Daniel Knoepflmacher, MD (Host): Welcome to On the Mind, the official podcast of the Weill Cornell Medicine Department of Psychiatry. I'm your host, Dr. Daniel Knoepflmacher. In each episode, I speak with experts in various aspects of psychiatry, psychotherapy, research, and other important topics on the mind.

As those of you who've listened to On the Mind before may already know, a repeated topic on this podcast has been the growing crisis in youth mental health we're facing in this country. Year upon year, an increasing number of American adolescents are struggling with depression, anxiety, attentional difficulties, suicidality, and other related problems.

This age group endured the social isolation and educational disruption of a global pandemic while also facing the unique developmental challenges that come from a smartphone-driven social media-obsessed culture that didn't exist when their parents were teens. Parenting adolescents has always been difficult, but in the face of so many new challenges, many parents feel lost as they do all they can to support their teenager's mental health.

Today, we're going to offer strategies for navigating the common challenges that emerge when parenting adolescents. I'll be speaking with Dr. Andrea Temkin-Yu, an expert on this topic, who will provide us with useful evidence-based guidance on how parents can support the mental health of their teenagers.

Dr. Temkin Yu is an Assistant Professor of Psychology and Clinical Psychiatry here at Weill Cornell Medicine. In addition to her work as a practicing child and adolescent psychologist, she's the author of a new book called Supporting Your Teen's Mental Health: Science-Based Parenting Strategies for Repairing Relationships and Helping Young People Thrive, published by Oxford University Press. Andrea, thank you so much for joining me today.

Andrea Temkin-Yu, PsyD: Thank you so much for having me. I really love the opportunity to talk about this topic.

Daniel Knoepflmacher, MD: I'm excited to get into it with you. So as always, I want to begin with your story. What led you to become a child and adolescent psychologist and ultimately an expert on parenting?

Andrea Temkin-Yu, PsyD: I always sort of the nurturer in my friend groups. I tended to be the one who people came to, and I liked that role. And I found out it really meaningful. And I sort of knew I had an interest in Psychology. So, I went to college, you know, that is my major. And then, my junior year I became a residential advisor. And I had all of these students on my floor who were so anxious or were depressed or were struggling, and I really didn't know the best way to support them. I felt really sort of paralyzed and I kept thinking, you know, "Who would know what to do? A psychologist. So, it sort of further fueled this interest I had, particularly in Clinical Psychology and particularly with young adults and adolescents.

So, I ended up in a graduate program and had the opportunity to work with Dr. Brian Chu at Rutgers, who's a real expert in Child and Adolescent Psychology. And it was such an amazing fit for me. You get to be so fun and creative and really sort of see these kids flourish with skills that you're teaching them. But what I came to realize and see is that even if kids were making awesome progress in session with me, they weren't always maintaining the gains they'd made if home life wasn't evolving with them. So, I had all these parents dropping their kiddos off at session, feeling really lost about how to support their kids. And we'd bring them in at the end of session, give them five, 10 minutes worth of little information, but it just didn't seem enough to me. So, I sort of became increasingly interested in spending more time with parents and giving them tools. And throughout the rest of my training, I had more and more opportunity to really sort of learn some of these evidence-based, parent-focused strategies, and it just became so immensely rewarding.

Parents love kids like nothing else in the world. And it's so meaningful to be able to sit with them and teach them how can do their best to support their child, to sort of get this double boost of the kid learning to thrive and the joy that parents have watching their kids work their way through these mental health difficulties. So, it's been a really sort of fun journey for me, and I love the parent-focused work these days, a really meaningful part of my life.

Daniel Knoepflmacher, MD: Well, one little part of that journey, which was this is just a bit of it, but I got to work with you when you were finishing your training and we were working in a partial hospitalization program where your focus was on young adults. We had a lot of 18 to 20, early 20s people in the program. And I can resonate with what you said, that kind of meaningful work. Of course, these were people who were struggling at that time and we had a lot of family meetings working with the parents and just seeing how much gain could be made by really thinking holistically So, I want to pivot though to what I talked about a little earlier in the introduction, which was the worsening trends in teen mental health. We see everywhere people using the word crisis to describe what's going on. And I'm curious as somebody who's out there working with kids and teens, how do you see these trends playing out in your clinical work?

