Melanie Cole (Host): Welcome to Bryan Health Podcast. I'm Melanie Cole and joining me is Dr. Matt Wittry. He's a child and adolescent psychiatrist with Bryan Health, and he's here to highlight adolescent mental health for us today. Dr. Wittry, it's a pleasure to have you with us. This is a really important topic, and it's a big one, and a lot of parents are struggling right now. We feel like we're going through the same thing. We're worried about our children and how much anxiety that they're under that we didn't feel that we were under back in the day. Tell us about some of the types of disorders that kids have and what you're seeing happening in your clinic and around the country. Tell us a little bit about the crisis that we're seeing with mental health in our adolescence.

Dr. Matt Wittry: Thanks for having me today, Melanie. I certainly would agree with you that there is a mental health crisis, especially for adolescents in the world we live in today. And I'm very appreciative to be here as a result. I think that the current state of mental health in our nation was maybe brought to the forefront even more so with the recent results of the CDC study where they reported on the accumulation of data of over a 10-year period from 2011 to 2021. And to somebody that is in mental health like myself, it wasn't necessarily a surprise, but it indicated this progressive worsening of multiple factors related to mental health and children and adolescence.

Host: It's really scary to watch what they're going through. I'd like you to speak to some of the factors as to why we're seeing that it's increasingly getting worse because we know that it is and what are the impacts of news, media, social media on kids' wellbeing, how they're processing the issues that they're seeing. Because, doctor, I don't know about you and your age, but when I was younger, we were not so worldly. We didn't know what was going on all over the globe. We didn't have all of these things coming at us all the time. We were a little bit blissfully ignorant. But these kids today, they know minute by minute what's going on. Is that one of the reasons that this is getting worse?

Dr. Matt Wittry: I certainly think that's a factor. I think this is such a complex and far-reaching issue. We know that depression and anxiety rates are higher than ever and trending in the wrong or concerning direction. And I think social media is a huge factor. I think recently with COVID-19 that decreased connectedness in a lot of ways. There are increased stressors on the family system and that's changed things at home and it's changed how we can access community resources. And, as more and more individuals have unfortunately experienced symptoms of depression and anxiety and other psychiatric disorders, access to care has also changed considerably.

Host: Well, that is for sure. When we're thinking about all of this, I'd like you to give us some tips for parents and caregivers as we're recognizing these potential mental health issues. What are we looking for, doctor?

Dr. Matt Wittry: It's a good question and it's a hard one. Because presentation can vary so much from individual to individual and even day to day. And some of that is due to what could be considered "normal development." But yes, as we had just talked about, given all the factors that are potentially contributing to mental illness, it's understandable and recommended to some degree for parents to be concerned. I think the best advice I can give to parents generally is that knowing your child well allows you to discern what's normal and when things begin to appear abnormal. Because the course of symptoms and symptom onset and progression can be very unique to the individual. But if we can have a good idea of what baseline is, that allows us a comparative perspective to then assess what's abnormal and what's potentially concerning.

Host: So, assuming that we communicate with our children, which is just so important to, as you say, get that baseline, to know them, to know their habits and their ups and downs and their mood swings. As we recognize all of it and we know their patterns, when do we seek outside help?

Dr. Matt Wittry: Yes. I think from both a symptom and behavioral standpoint, it's important to gauge where our kids are at. Symptoms can be anything from how a kiddo might verbalize how they're feeling or what we see from a general level of function. If grades decline, eating habits change, sleep habits change, there are more oppositional behaviors or concerns for substance use, changes in friend groups, changes in level of isolation or withdrawal tendencies, I think those are important things to consider and be aware of.

When it comes to what to do next or when to seek help, I would tell parents to, again, go back to what they know about their kids, what they know about their kids likely better than anybody else does. Rely on what they see and rely on what other individuals around them are potentially reporting to them. And certainly attempt to show support and solidarity for their kids all the time, to never attempt to come across as punitive without knowing the reason behind the behavior or attempt to be questioning or to suggest that it's a personality flaw or character trait issue, but to be supportive to continue to have those open lines of communication. And then, talking with the youth about what next steps might look like so that they have a good idea as far as the potential options for treatment. And so, that they're comfortable with pursuing next steps, whether that's an evaluation in the emergency department if symptoms are so severe that there's an imminent or urgent concern for safety or if that looks like following up by scheduling an appointment with outpatient providers to glean further individual treatment recommendations.

