How Do You Know if Your Troubled Teen Needs Psychiatric Treatment?

The teenage years can be challenging for teens and parents alike.

Adolescence is a time of radical transformation in virtually every area of a teenager’s life. Without going into extensive detail in each of these categories, we’ll review the major changes that occur for everyone during the teen years.

Adolescence: Five Big Changes

1. Physical

The presence of new hormones causes teens to transform – physically speaking – from children to adults. They get taller. Some get muscular. Some grow facial hair. The most noticeable thing, however, is sexual maturity. From the outside, girls begin to look like women and boys begin to look like men.

2. Psychological

During adolescence, teens develop a unique and individual sense of self, separate from their parents and family. This new self may closely resemble the child they were, or it may not. Some teens develop a perfectly healthy personality/identity that’s much different than the little kid version of themselves. At the same time, some kids simply become bigger, more mature versions of their little kid selves.

3. Emotional

The hormones mentioned above – combined with nascent sexuality – can make adolescence an emotional rollercoaster. This is complicated by the fact that the prefrontal cortex, which is the part of the brain responsible for impulse control and rational decision-making, develops later than the rest of the body. This is one reason teens can be challenging. They may look like adults and have impulses, emotions, and thoughts like adults. But they lack something critical: the decision-making capabilities bestowed by a fully developed prefrontal cortex.

4. Intellectual

The teenage brain develops the capability to understand and apply advanced, complex, abstract concepts. Granted, some develop these abilities earlier, but adolescence is generally when humans develop the capacity to understand and apply high-level math and science, play sophisticated music, and engage directly with theoretical concepts in literature and life that were beyond them before adolescence.

5. Social

The physical, psychological, emotional, and intellectual changes lead to and influence changes the way teenagers relate with peers, adults, and the rest of the world. Their peer group may change. Their friendships may become more important – to them – than their relationship with their family. Many begin dating and experience their first loves, infatuations, and, unfortunately, their first heartbreaks.

What parents know – what we all know, because we’ve all been there – is that whether they’re obvious or not, change happens. Changes happen. They can be extreme, or they can be subtle.

They can be easy to handle, or they can be challenging and confusing. The most confusing part for parents is identifying what’s healthy and what’s not.

Parents and Troubled Teens

If your teenager is having a rocky, turbulent adolescence, here are several questions we’re sure you ask yourself almost every day:

How do I know if I have a typical moody teen or a legitimately troubled teen?

How do I know if my teen needs enhanced rules and consequences – i.e. behavioral boundaries attached to specific outcomes – or something more?

At what point might my teen need psychiatric treatment?

First, we want to reassure you that almost every parent of every teenager around the world asks themselves similar, if not identical questions. Second, we want to remind you that right now – meaning halfway through 2021 – teens are in a particularly vulnerable position. In addition to the physical, emotional, and social upheaval that often accompanies adolescence, the coronavirus pandemic turned their world – quite literally – upside down.

Data from sources across the U.S. and around the world show that over the past year, teenagers experienced significant increases in the symptoms of a variety of mental health disorders. From anxiety to depression, the disruption of the pandemic and the social isolation caused by virtual school and shelter in place orders had a negative impact on the emotional health of our youth.

To get an idea of what the national data looks like, please read our articles here, here, here, and here.

For the purposes of this article, we’ll focus on a report about teens in California published earlier this year.

Troubled Teens in California: Facts and Figures

Data collected throughout 2019 by researchers for the annual California Health Interview Survey (CHIS) show what the state of teen mental health was like before the pandemic. Combined with the data about teen mental health during the pandemic in the articles we link to above, these numbers are a wake-up call. Parents, teachers, and policymakers across the state should see and understand these statistics.

Though this data is specific to California teens – and illustrates the need for psychiatric treatment for troubled teens in the Los Angeles area – we can safely assume that teens around the U.S. experienced many of the same challenges as Los Angeles teens. Therefore, these numbers are a wake-up call for concerned adults nationwide.

