Scott Webb (Host): Those of us who have teenagers, know that these are challenging years for parents and our teens. These years bring about emotional, physical, and mental changes quickly. And sometimes that means mood swings, emotional outbursts, and other emotional triggers. And I'm joined today by Dr. Chantal Walker. She's a Board Certified Pediatrician with the Franciscan Physician Network. And she's here today to help us to understand our teens, what they're going through, and how we can help them.

This is the Franciscan Health Doc Pod. I'm Scott Webb.

Doctor, it's so nice to have you here today. We're going to talk about how we can help our teens stay mentally healthy. And I was mentioning to you, I have a 16 year old and a son who's 21. So he was a teenager at one time.

And of course I was a teen myself way back when. So a great conversation today. Nice to have you here. Nice to have your expertise. And before we get into the meat of things today, just, overview, if you would, a specialty of pediatric medicine, tell us more about what you do.

Chantal Walker, MD: I am a pediatrician, which means that I take care of kids from the time that they're born until most pediatricians stop at 18. I will continue to see them until they graduate from college. So, I'll have some 21, 22 year olds and sometimes they don't want to leave, but. That's pretty much it.

Host: Yeah, that's kind of the situation with our son right now, being almost 21, is he doesn't really have a, you know, an adult doctor per se, so he still goes to the pediatrician's office when he's home or when he's sick, and I think he's starting to feel like, maybe I should have an adult doctor, maybe, you know.

Chantal Walker, MD: Yeah, it's time to make the transition.

Host: Yeah, it does feel that way for sure. I'm just wondering, do you have any clinical interests that you want to share?

Chantal Walker, MD: Well, I'm very interested in atopic dermatitis or infantile eczema. I'm a big proponent of developmental concerns with kids. Those pretty much are it.

Host: And as I, tease there, we're going to talk about teens and mental health and things that all of us parents, especially those of us with teens, things that we sort of deal with and confront and think about. And I know it's understood that the adolescent years, bring emotional, physical, and mental changes very quickly.

And sometimes that means mood swings, emotional outbursts, and other emotional triggers. Some of these things could be symptoms of something bigger, and maybe you can elaborate on that.

Chantal Walker, MD: Well, absolutely. So, I also have a teenager. I have a 17 year old daughter.

Host: Okay.

Chantal Walker, MD: Uh, so, I can speak from a parent's perspective as well as the medical professional, but the time of adolescence, the teenage years is a time of lots of growth and development. Physically, mentally, so your body has a lot of hormonal changes that are happening at the time.

And with the hormonal changes, there are the mood swings and other things that you observe that you're like, what happened to the sweet little kid I used to know? But the most important thing that we need to remember about this is that they are physically growing. Their brain is continuing to develop. So we just have to nurture those things. So the best thing that we need to do is make sure that they're healthy. So we need to make sure that they're getting adequate sleep. Teenagers need to sleep a little bit more than we do because they are still growing. So while you're thinking, would you just get up while, how can you be tired? They do need a lot of sleep. They should get at least eight to 10 hours of sleep at night. Proper diet, enough exercise. All of those things are important to ensure that they can get through these growth spurts and other developmental changes that their body is going through.

Host: Yeah. That's one of the biggest battles that I face with our daughter is just getting her to go to bed. You know, I'll still hear her creeping around after midnight on a school night. And I just know that's not enough sleep for her. She assures us both, my wife and I, that she's fine. Don't worry about her. But then we see how tired and cranky she is in the morning. And we know that, uh, that more sleep would have been right for her. And I guess I'm wondering, when we think about the symptoms of depression in teens, how is that different or is that different from just occasional sadness?

Chantal Walker, MD: In this day and age, it's very tricky because it's not your typical sadness. Sometimes in teens it's being withdrawn or isolated. They're just not very talkative or you don't see them hanging out with friends or even talking to friends or engaging with other people. They're just, they don't seem sad, but they're just by themselves a lot or, they're withdrawn from other people.

So you have to observe changes in behavior or changes in their routine that, you know, that's just not like them. Any deviation from what you've previously seen can be a sign of depression.

Host: Yeah. And sometimes just like adults, sometimes we have good days and bad days and happy days and sad days. And so, you know, trying to figure out the difference between just sort of a sad day or sadness and actual depression where we might need professionals involved for diagnosis and treatment, of course.

Do we have a, an understanding of the causes of depression and some of the other mental health disorders for teens? Is it just hormones? Is it just being a teenager and being in school and social media and all these other things that they're dealing with?