Andrea Temkin-Yu, PsyD: Yeah. It's definitely concerning. We're certainly seeing upticks in mental health concerns among sort of children of all ages almost. And I think there's a couple of things, right? There's just worries about a lot of stuff. You know, when I started graduate school, I was working in this anxiety-depression clinic. So, I'd come in and there'd be an 11-year-old who only had a social phobia, and that was it. We treat that social phobia and send them on their way and everything was fine. And now, we have kids in the office who are anxious and have a diagnosis of ADHD and there's substance use at play, or we have a teenager who has disordered eating and depression and difficulty with peer relationships, right? So, it almost feels like there's just sort of increasing complexity in addition to increasing rates, and that makes it really hard for the teens to manage, really hard for the parents to manage, right? They almost don't know which way to try to help first. So, it just feels like across the board, symptoms are rising, they're getting more intense, and they're happening to more and more kids and teenagers.

Daniel Knoepflmacher, MD: And what do you think are the main contributing factors to all of these increasingly complex and growing number of problems that are facing adolescents?

Andrea Temkin-Yu, PsyD: I think you mentioned a few of them before. Certainly, the pandemic was a major hit, right? We saw a huge increase in a lot of symptoms. And then, as kids came back into school and were sort of thrust back into these high-pressure academic environments without having had as much support for several years, that had a really negative impact. I think that, for sure, social media is really complicated. Kids have these intense pressure of needing to be online all the time, because that's the major source of social connection. So, they're getting exposure to things they probably shouldn't be seeing. They might be prioritizing online relationships over in-person relationships. That's really tricky.

I also think kids are just more aware of what's happening in the world these days, certainly more than I was when I was a teenager. And we have a lot of teenagers who come into the office and, yes, they're very worried about peer stuff and they're very worried about academic pressures, but they're also really stressed about politics, and they're really stressed about climate, and they're stressed about their safety in school. And these are really big questions that are unnerving for the adults in the world, much less the teenagers who have significantly less power to affect change in these areas. So, I think there's just been a much bigger burden placed on the shoulders of our teenagers who feel really stuck about how they're supposed to move through it all.

Daniel Knoepflmacher, MD: Complex times causing, you know, increased stress at all levels. But this generation is really facing it in ways that we certainly didn't.

 I just put myself in the shoes of the parents who work with you. And I just can imagine how grateful they must be to have your help. So when you're first meeting with parents, what are the most common questions you get from them as they come in thinking about raising their teens?

Andrea Temkin-Yu, PsyD: Yeah, lots of questions about screen time. How much is too much? When is it okay? Parents are really stuck around this because they sort of know too much screen time is problematic or it disrupts their kids' sleep, and they also want their kids to have a good social support, and if they take away screens entirely, all of a sudden that becomes much more difficult. The screens are a big question. I think there is a lot of uncertainty about when to push in general. You want your kid to do well, and you don't want them to be overstressed. You want them to try new things, and you don't want to push them too far.

So, regardless of the specific behavior or situation parents are worried about, the underlying theme is almost always, "When am I supposed to nudge my kid along? When am I supposed to back off?", which is a great question and, of course, does not have an easy answer to it. So, a lot of times we're talking with parents about, "Okay. All right. Your kid, what do they need?" It's not a one-size-fits-all answer. But for their values, for your family values, for your child's skill level, how can we push them so that they're challenging themselves without feeling like they're drowning? And then, okay, as parents, as the adults in the situation, what supports are we putting them in place to sort of help them keep building that skill over time? But yeah, you're right, it's really hard for parents. They've got a lot they're grappling with and there's no one perfect solution to help your kid through these tough situations.

Daniel Knoepflmacher, MD: So, it sounds like some flexibility and contextual approach is important to always keep in mind.

Andrea Temkin-Yu, PsyD: Yes, definitely.

Daniel Knoepflmacher, MD: I have to ask you though, I'm sorry, because you mentioned screen time, so could we spend 30 seconds on what's the advice for screen time?

Andrea Temkin-Yu, PsyD: I wish I had a crystal clear answer for everybody, but the truth of the matter is we actually just don't have research that says, "This amount of screen time is too much, and this is not enough." It just doesn't exist yet. We do have some research showing that, particularly for teenage girls, the more time you're spending on screens, the higher rates of anxiety symptoms and even trauma symptoms that we're seeing. So, we definitely want to be wary of it.

What I usually recommend to parents is screen time is fine if it's not getting in the way of the other things that are important to your child. So if a kiddo is doing okay in school and they're seeing their friends outside of school a few times a week and they're on the soccer team, or they enjoy art or whatever, they're doing all of that, and then they still have some spare time that they want to be on their phone or playing video games or watching TV, I'm not particularly worried about that.

Where I do get worried is when kids are sort of holed up in their room on devices at the exclusion of these other things that could be really meaningful and valuable to them. So, I want parents to look for balance in that way. And then, I do think some conversations around internet safety and an awareness of what your kids are accessing is important, really difficult. It's really hard to stop kids from accessing things 24/7. But, you know, I want parents to sort of generally be aware of what types of sites they're communicating with them about things to watch out for. Just sort of basic internet safety stuff, I think, is important no matter how old your kid is.

