Tuesday, December 08, 2009

Assessing Teenagers

Teenagers. They should be considered their own species (--note, no one asked me).

Perri Klass, M.D. has a nice piece in the New York Times about assessing teens for depression and suicide, "18 and Under--Asking the Hard Questions." It's mental health from the perspective of a pediatrician, and I like that she's thoughtful about the issues.

Here's an excerpt:

And before you get to the S’s, there is the E for emotion, which, Dr. Ginsburg said, should be much more than screening for depression. “If you start by asking boys if they’re depressed or sad, most boys will deny that,” he told me. “If you start by saying, ‘So, are you stressed out?’ — every boy, no matter how big and strong, every girl, no matter how much she wants to portray herself as being in control, will admit to stress.”

Markers for depression may help identify adults at risk for suicide, but they are not a reliable way to screen adolescents. “Only about half of kids who kill themselves are depressed in the way that we think about depression — sad, not taking care of themselves, not sleeping or sleeping too much, not eating or eating too much,” Dr. Ginsburg said. The other half may be impulsive, angry, disappointed, trying to get even.

Dr. Shain said adolescents often changed their ideas and their plans. So an assessment has to go beyond the feelings of the moment to include thoughts they have had, dangerous ways they have behaved and the important questions of intent and ambivalence.

“Sometimes you’ll get an ‘I don’t know’ answer,” he explained, “which might be ominous, might mean they don’t know or might mean they don’t want to tell you.”

If a teenager does acknowledge thinking about suicide, there are many more questions to be asked. Dr. Lydia A. Shrier, director of clinic-based research on adolescent and young-adult medicine at Children’s Hospital Boston, said some young people chronically struggled with these issues.


Anonymous said...

I'm pretty sure it's Perri Klass, and she's female. She's written several books, both fiction and non-fiction, and writes regularly for the NYTimes.

Dinah said...

Thanks, anon!

Tiger said...

hey, thanks, I needed that article for a paper I'm writing. =D How'd you know?

Sarebear said...

I wish someone, anyone, had asked me these questions when I was a teen.

I wish someone had asked me if anyone was hurting me, too. There were no physical bruises, but I was being hit.

Who do you tell that to? You don't just pipe up in class and say that, not when life has taught you that people in authority don't care (I believe I recently referred to a childhood episode of a boy pushing me down in the mud in front of a teacher on the playground in elementary school, and I walked up the short hill to the teacher and, a rarity for me, complained, and she said, "Oh, he's just mad you scored higher on the math test than he did." Which also reinforced that perhaps I shouldn't be doing so well academically, either, as well as perhaps that it was my fault that he pushed me, etc., etc., etc.)

Anyway, examples like that from earlier in life surely didn't leave me with any reason to think that anyone would believe me or treat me with respect if I said, "Hey, my mom's hitting me, and it makes me want to die."

Besides, as I said to my psychologist today, even though we've already discussed the abuse in depth recently, my mind still tries to tell me, hey, you were 13, 14, 15, whatever, that's too old, it doesn't count as "abuse".

His response was kind, supportive, and reinforcing of my sense of self that is speaking up after all of these years about it, and he indicated that although I may have been old enough to have more words than younger victims of abuse, it was still abuse. (Even though that one part of me inside is still trying to say it wasn't lol sort of in a sad way, guess I have more work to do . . . .)

Anyway. If someone had asked me questions, I probably would have looked at them with fear, because I had been taught that no one would believe me or treat me with respect anyway. Maybe the fear would be a clue to you, coming from a teenager, that something was going on? I've often wished that someone could have intervened back then, but that's not the way things worked out.

bearyfaery said...

Just wanted to follow up to sarebear's last paragraph by saying that part of the reason people who work with adolescents do ask those questions (and ask them repeatedly) is to try and instill the sense that there are people who care. It just takes some work sometimes to find them.

The unfortunate thing about child and adolescent care (heck, all psychiatric care), is the number of cases that never come up, that never get seen, because so many people believe that no one cares, that there's no one to tell. It just sometimes takes some work to find them. It's unfortunate, but true.

Anonymous said...

I too wish someone, anyone, had asked me these questions when I was a teen. I became profoundly, deeply, suicidally depressed my junior year in high school. It lasted well into college -- and beyond. No one noticed, no one cared enough to even ask me if something was wrong.

I never received any type of treatment, i.e., therapy and medication until I was much older. I wonder how my life would have been different had I been diagnosed as, and treated for, Bipolar II while in high school or college.

Anonymous said...

On the other hand, I found it insulting as a teen when I got asked about suicidal ideation and intent/plans. What I garnered from it is that most of these adults didn't understand how I operated, how I made decisions, or what my code of ethics was, and weren't interested in finding out. What I heard was that either they were going down a question list for liability purposes / to make themselves feel better or were stereotyping me as an impulsive, illogical teenager. I also, even more than now, did not like to self-disclose in any significant way to people I didn't already know and trust in a particular way, and thus found such questioning intrusive. So, as they say, your mileage may vary. I like this pediatrician's approach of "are you stressed?"