Chantal Walker, MD: All of these things are contributory. Like I said, at first we want to be preventive and try to promote healthy lifestyle. The next thing you want to do is to try to identify, you know, stressors. And anything can be a stressor. What is their academic performance? How is that at school? Is their academic load too heavy? Is their schedule too stressful? Are they being bullied? Do they have a good support network? Do they have a group of friends? So you need to identify stressors, and then help to make sure that they have adequate means of managing stress. Do they have good coping skills?

When you get to a point where you see that whatever the stressor is or whatever the problem is, is rendering them non functional; where it's causing harm as far as their attendance at school or their performance at school or their hygiene or they're just not functioning properly; that's when we need to seek other forms of management or treatment as far as seeking outside help.

Host: Yeah, I want to talk about isolation, uh, the internet, screen time, and how all of those things, can impact depression and mental health and really impact our teens.

Chantal Walker, MD: Yeah. So, there have been all of these studies and it is absolutely irrefutable that time spent on digital technology directly correlates to the likelihood of developing depression or anxiety. So I really encourage parents to try to limit screen time. And it's not a thing of just saying, okay, put your tablet down or put your phone down.

We need to find other ways to occupy their time. So the kids should always be involved if they can, in extracurricular activities, outdoor activities. The family should spend some time together, you know, playing games, board games, working out, doing other things, so they're not just sitting looking at the computer or looking at their phone. Because social media can send them into that rabbit hole of depression, bullying, anxiety.

Host: So let's try to pick your brain here as an expert. How can we begin the conversation with our teens about depression and mental health and some of the concerns we may have, as you say, sort of paying attention to these stressors and drastic or dramatic changes in them. How do we initiate that conversation?

Chantal Walker, MD: Well, this is the reason why it's so important for kids to have their annual exams with their primary care physician, because a lot of times these things will come up and the parents had no idea. Now the American Academy of Pediatrics is recommending some type of depression screening at each well child exam. This is something that I've kind of always done when the kids come in, when they're small, we're checking their developmental milestones. Once they enter school, I'm asking questions about their school performance and their extracurricular activities. And as they get older, you know, what are their goals? What do they want to do?

A lot of times with the questioning, I'll get answers that will either raise red flags or prompt other questions. If a kid tells me that they don't have interest in anything, they don't know what they want to do, they don't know, they don't have any friends, then of course that's going to make me ask more questions.

And then we can have a conversation with the parents. Now that we're actually using tools for screening, where they actually have to fill out questions, of course, if there are any red flags in those answers, that prompts the conversation with the parents, and a lot of times, as we go over those answers, the parents say, well, I, I had no idea that they felt that way.

Another thing that happens with the exams is that I've had instances where I'm examining the kids and they have to get undressed, of course, for a physical exam, and I'll see that they've had some self harm and the parents didn't know because they don't see the kids you know, undressed after a certain age. It's really important to have the physician as a part of the group or the network that's helping, you know, facilitate these type of things.

Host: Just wondering about homelife. Are there things that we can help them to do, or ways that we can help them to face challenges? You have some suggestions on how we can create a really supportive environment to help them with their mental health. You know, that sort of thing. What can we do at home?

Chantal Walker, MD: So I think the most important thing is to always have open communication. Kids and teens should feel free to come and talk to their parents about whatever is going on. If they know that they can voice, you know, I'm feeling anxious, I'm feeling sad, I'm feeling depressed; that's the first step, if they feel like they can share that with someone.

And from the parents, if the kids say that, they need to have an open mind and hear them out. Don't be dismissive. It's a very different time than when I was a teenager, you were a teenager, or even your 21 year old was a teenager. So the stresses that they're feeling are different than before. So don't dismiss, you know, listen to what they have to say.

And then if you don't have the answers, make sure that you seek out someone else that would have answers. In addition to, communicating, just staying active, staying busy. Don't let them withdraw and be by themselves and just stay in their room all the time or not engage with other people. That was a huge side effect of COVID and that isolation has kind of lingered and we're trying to draw people, kids back out into the world to engage with each other.

Host: Yeah. The open lines of communication for sure. And I find at least with my teenager, that the less I talk, the better, right? When I follow my instincts, which are to try to fix everything and help with everything and you know, respond to everything that she says, I feel like she closes off more and withdraws more.

So, I work really hard. It's not easy being a parent. As we know, it's not easy being a child. It's not easy being a parent. But one of the things that I do, Doctor, is I just try to listen more and not judge and not try to fix everything because I feel like a lot of times she just wants someone to listen to her, and not necessarily fix things. Has been your experience? Yeah.

Chantal Walker, MD: Absolutely, they want to be heard, they want to be validated, and we have to keep in mind the goal is to produce an independent functioning adult. So you want them to try to problem solve on their own and try to think through some of these things on their own. So listening to their thought process and their logic tree without, you know, just saying, well, you should do it this way, is very helpful because they're learning to problem solve on their own, and you can help guide them, but they need to initiate and learn how to do this.