Daniel Knoepflmacher, MD: Really helpful. It's funny because we were talking about flexibility and I'm like, "Give me the rules on screen time." But no, that's very helpful. And I know when I've talked to parents in my work who often come with concerns about their kids, they typically describe a series of behaviors often change from the past that worries them. And maybe, I mean, I can just give different examples, but you could see the extremes in the other direction. Maybe a kid who used to be very involved in family activities and super engaged and connected is now mostly out with friends and doesn't want to interact when they're home, holed up in their room. And they're totally separating in very obvious ways from the family. Or maybe there's a change in their approach to school. The kid who was always very engaged in school is now no longer handing in homework or acting differently in the classroom. So when parents come to you with concerns about behaviors, maybe behavior changes, how do you help them make sense of these changes?

Andrea Temkin-Yu, PsyD: Yeah, that's a great question. I want parents to sort of scale back. We're all hyperfocused on the behavior, which makes sense, that's what's causing us concern. But we need to understand them if we have any hope of actually shifting them in a more skillful direction. So, I want parents to be thinking about big picture in your kid's life, what's your child's context? What's working for them? What's not working for them? So in a global level, is the school a good fit? Do they have the right supports in place, whether that's academic support, mental health support, medical support? Do you have a kid who has a really good structured routine and sort of knows what they're doing? Or are things really wishy-washy day to day and they don't know where they're going and they don't know what the plan is, right? So, we have sort of big picture things that are going to trickle down and impact their behavior day to day.

And that goes from a developmental stage too. Are they just at a life stage where rebellion is really typical or caring more about what your friends think than parents think is really typical. If we can keep in mind that kids move through these phases and a lot of these behaviors are at least somewhat normative, it helps parents understand them a little bit more.

And then, I want to narrow down a little bit and say, "Okay, moment to moment, what's happening for your kid?" So when you're seeing problem behaviors pop up, what's the context for them? Is it when your child is doing a task that's really difficult and makes them feel awful about themselves? Is it when they're bored out of their mind and they're getting too restless to behave appropriately? Is it when they're hangry? Is it when they didn't get enough sleep because they're stressed about their chem test tomorrow, right? So if parents can start to look for patterns around the types of situations that impact their kids, now we have a much clearer picture of why certain behaviors are happening and now parents have options. If I understand the contextual factors that impact my kid, I can change some of those factors. If my kid is not getting the right support in schools, I can advocate for that. If they always end up fighting with their siblings on Saturday afternoon, they're bored, I can work on putting some stuff in place so that have a little bit more of a structured activity. There's things I can do to change the environment to be a better fit for my kid.

And then, there are some times where I can't change the environment or I don't want to change the environment. So if my kid fights me every time they have to do math homework because it's hard and it makes them feel badly, I don't say, "Don't worry sweetheart, just don't do math homework ever again." But if I can remember that, this is tricky for them, they don't feel good, it's stretching their limits, now, when they argue with me about getting it done, I can at least be much more empathic towards them. I can meet them sort of as a team member rather than an adversary. And now, we have a much better chance of sort of moving forward effectively. So, I've got to get parents to really think what's happening for my child. This behavior is not occurring in a vacuum. So, how can I keep that in mind and then help us all move

Daniel Knoepflmacher, MD: So, context is everything. It's similar to what you were saying earlier about there isn't onesize-fits-all to this.

Andrea Temkin-Yu, PsyD: That's right. That's right. There's so many things that impact kids, and I think parents do know this, but they forget it, right? So, a good example is during peak COVID, we were really seeing symptoms flaring for a lot of kids. And parents would come to my office and they'd say, "Andrea, what's wrong? I don't get it. What's happening? Why is everything so much work?" And I would say, "Well, we're still in a pandemic. That hasn't changed." And parents are sort of like, "Oh, yeah," right? But it's easy to sort of forget how much the stuff matters. It's easy to just sort of brush it under the rug, and we really can't. That's not fair to do to our kids. They're totally impacted by these stuff, so we want to keep that top of mind.

Daniel Knoepflmacher, MD: There's so many popular tropes about modern parenting. There's the helicopter parent who's obsessing over every detail of their child's life, or an overstretched working parent who's so consumed by the demands of their professional life that they're missing out on meals or other important moments of meaningful connections with their kids. Maybe there's guilt there. The reality is that all parents struggle with paying either too much or not enough attention at different times. And I'm wondering, what guidance do you have for parents on how to give attention and connect with their kids?

