phases of life. So we don't wanna act like there's not an arc of justice that's gonna bend the right direction over time, even if we can't convince adolescents of the value of their family, you know, in this moment.

But what we really focus on with parents is trying to say to teens, look, I wanna support your social life. There's a balance here. In the sense that I still wanna have, you know, a few family meals each week. I still wanna be able to go on vacations as a family together. I still wanna make it so that we have some family activities we do together, or some face-to-face family time that we spend, and I'd like you to be a part of that, even if that means you're being a part of that under gentle protest.

And as we say those things frequently, it kind of comes down to this kind of social contract of adolescence where we're saying, I know you need possibly transportation, or you might need my financial assistance in some way, or you might need my permission to engage in certain aspects of your social life.

I don't wanna necessarily be a huge roadblock on that, but I am gonna set some boundaries. I'm gonna monitor where you are. I'm gonna need to know you know who you're with and that the situation is safe. I might set a curfew and I might also say, look. You know, cross holidays and vacations. I'm gonna expect you to spend a bit of time with a family and then, you know, for that I'm gonna trade off and let you spend, you know, more time with your friends.

One of the last things I'll say about the reasons why it's good to be explicit about the importance of family time is that research shows that when we look at substance and alcohol abuse, uh, having family dinner a few times a week, regardless of the quality of interaction that happens at family dinner is immensely protective for kids.

Drug and alcohol use. The main reason kids know you care about where they are. Kids know you care about your relationship and kids also. You, you know where they are a few nights a week. Like they're just right there in front of you, even if they're again at dinner under protest. But that's where we say to parents, you know, you set that boundary.

Hopefully some of these interactions are more positive or they're less moody, or they involve some enjoyable activities. But at the end of the day, know this, even if your teen is moody, protesting the fact that they're even having dinner with you, that is protective for their overall development and their health.

Thank you so much to our listeners and to our Thriving Kids Podcast community for sending in your questions about teenagers. If you're looking for more strategies, including how to spot warning signs and strengthen your relationship with the teens in your life, you'll find resources linked in our show notes and at our website, child mind.org.

Next week we'll tackle one of the most sensitive topics parents face talking to kids about sex, safety and consent. I'll be joined by Dr. Angela Glymph to walk through how to approach these conversations early and keep them healthy as kids grow. If you have questions for a future q and a episode, reach out on our social pages or email us at podcast@childmind.org.

I'm your host, Dr. Dave Anderson. Thank you for listening to Thriving Kids, and I'll see you next time.