Host: Yeah. It's one of those things where you want them to be kids as long as possible, but the reality is, you know, our daughter has a driver's license and a car and she's like a person in the world now, right? She doesn't need mom and dad for everything. And so, teaching them best practices, safety practices, self care, that type of thing is all really important because they're going to be adults and they're not always going to live with mom and dad, presumably. So wondering how do we do that? How do we teach them better self care?

Chantal Walker, MD: I think modeling first of all, you know, kids imitate what they see. Second, I think that if you do observe something that you don't think is helpful or a best practice, I think you should bring it to their attention and explain why this isn't a good practice, have a conversation about it.

I think kids want to be respected and heard. So if you talk to them in a certain way, they're more receptive to the information.

Host: Yeah, the receptive part is key. And that kind of ties into my next question. So let's assume that we believe that our child needs some medical, or in this case, mental health support, mental assistance, maybe; what do we do if they refuse, right? Do they get to refuse? And what do we do if they refuse?

Chantal Walker, MD: So a lot of times the kids will say, you know, I don't want to talk to anyone. I'm okay. I don't think there's a problem. The parents, I think have to insist that we still, you know, follow through. And once the kids have that initial conversation or the initial therapy session, a lot of times they change their minds and they say, you know what, I feel a lot better.

I do enjoy discussing these things with someone else, an objective person. I didn't realize that this would make me feel better. So sometimes you still have to be the parent and say, even though I know you don't want to do this, I think this is necessary. Push the issue and once you get there, the kids will open up and become a part of the team to help with their mental health.

Host: Yeah, that was our experience with our son when he was in high school. He needed to speak with somebody, someone who could listen more objectively and it was some trial and error, right? So we went to a couple of people. It wasn't a good fit. It didn't feel right. He was thinking that this was maybe not a good thing for him. And then we found the right person and the right fit. And I would want that for every parent trying to help their child to find that right fit. I'm sure you recommend that as well.

Chantal Walker, MD: Oh, your experience is very typical. You don't always get the right person the first time, but that doesn't mean that this isn't worthwhile. You just have to find the person that your child feels most comfortable with, or the person that you think understands your child, the personality of your kid. Because everyone might not look at your kid the right way.

You might need someone who's looking through a different lens. So there, there can be some trial and error, but once you find that person, I personally feel that everyone should have therapy. Everyone should have that person that they can talk to objectively and they can add some stress relief or coping skills in their life.

Host: Yeah. No matter how much we love our friends or spouses, our parents, whomever, our pets, maybe, being able to speak with someone and be heard and feel like you're not being judged and that you can just say whatever's on your mind. I think you're right. I think that would be good and healthy for all of us provided that that's feasible and affordable and all of that.

 Just want to finish up here, talk about some resources for parents. Where can we find resources besides the pediatrician's office, of course? Where can we find the resources, phone numbers, websites, that sort of thing?

Chantal Walker, MD: It's difficult because I don't think that we have enough resources for mental health care for teens or children. But, if you Google pediatric therapy, you will find a few agencies. The agencies just a lot of times have long wait lists, but I'll start with your pediatrician or your primary care provider, they can give you a referral and sometimes get you higher up on that waiting list, especially if there's an urgent matter.

Host: Yeah, start with our providers, some Google searching, of course, if necessary, and I just want to give you a chance here at the very end, maybe you have some examples of how we can help our teens stay mentally healthy. You know, we've talked about some of the strategies and things today and what to listen for and look for, but just finish up here, just as some examples of, you know, things that you know have worked.

Chantal Walker, MD: I am a huge proponent of the extracurricular activities. I find that, you know, kids that are anxious, especially when they have social anxiety, if they become involved with some extracurricular activity that they enjoy, it promotes bonding with the other people in that activity, you know, be it a sport or theater, whatever it is. They feel more comfortable, they feel more confident. So finding something for them to do to engage their time is a great way to keep them healthy. The other thing is if you do see that there's a problem, don't put it off. Right away, you know, go and talk to your primary care provider, seek out the help from a professional so that the problem doesn't become too large or insurmountable.

Host: Yeah, right. We don't want to overreact per se, but we don't want to underreact either. And because things can be so dramatic and traumatic in teens lives and because they're changing so quickly and have trouble processing things, you know, we want to be on the lookout and looking for things, listening for things, communicating with our teens, reacting maybe without overreacting. All good stuff today, Doctor. Thank you so much.

Chantal Walker, MD: Well thank you for having me.

Host: And for more information, visit franciscanhealth.org and search teens and mental health.

 And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.