Andrea Temkin-Yu, PsyD: It's a great question, and I think I want parents to be considering when they can connect for the sake of connection, right? I think a big trend in modern parenting is we all feel like we have to be on top of everything all the time. All of our interactions have to be for a reason. We're trying to coach our kid or guide our kid or give them a teachable moment, and there are totally good reasons to do those things sometimes.

But I really want parents to think about how they can spend time with their children that's just enjoyable. It's just for the sake of it. So, one thing that we ask a lot of parents to do is just a daily, five-minute one-on-one time with their kid. Kid can pick the activity within reason. They can't break any house rules. But they get to pick the activity, so we know it's something that they enjoy. They're not going to fight us on it. And in that five minutes, the parents' job is just to be present with their child. So, they're not making dinner, they're not answering work emails. Ideally, we're not yelling at the other siblings in the room at the same time. It's just focused attention with that one child doing something they enjoy.

And then, we encourage parents to focus on praising their kid. What are they noticing that they appreciate? What's their child doing well? You know, for young kids, that might be playing Legos and praising their creativity. But for the teenager, maybe it's just going on a walk and showing your appreciation for them spending time with you or being open with you or commenting on that awesome thing you heard about from school, right? So, we're just focusing on upping this nice, positive attention, lots of praise.

And then, I also ask parents to focus on reflecting what their child is saying, which is easier said than done. So when I say reflecting, I mean, literally just sort of repeating back what your child says to you. And if you think about this from a teenager, you're on your five-minute walk and they say something like, "I hate my teacher." And we say, "What do you mean you hate your teacher? You have a great teacher." But as soon as we say that, we've shut the conversation down. Kid gets defensive, they think we don't get it, they're done.

So during that five minutes, what I want you to try to focus on instead is when your kid says, "I hate my teacher," we're just going to reflect back and say, "Oh, you hate your teacher, dot dot dot dot dot," right? And this is going to give kid a chance to give you more information if they want to. We've left the door open to more communication and that's going to build that sense of connection.

So, five minutes daily, one-on-one time. We're letting the kid pick the activity so it's something that they enjoy. We're focusing on praising them or focusing on reflecting. And we're going to purposely not make this about teaching them things. This is not the time for gentle criticism. This is not the time for feedback. Do that all later. This is just about fun time with your kid.

If you have a teenager who does not want to spend five minutes of one-on-one time with you, which is not that uncommon, parents can create what I call conflict-free zone. So, you just pick 10, 15 minutes of the day where you're purposely avoiding hot button topics. So, maybe it's the first 15 minutes of dinner or it's the 10 minutes after school. And during those period of minutes, you are not asking them about the homework. You're not reminding them about chores. You're not letting them know they have to come to family dinner with their least favorite cousin on Saturday, or just purposely avoiding things that could sort of blow up because kids and parents need to start to feel like they can coexist in a space without it turning into a fight. And if we can reset that, it's going to make that connection come a little easier.

Daniel Knoepflmacher, MD: These are such valuable tips. Thank you for sharing all of these with our audience. When returning to, you know, the past when I was working the partial hospitalization program and got to work with you there, one aspect of the treatment that I thought was really powerful was these family meetings often with parents who were supporting a young adult struggling at the time. If there was one skill we discussed more than any other, it was validation. So, I was wondering if you can describe what validation looks like and why it's so important and effective.

Andrea Temkin-Yu, PsyD: Yeah, this is great. Validation's so important, and it's very much a buzzword right now, but I think it's very confusing to a lot of people. So when I say validation, I mean, just expressing that you can see where another person is coming from. You can see how, from their perspective, they may have ended up where they did. And it's a super important skill.

So, validation has a couple of benefits. The first is it builds trust and communication. If my teenager tells me something and I immediately try to get them to problem-solve, or I immediately try to get them to see my perspective, we're done. Conversation's done. They're not coming back to me. If instead I can say, "Oh, my gosh, I can see why you feel like you hate your teacher because you thought that grade was really unfair," now I've made them feel much more settled, right? They're much more likely to continue talking to me, I've given them bit trust in what they're telling me.

Validation can really be helping at decreasing escalation. So, you know, as humans we often just want to feel understood. We want to feel like somebody else gets it. And when we don't, when the person sitting across from us is dismissive or just sort of obtuse, it's almost panic-inducing. We get really flustered and frantic. And that's certainly true for our teenagers too. So if teenager feels like their parent isn't seeing their side, we're much more likely to see a big escalation in behavior and emotion. That could be temper tantrum, it could be screaming, it could be slamming the door, it could be shutting down. If instead parents enter with validation, it sort of soothes that sense of stress, that fight or flight response, and kids are much more likely to stay settled and neutral.

