Daydreaming is good, loud music bad, as far as general signals about teenager mental health are concerned, says an expert in adolescent psychology, who urges adults to not ignore teenage depression.
Plenty of disturbing youthful behavior may be normal - but taken to extremes or in chronic cases, it may indicate a serious depression and even suicidal tendencies.Recently released statistics show a slight, though statistically not significant, rise in teenage suicides, which the American Association of Suicidology in Denver says occur among 13.1 out of 100,000 youths.
But those are reported suicides, and Dr. Derek Miller, a psychiatry professor at Northwestern University Medical School, fears many remain unreported because they occur through fatal car accidents or homicides.
"Look at the self-destruction rate - death by homicide, by motor vehicle accident and by suicide. They are an actual package," Miller says. "It is a fairly common attitude in adolescence to go out and get yourself killed. In urban areas, we don't know how many street shootings are a result of that."
Miller argues that depression and marked disobedience are warning signs of either emotionally or physiologically based troubles to be taken seriously.
But how do parents distinguish between their teenager's sowing a few wild oats and having normal mood swings, from symptoms of serious distress?
A teenager who eschews daydreaming for constantly blaring music, or abuses drugs or alcohol, may be trying to cover up a feeling of emptiness, Miller says, adding that daydreaming and fantasizing are healthy activities.
"This ought to be a time when people daydream a lot," he says.
Dr. Marilyn Gould, a member of the National Task Force on Adolescent Suicide, has worked on constructing psychological profiles of suicide-prone youth based on information gathered about young victims.
"We've been finding a combination of depression with acting-out problems," Gould, a Columbia University assistant professor of psychiatry and public health, has said.
At Northwestern Memorial Hospital's Adolescent Psychiatry program, Miller and his colleague, psychiatrist and pediatrician Barry Carlton, have summarized the behavioral signs of teenagers who may need medical evaluation and treatment:
-Inability to concentrate
-Has become "unknowable"
-Isolates self from others
-During arguments with parents, pushes to "boiling point"
-Significant gap between self and friends
-Trouble with drugs and alcohol
-Sleeplessness, sleeping more than usual, or a disturbed sleep pattern
-Weight loss and poor appetite, especially early in the day
-Runs away from home or unexplained absences
-Hits or strikes others
-Talks about suicide
"It sounds like a lot of children are depressed, doesn't it?" Miller commented, answering himself with emphasis, "Well, it's true!"
The NMH psychiatrists cite the easy availability of drugs, difficulties in the rising number of one-parent families, and lack of psychosocial support in schools as contributing factors to increased substance abuse, promiscuity, depression and suicide among teenagers.
Depression is believed to be a problem for up to 40 percent of children aged 13 to 18, while some estimates rank suicide as the second most common cause of death among those 12- to 17-years-old and even the leading killer of those aged 13 to 18.
Responding to a troubled child is not easy, and too often, Miller admits, "It's unrealistic to say, `Take the kid to a child psychiatrist,' The first line of defense for parents is to ask themselves if their child is getting what he or she ought to have to grow up straight."
Besides watching out for a child's physical and creative needs, parents also need to provide discipline, the psychiatrist advises.
"Parents have to be ready to say `no,"' he says, while acknowledging the difficulties. "Parents are so overwhelmed. They come home tired . . . They don't want their kids to get mad at them. But the worse thing children can feel is that they get no guidance."