Heres’ the data:

Teen Mental Health in California:  Psychological Distress By Age and Gender

• Serious and Moderate Psychological Distress (age 12-17):
  • 45% of teens said they experienced psychological distress:
    • 29.7% reported serious psychological distress (SPD)
    • 15.7% reported moderate psychological distress (MPD)
  • Older/Younger Adolescents:
    • 35.9% of adolescents age 15-17 reported SPD
    • 22.9% of adolescents age 12-14 reported SPD
  • By Gender (age 12-17):
    • 36.% of females reported SPD
    • 22.4% of males reported SPD
    • 26.4% of gender-nonconforming teens reported SPD
    • 27.7% of gender-conforming teens reported SPD

Those numbers are clear, and don’t need our interpretation. We’ll now offer another set of numbers, specific to the Los Angeles County Unified School District, which focuses on depressive thoughts and suicidal ideation.

Here’s the data:

LAUSD Mental Health Survey Responses, 2018-2019

• Experienced chronic sadness/hopelessness:
  • 30% of 7^th graders
  • 30% of 9^th graders
  • 29% of 12^th graders
• Engaged in suicidal ideation:
  • 15% of 7^th graders
  • 14% of 9^th graders
  • 12% of 12^th graders

Those numbers are also clear: there are thousands of teenagers in Los Angeles at risk of developing depression. There are also more teens who consider suicide – i.e. engage in suicidal ideation – than most parents realize.

NOTE: If you think your teen is in danger of harming themselves, call 911 or take them to a hospital emergency room immediately. Do not ignore or minimize talk of suicide.

Since we’re on the topic of depression, we’ll use that as an example of how to answer the question posed in the title of this article: Are Psychiatric Treatment Centers the Best Option for Your Troubled Teen?

The Difference Between Typical Teen Troubles and Mental Health Disorders

We’ll walk you through the signs and symptoms of depression, the help you distinguish between typical teen moodiness and clinical depression. You can apply the framework of this discussion to other issues your teen faces, such as anxiety, emotional reactivity (anger/tantrums), and alcohol and substance use

The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) refers to depression as major depressive disorder and defines it as “…an overwhelming feeling of sadness, isolation, and despair that last two weeks or longer at a time.”

Symptoms of major depressive order include:

• Consistent feelings of sadness and/or emptiness
• Crying every day, or crying most days
• Feelings hopeless or pessimistic every day, or most days
• Displaying irritability, hostility, or anger every day, or most days
• Persistent feelings of guilt, worthlessness, or helplessness
• Declining interest in favorite hobbies, sports, and activities
• Persistent fatigue
• Withdrawing from social situations
• Impaired communication
• Constant boredom and low energy
• Excessive restlessness and agitation
• Problems with concentration, memory, and/or decision-making
• Drastic changes in sleep – too little or too much
• Drastic changes in eating patterns or habits, including dramatic weight gain/loss
• Suicidal ideation (see note above)
• Suicide attempts (see note above)
• Ailments such as headaches or stomachaches that have no clear physical origin that don’t respond to typical treatment

What we want you to focus on here is the last part of the definition from the DSM-V: “…[symptoms that] last for two weeks or longer at a time.”

That’s the factor that helps you determine whether your troubled teen needs help at a psychiatric treatment center or something less intensive or focused – and you can extrapolate from this discussion about depression to other issues common to teens, such as anxiety, alcohol and substance use, and emotional regulation issues.

How to Analyze Your Teen’s Behavior

Here’s the concept: when considering a teen’s daily actions and moods, you need to have perspective. Troubles that last a day or two and go away are, most often, typical teen troubles. Troubles that last for weeks, however, may be cause for concern.

Teens get caught up in the drama of the moment: you should not.

For instance, a teen who’s dejected and despondent half the week over a romantic breakup that happens on Monday but bounces back and has a great weekend with friends probably does not meet the criteria for clinical depression. However, a teen who experiences a disappointment of any sort and becomes dejected and despondent for weeks on end may, indeed, need professional psychiatric treatment.

The same is true – and you can use the same template – for other types of behavior typical for a troubled teen.

For instance, a teen who shows signs of alcohol or drug use several days a week, for weeks on end, or every day, for weeks on end, may indeed have an addiction problem that meets the clinical criteria for an alcohol or substance use disorder. However, a teen who comes home smelling like alcohol and tobacco once or twice over the course of several months or a year may not have a clinically diagnosable addiction problem.

