Through most of her routine physical exam, the teenage girl chatted amiably with pediatrician Sunanda Vadapalli, M.D. Then, at the doctor's request, the girl's mother stepped out of the exam room. That was when the patient, with tears in her eyes, admitted the truth: She felt such relentless pressure from her parents that she was living with constant anxiety.
Scenes like this incident have become more common in recent years as pediatricians have seen marked increases in mental health challenges among teenagers—in particular, depression, anxiety and suicidal thoughts.
"We're getting better at identifying kids with these issues," says Vadapalli, one of more than 150 pediatricians in Los Angeles and surrounding communities who make up the Children's Hospital Los Angeles (CHLA) Health Network. "The earlier we do it, the more we can make a difference."
An issue on the rise
No one knows why rates of youth anxiety and depression have risen so sharply. The number of U.S. children hospitalized for considering or attempting suicide doubled between 2008 and 2015, according to a study published in the journal Pediatrics.
Certainly, teenagers are experiencing more academic pressure than ever, and they typically juggle multiple extracurricular activities, leaving little time to decompress. Some blame social media and the omnipresence of smartphones for making adolescents lonelier and more likely to feel anxious about missing out on what others are doing.
Whatever the causes, we simply don't have enough pediatric psychiatrists and psychologists to meet the need. So the CHLA Health Network is working to help pediatricians better serve patients and families coping with mental health challenges.
Partner with parents
Every CHLA Health Network pediatrician screens patients with a questionnaire to help detect signs of depression and anxiety. And a program called Making Behavioral Health Matter is educating pediatricians to triage and treat anxiety, depression and attention deficit hyperactivity disorder (ADHD).
The program also helps pediatricians identify qualified mental health specialists in their local area. And the Network offers a "warmline" pediatricians can call to get expert help with treating mental health issues.
Of course, parents play a central role too. "Parents can help by paying close attention to their kids and maintaining good communication within the family," says Vadapalli.
While it's not unusual for adolescents to appear aloof or moody or to choose time with friends over family, some behavior changes could signal more serious challenges. If a teen loses interest in something that used to bring pleasure—such as a sport or hobby—or if the child spends excessive time alone, has no appetite or simply can't handle situations, it's worth seeking intervention.
There's no foolproof checklist of danger signs, but encourage parents to set up a visit with the pediatrician if they have any concern about their child's mental health. While mental health specialists obviously bring a wealth of experience, many teens are more comfortable sharing with a doctor who's already a familiar face. And a physician who has known the patient and family for many years is often in the best position to assess and treat mental health challenges.
As much as most parents want to help their teens cope with serious issues such as anxiety and depression, many worry about the stigmas that come with these challenges. "Parents need to realize that depression and anxiety are chemical conditions in the brain, a physiological condition, just like diabetes or high blood pressure," says Vadapalli. "Rather than judge their kids, parents should be there to listen and talk."