And then, I also think validation is really important at decreasing shame. People feel a lot of guilt or shame or frustration with the emotions that they have, right? A teenager is really anxious about a test and then gets mad at themselves for feeling anxious, or they feel really frustrated with their sibling, and then they feel really sad that they're so frustrated. So if we can come up with validation and just say, "Oh, my gosh, I can totally see why you're so angry," or "It totally makes sense to why you're frustrated. We're eliminating that sense. That shouldn't be feeling certain things. That's a really important buffer when it comes to, again, those negative feelings like anxiety or guilt or frustration. It can be a really powerful buffer against that anxiety and low mood. So, validation serves just a ton of useful purposes. I would love to see parents using it more in their interactions with their teenagers.

Daniel Knoepflmacher, MD: So important, and maybe we could all use a little more validation in our polarized world in general, but it's a topic for another episode.

Andrea Temkin-Yu, PsyD: Sure. That's right. No, all these are actually just human skills. We're just applying it to teens right now.

Daniel Knoepflmacher, MD: Well, that's where it all begins. So, it's really important. Modern life is so chaotic for parents. And of course, that's even more the case when you have adolescents in the mix. What guidance do you give families to help manage all of the chaos, the schedules, the activities, all these things going on at once in their households?

Andrea Temkin-Yu, PsyD: I think some sort of structure is really helpful, even if your actual routine changes day to day. Literally, just writing down what the routine looks like on Monday versus Tuesday versus Wednesday is really helpful because a lot of conflict emerges when kids and parents aren't on the same page in terms of what's supposed to happen day to day. So if we've plotted it all out, even if there are a lot of moving parts, that can eliminate some of that, confusion or frustration or irritation that pops up.

And then, with everything kids have going on, I see more and more in my sessions with them that they're not making time for things that are actually sort of meaningful or enjoyable to them, right? They're hyperfocused on academics, they're spending a ton of time, hours and hours at their one afterschool activity. Not that's bad per se, but there's no time to relax. They're not seeing friends. They feel too stressed to just go take an enjoyable walk in the beautiful spring weather.

So when I'm working with parents, I want them to think about how they can carve out time for other meaningful activities to their kids. And there's sort of five different areas we think of this. We want kids to be doing stuff that's just fun for the sake of having fun; something physical, that could be they're on the track team, or it could be they like to stretch, or it could be they go on that short walk around the house, right? We want something social. Are they getting time to be with their friends? Interact in a positive way with kids their own age. Mastery. meaning, can kids develop a sense of productivity or progress in a skill? Maybe it's baking, maybe it's woodworking, maybe it's swim. And then service, are there small ways that they can give back?

Of course, I'm not expecting for families to fit all of these categories into every single day. But over the course of a week, over the course of a month, do we have sort of a smattering of these different domains built in? Because we know they can be really positive in terms of mood and helping kids feel engaged in meaningful, enjoyable areas of their lives.

Daniel Knoepflmacher, MD: That makes so much sense, because the things that cause you stress, the homework, the stuff with your work as a parent, those are always going to cause some anxiety and be things that are going to be in the front of your mind, but making the time for the things that actually benefit your mental and physical health might get pushed aside. So, you're kind of focusing on these to make sure that those get included in the schedule.

Andrea Temkin-Yu, PsyD: That's exactly right. And if you think about it, you know, it's like the saying, you don't want to put all your eggs in one basket, right? So if I have a teenager who's basically only doing academics and swim team, and then they have a really bad meet, well, guess what? That mood is going to tank, that anxiety is going to spike. Because half of their entire sense of self just went really poorly that weekend. But if I have a teenager who cares a lot about academics and is still on the swim team, but also is seeing friends and also likes to bake on the weekends and also has a regular call with grandma every month, yeah, the poor swim meet is a real bummer, but it's not 50% of their entire sense of self, right? They just have more domains that make up who they are and what brings them meaning in their lives. So, we just see a much more effective sort of buffer to these potential dips in moods or increases in anxiety and stress.

Daniel Knoepflmacher, MD: Earlier we were talking about behavior and you spoke about understanding the context that influences an adolescent's behavior. you want to get beneath the behavior to going on. So, understanding is such a crucial first step. I want to turn to the next step. Action. Behaviors are good. Behaviors are bad. Sometimes you want them to be encouraged. Other times, maybe discouraged. There's consequences that parents use for this process. How should parents use consequences to help shape behavior?

Andrea Temkin-Yu, PsyD: This is a great question. And it comes up every single time I see parents because it's confusing. So I want parents to be thinking about, "Okay, what's the unskillful behavior that you're seeing? And what skillful behavior would you like to see instead?" If parents are just focusing on, "Hey, kiddo, stop X," it gets much more difficult. So, I want you to actually build why. "I don't want you to just stop whining. I want you to work on taking a break when you need it."