Don’t misinterpret that: teen alcohol and drug use are not good things.

We do not approve. We are not blasé or casual about teen alcohol and/or drug use/experimentation. And we don’t think you should be, either.

In this example, what we mean is that a teen who experiments with intoxicants once or twice may not need psychiatric treatment at a teen rehab facility, whereas a teen who experiments constantly may, indeed, have an addiction problem that requires psychiatric treatment at a teen rehab facility.

The way to determine whether your troubled teen needs psychiatric treatment is to arrange for a full biological, psychological, and social assessment – known as a biopsychosocial assessment – administered by a mental health professional. That’s true whether your teen’s troubles are emotional, as is the case with a depressive disorder, or behavioral, as is the case with the disordered use of alcohol and/or drugs.

Steps to Take With A Troubled Teen

Let’s back up to the questions we pose in the first section of this article:

How do I know if I have a typical moody teen or a legitimately troubled teen?

How do I know if my teen needs enhanced rules and consequences – i.e. behavioral boundaries attached to specific outcomes – or something more?

At what point might my teen need psychiatric treatment?

The answer to all three of these questions is the same. For a definitive conclusion, we advise you to seek the help and support of mental health professional. You can use the information above to help you narrow things down, but an article like this cannot diagnose your teen, nor can it stand-in for a full biopsychosocial assessment.

If you take your teen for an assessment and the clinician identifies a mental health or psychiatric disorder, such as major depressive disorder (MDD), general anxiety disorder (GAD), and/or alcohol/substance use disorder (AUD/SUD), they’ll most likely recommend one of these four levels of care:

1. Outpatient Treatment

Outpatient treatment is appropriate for teens with symptoms that are not excessively severe or extremely disruptive, but need help working through serious problems. This level of care may occur in an office or a psychiatric treatment center. Teens in outpatient treatment typically see a therapist once or twice a week.

2. Intensive Outpatient Treatment

Intensive outpatient programs (IOP) are appropriate for teens with symptoms that are severe and disruptive, but can still live at home and participate in typical daily activities and keep up with daily responsibilities related to family, work, or school. Teens in IOP programs participate in treatment 3-5 days a week for 2-4 hours per day.

IOP programs typically occur in psychiatric treatment centers, but may also occur in an outpatient, office setting.

3. Partial Hospitalization Treatment

Partial hospitalization programs (PHP) are appropriate for teens with symptoms that are severe and disruptive. Teens who need a PHP program have trouble keeping up with typical daily responsibilities related to school, family, or work. However, these teens are stable enough to live at home. Teens in PHP programs participate in treatment 5 days a week for 5-6 hours per day.

PHP programs typically occur in psychiatric treatment centers.

4. Residential Treatment

Residential treatment programs (RTC) are appropriate for teens with symptoms so severe and disruptive they need 24/7 monitoring by licensed mental health and medical professionals. Teens in RTC programs are unable to participate in day-to-day activities and are not stable enough to live at home. RTC programs typically occur in psychiatric treatment centers. Teens in RTC programs participate in treatment or treatment-related activities 8-10 hours a day, five days a week, with slightly modified – but fully therapeutic – weekend schedules.

RTC programs typically occur in psychiatric treatment centers.

In conclusion, psychiatric treatment centers are the best option for teens who receive a diagnosis for a mental, emotional, or behavioral disorder and experience symptoms that are so severe and disruptive they need more immersive treatment than they can receive in an outpatient setting.

Finding Help: Resources

If you’re seeking treatment for your teen, please navigate to our page How to Find the Best Treatment Programs for Teens and download our helpful handbook, A Parent’s Guide to Mental Health Treatment for Teens.

In addition, the American Academy of Child and Adolescent Psychiatry (AACAP) is an excellent resource for locating licensed and qualified psychiatrists, therapists, and counselors in your area. Both the National Institute of Mental Health (NIMH) and the National Alliance on Mental Illness also provide and high-quality online resources, ready and waiting for you right now.