Host: So, I'd like to talk about treatment, Dr. Wittry. But before we do, as we're getting to know our children and seeing these patterns, what are some things that we can try at home to help support positive mental health in our teens? Tell us some things that parents can try to help kids manage their anxiety, which may not need professional treatment yet at that point, whether their home, self-care, tips, exercise, yoga, meditation, what can we do for our kids? And we do know, while you're telling us this, that sleep is going to be one of those very important things. Because our teens, you know, they could be on their phones all night and doing homework and all that stuff, so they're really not even getting the sleep that they need.

Dr. Matt Wittry: Right. You got it. I think that lifestyle strategies or lifestyle practices are incredibly important in development and general health. In my mind, there's not a separation between physical health and mental health. They're certainly co-occurring. And good physical health promotes good mental health and vice versa. So, yes, sleep is incredibly important and that can be affected by blue wavelength light when kids are on screens, for example. So, encouraging good sleep hygiene, encouraging healthy, well-balanced meals and overall nutrition, attempting to connect kids with areas of interest, whether that be 4-H or sports or music or theater, attempting to really help promote that.

I think again, that communication piece is huge. Sometimes we as parents want to fix things. I certainly fall into that all too often and sometimes when kids communicate, it's not a matter of parents fixing, it's a matter of, again, listening and showing empathy. I think there's other things that can be done about attempting to ask a lot of questions and challenging not by saying, "Well, this is my experience” or this is how you "should" think about something. Ask leading questions to potentially softly challenge an opinion or perspective that can be modified, to encourage an accurate pattern of thoughts as opposed to maybe a shortsighted or pessimistic viewpoint.

Host: That's good advice and keeping open those communications. I also like to use gratitude when I feel like my kids are doing a woe-is-me kind of thing. You know, gratitude, what we have, being thankful, some of those kinds of things can help as well. And I'm an exercise physiologist, doctor, so I'm always like, "Okay. You know, let's take a walk or do some exercise" or something like that. But now, tell us about treatments, cognitive behavioral therapy, inpatient versus outpatient. What are all of these different therapies that are available now through professionals, tell us about what those look like.

Dr. Matt Wittry: I think that's the exciting piece. Yes, it can be something as seemingly simple as you said, going for a walk or a breathing strategy all the way to newly approved psychotropic medications to numerous evidence-based therapy modalities to different settings with regard to how that treatment is delivered. Again, I think that it's important to take what we know about our kids to match that up with treatment that there might be interest in or that might be initially comfortable. I think that's certainly an important thing to consider when we can. And then, to also utilize professionals and appropriate access or knowing when to access appropriate evaluations or levels of care to best match our kids with what's needed in that moment of time. Again, if a child is suggesting that there are suicidal thoughts or serious thoughts of self-harm with plan, it's really important to intervene to attempt to ensure safety. If things aren't as imminent or urgent, then recommendations can be sought on an outpatient basis either through primary care, utilizing established medical relationships for referral suggestions or attempting to schedule an initial evaluation or diagnostic interview with a therapist or psychiatry provider for example.

Host: There's a lot to think about. And it does help our kids when we do need to seek a professional. It really does help for them to talk to someone sometimes that isn't their parents. And we could do another podcast on the medications and what those are like and what parents can expect and how to talk to their teenagers. But for this one, as we get ready to wrap up, I'd like your best advice, Dr. Wittry. What do you tell adolescents and their families every single day during these times, the stress and anxiety that we're all under and managing that the best we can?

Dr. Matt Wittry: I think I would tell teens and families the most important thing is to lean on each other and to establish the aspects of a relationship that are foundational. Two of which are trust and communication and, in difficult times, to use those foundational strengths. I would also tell parents and families that there are a number of individuals that are experiencing some of the same difficulties and symptoms. And that's certainly not to minimize what anybody is going through, but potentially maybe there can be some solace in that, in knowing that there are treatments and resources that are readily available and that they can be utilized to result in marked improvement in symptoms and behaviors, to get back to or find a new level of enjoyment, fulfillment and contentment moving forward.

Host: Thank you so much, doctor, for joining us today. It's been informative and it really is such an important topic that all parents need to hear. And I'd also like to thank our Bryan Foundation partner, Inpatient Physician Associates. To listen to more podcasts from our experts you can always visit bryanhealth.org/podcasts. That concludes this episode of Bryan Health Podcast. I'm Melanie Cole. Thanks so much for joining us today.