Once we've identified the behavior we want to see, we're going to try to focus on rewards that build that behavior over time. So, the first thing I want parents to think about with consequences, reward or punishment, is it's not going to be all or nothing right off the bat. They're going to want to reward small steps in the right direction, even if there's still room for their kiddo to grow. And then, I want them to think about using consequences, reward or punishment, that their child actually cares about, which seems so obvious. And yet, it's actually a little tricky sometimes. So for example, a lot of times parents are willing to give something like maybe a little extra allowance money, but that's not what their kiddos cares about. What their kiddo happens to care about is a later curfew, and parents don't want to cave on that. Or their kiddo desperately wants to paint their room, but it seems really annoying for mom and dad, so they say no to that. So, parents are trying to scramble to find a reward or a punishment that they're willing to do. It doesn't work, and then they're really confused about why their kid isn't changing behavior.

So, step one, you got to find something your kid actually cares about. And then, you have to be consistent with the follow-through. So, this is the single biggest concern I see with parents, is they have a plan in place, they've told the kid, "Okay, if you can make progress at taking a break when you're upset, instead of just whining, you'll earn stuff towards that trip you want to take or those sneakers you want, or whatever it is," and then they don't follow through. And as soon as we don't follow through, we've undermined the whole system. And there's sort of two ways that parents don't follow through.

The first is they say, "If you start to whine, you're going to lose 10 minutes of screen time." Kid whines, parents say," Okay, you don't have 10 minutes of screen time." And then, later when the kid is begging and begging and begging and begging for screen time, the parents say, "Okay, fine." Well, now the kiddo knows that the punishment isn't actually that reliable. They can probably weasel their way out of it, and they will definitely try.

The other thing that happens is parents say they're going to give a reward, and then they forget or they change their mind because their kid did something else that annoyed them. And now, the kid comes into my office and says, "Andrea, I tried. I really did my part and parents didn't follow through. So, why would I trust them? I'm not going to listen to them. They're not going to hold up their end of the bargain. So why should I?"

So whichever side of the spectrum a parent happens to follow on, we need to move towards greater consistency. Once we do that, we're much more likely to see positive progress, but that consistency's got to be sort of number one thing in parent's head.

Daniel Knoepflmacher, MD: Got it. Well, you mentioned that time when the kid gets upset. And certainly, in adolescence, emotions boil over more than maybe at other points in a person's life. I'm wondering what parents should do during times of intense emotions and conflict that are almost inevitable during this period.

Andrea Temkin-Yu, PsyD: Yeah. And they can feel like such struggles in the moment. So, the first thing is if you can catch your child before they're in true, true peak, so you can catch them when they're starting to get upset and agitated, but they're not full blown teenage temper tantrum, I really want parents to start with validation. We're not going to fight with them about it. We're not going to tell them they're being ridiculous. We're going to say something like, "Oh my gosh, I totally get why you're so angry," or "I can see how, from your perspective, it seems like I'm not being fair." If we can catch it early enough and validate, we might prevent that entire big escalation. But inevitably, there's going to be a moment of burst at some point.

So when your teenager is really sort of mid peak, I actually want parents to step away, which seems very counterintuitive because those peak behaviors, like the yelling or the screaming, or the cursing or the slamming doors, it pulls for us as the parent to intervene. But when we do that, two things happen. One, we just gave this inappropriate behavior a ton of attention, and it turns out that's pretty reinforcing, and it's going to make those behaviors more likely to happen again in the future.

The other thing is my kid's really mad, they're really upset. So when they slam the door and I march in right after them, I'm just fueling the fire. I'm going to keep that conflict going way longer than I want it to. So, as hard as it is, when your kid is mid peak, you really actually want to sort of retreat a little bit. It doesn't mean you're losing control. It doesn't mean your child is winning. It just means we're recognizing nobody is in a place to be skillful at this moment. So, let's all walk away. Later, when everybody is sort of reregulated back to the baseline, now we can have the conversation about their behavior. Now, we can deliver a consequence if we need to, but I have a way better shot of that being a meaningful exchange if I wait until after the explosion has died down.

Daniel Knoepflmacher, MD: So in that moment, are you advising parents to kind of reflect what's going on and say something along the lines of, you know, "Right now, it doesn't seem like we can talk. Let's take a break and when things are calmer, we can talk" or some way to kind of set the stage for that?

Andrea Temkin-Yu, PsyD: It's a good question. I don't mind that, if your kid is listening. So when your kid is in the living room shouting at you, I don't mind you saying, "It just seems like I'm not helping that much right now. So, I'm going to go take a beat. I'm going to go calm myself down. And then, I'll come back in a little bit and we'll check in and we'll finish." That's totally fine.

What I don't want to happen is your kid is annoyed, they go stomp off and then parents screams, "We're talking about this later." That's not going to help. Just let them go. It's fine. You'll show them that you're going to return to the conversation once they're calm. And you do return to the conversation. So, I just want parents to be careful falling into the trap of sort of getting the last word in. That's not the aim here. But if the kid needs a break and they need to go, just let them go. That's okay. They're not being disrespectful. They're being smart enough to recognize that they need a minute. I mean, they might be being disrespectful too, but they need a minute. So, let them have that minute and then we can regroup afterwards.

Daniel Knoepflmacher, MD: That's makes sense, that even that kind of, as you said, having the last word is reinforcing that attention for that behavior.

Andrea Temkin-Yu, PsyD: That's right. Exactly.

Daniel Knoepflmacher, MD: Parenting is a lot of work. You have to balance your career, your social life. Family demands are often overwhelming. And I always talk about the analogy of being on a plane. As a parent with your child, you are told you have to put on the oxygen mask first so that then you can put on the oxygen mask for your child to get the oxygen they need. And similarly, maintaining one's own wellness is such an important first step in raising healthy children. So, what tips for parents do you have to help them maintain their own wellbeing as they do the work of raising healthy teens?

Andrea Temkin-Yu, PsyD: It's such a crucial part of being a parent that is often totally disregarded because we're so overwhelmed as parents, and it's very easy for our own wellbeing to just take a complete backseat. So, I talk with parents about picking one domain, not five, but one domain, that if they had time, energy, resources to devote to it, it would just bolster their overall emotional reserve, their overall wellbeing. And it could be sleep, it could be your mental health, it could be the social support you want. It could be exercise. Just one area that if you had some energy to put towards it, it would sort of rise the tide.

So once you've picked one domain, let's say it's social support, I want to set a long-term goal. Six months from now, what would you like this social support to look like? And it can be anything. Whatever feels meaningful to the parent. So, it might be, "I want to have at least two social outings a month," or it might be, "I want to know, I have at least three people I can call when I have a bad day." Doesn't matter. It's just whatever feels meaningful.

And then, once you have that sort of long-term six-month goal, then we're going to work backwards by finding teeny tiny little steps they can work on each week. So when I say teeny tiny, I mean a task that's going to take you five to 10 minutes max over the course of the week. So if my goal is increasing social support and my long-term goal is to have two social outings a month, my week one goal might literally just to be to scroll through the contact list on my phone and put a star next to anybody I'd want to spend time with, right? And my week two goal might be to do an internet search of sort of free local events in the area over the next six months. And my week three goal might be to think about anybody in my life that I've sort of met once or twice, but I don't really know that well, but that maybe I'd want to build a connection with. So, we're three weeks in, we're almost a month in, and I haven't actually had any more social support yet.

But that's okay because what I'm trying to do is create a sustainable system, one that actually makes that long-term goal feasible to reach and then maintain over time. And that's where I think parents get hung up on this. They go really hard, really fast. They say, "Okay, my goal is social support, so this week I'm going to see three people and they do it," but it was not sustainable and it immediately drops off. So, you know, we're going to really just try to take it tiny baby steps at a time,

 And then, the other thing I talk with parents a lot about is linking their own wellbeing to a bigger picture value. As parents, again, it's really easy to dismiss your own needs and let them fall by the wayside. But if we remember, your wellbeing is not a luxury. It's actually just a basic building block of being a human, being the parent you want to be Now, spending time for yourself is not something to feel guilty about. It's not something to feel badly about. It's actually in service yourself and your family. And if we can remember that, it can make it a little bit easier to actually follow through on those goals that you set.

Daniel Knoepflmacher, MD: So important. I mean, this kind of resonates with this when we're talking about structure before. I mean, that was at the family level, which of course I imagine meaningful moments with your kids can help feed that, but you need those for yourself as well. And that, in that scheduling, has to be factored in, maybe not in such a rushed way that you get discouraged, but it's another important thing to always keep in mind.

That's right.

Andrea Temkin-Yu, PsyD: Slow and steady wins the race here. Small little incremental changes over time. We'll see improvement over time as you go.

Daniel Knoepflmacher, MD: Well, there are times when parenting unfortunately is not enough. And that's when mental health problems come up that require professional help. And again, when we're talking about adolescents, which is such a complex time in a human's life, how do you help parents identify these moments when they meet that threshold and then navigate them?

Andrea Temkin-Yu, PsyD: As clinicians, we often talk about this idea of frequency, intensity, and duration. Meaning when you see your child is struggling, how often are you seeing them struggle? How impairing are those symptoms and how long is it lasting? So, that's what we want to think about with parents.

When they're noticing some changes in their kids, is it here and there, kind of intermittent? Their kid can still mostly do what they need to do and then the symptoms fade and we're all good? In which case, great. Whatever it was, is probably just a typical blip in teenage development. But if you're seeing these changes happening more and more and more, you're noticing it several times a week, every day. If they're lasting a longer period of time and they're starting to get in the way in multiple areas of your child's life, now we want to be more worried. Now, we want to make sure we're getting support sooner rather than later.

So, a good example of this is, let's say you get a call that you're kids skip class, and it's the first time it's happened. Not a big deal. They didn't fall majorly behind. Kids do this sometimes. We want them in class. You might have a consequence for it, but not overly concerned. But if they start skipping multiple classes a week and they're not showing up to soccer practice and their grades are, you know, starting to see a little bit of a dip and the coach is concerned, now I'm a lot more worried. So, it's not just the behavior in and of itself that I'm worried about, it's what's the overall context that it's occurring in and can I see how it's starting to impact their life.

And then, of course, even if you're not noticing these things, but your kid is just saying they want more help, great. You don't have to wait until there's a crisis to get them support. I'd actually rather see a kiddo in my office who just needs a little check in, make sure they're good to go. Just it'll be easier for them. So if your kid is asking for help, for sure, you don't have to wait till things get worse to reach out.

Daniel Knoepflmacher, MD: Andrea, you've shared so much useful information in this podcast today. I could keep going, but we do have to end. And I want to just see if you could offer three easy-to-remember tips. Like if someone just tuned in for this part and there was some take-home of three useful tips for raising mentally healthy teens, what would they be?

Andrea Temkin-Yu, PsyD: So, the first one is to focus on connection, which we've spoken about a little bit today, but with everything going on in your kids' life, with everything going on in your life, prioritize that relationship. It's not going to solve everything, but your support is so important to your child. Whether or not they give you the satisfaction of showing that to you, it's really important. So, take those moments to recognize their efforts, to validate, to spend time with them. It goes really long way, both now and in maintaining this really nice warm positive relationship as they grow up.

 Second tip is to try to be consistent. Being a teen is confusing enough. They have so many forces at play in their lives, and if parents are sort of constantly flip flopping back and forth on what the rules are and when there's a punishment and when they get rewarded on what's okay, what's not okay, it's really hard for a teen to make sense of it, and they're much less likely to make skillful choices. So, the more consistent you can be as a parent, the clearer you can be with your expectations, the easier things go for you, the easier things are for your kid, the less conflict you're going to have overall.

And the last tip gets to the last question you asked before, which is just take care of yourself. You could memorize every tool that I've written about in my book. But if you're running in fumes, you're struggling, it's going to be really hard to use them. So, work on your own wellbeing, solidify your coping strategies, and then you'll get much closer to where you want to be as a parent, and it'll be way easier to support your teenager in the way you want to.

Daniel Knoepflmacher, MD: Connection, consistency, caring for yourself, the three Cs.

Andrea Temkin-Yu, PsyD: You got it.

Daniel Knoepflmacher, MD: All right.

Andrea Temkin-Yu, PsyD: We got a new acronym.

Daniel Knoepflmacher, MD: Yeah, no, that's wonderful. Andrea, I'm so grateful to you today for sharing all of your knowledge and your expertise, all of this great useful advice. I mean, I say that as a parent, as well as a mental health clinician.

So, congratulations on the publication of this amazing book, which by the way goes into much more detail about all of these topics. It's phenomenal. And so, for anyone who wants to go deeper and learn highly practical strategies that include exercises and worksheets that you can tailor to your specific situation, because as Andrea said, everybody's situation is unique and contextual and you want something that's flexible, this is the book to help you with that. It's again called Supporting Your Teen's Mental Health: Science-Based Parenting Strategies for Repairing Relationships and Helping Young People Thrive. Important topic for so many parents out there.

So, everyone should stay tuned and look out for Andrea, because I have a feeling you're going to be out there a lot sharing these important parenting strategies with the world. So, thank you so much for joining me today on the podcast.

Andrea Temkin-Yu, PsyD: Thank you. I really appreciate the chance to talk about it. I think it's such an important topic and I love being able to speak with you.

Daniel Knoepflmacher, MD: It was great, and thank you to all who listened to this episode of On The Mind, the official podcast of the Weill Cornell Medicine Department of Psychiatry. Our podcast is available on many major audio streaming platforms that includes Spotify, Apple Podcasts, YouTube, and iHeartRadio, and others. If you like what you heard today, give us a rating please and subscribe so you can stay up to date with all of our latest episodes and tell your friends. We'll be back again next month with another episode. Until then, wishing you good health in body and mind.