of psychosis, which can consist of delusions (false beliefs) and hallucinations (seeing or hearing things that others do not see or hear). Experiencing psychotic symptoms is a significant risk factor for suicide, and the early stages of psychotic disorders like schizophrenia represent a particularly critical period of risk. Other symptoms of schizophrenia include incoherent or nonsense speech, and behavior that is inappropriate for the situation. People with schizophrenia may also experience depression, anxiety, sleep problems, social withdrawal, lack of motivation, and difficulty functioning overall. They may seem like they have lost touch with reality, which causes significant distress for the individual, their family members, and friends. Onset of schizophrenia is typically in young adulthood, but the initial and less severe phase of psychotic symptoms may begin in childhood or adolescence. If left untreated, the symptoms of schizophrenia can be persistent and disabling. However, effective treatments are available. When delivered in a timely, coordinated, and sustained manner, treatment can help affected individuals to engage in school or work, achieve independence, and enjoy personal relationships.28
Generalized Anxiety Disorder
Anxiety is the most common emotional problem in children. Youth can develop crippling worries about many things, from germs to vomiting to their parents dying. Some anxious kids are painfully shy, and avoid things that other kids enjoy. Some have tantrums and meltdowns, and others can develop elaborate rituals, like compulsive handwashing, aimed at diminishing the fear.29 Generalized anxiety disorder is a mental health disorder characterized by feelings of worry about multiple things that are strong enough to interfere with one's daily activities. Examples of other anxiety disorders include panic disorder, social anxiety disorder, and specific phobias. The ongoing worry and tension of anxiety may be accompanied by physical symptoms, such as restlessness, feeling on edge or easily fatigued, difficulty concentrating, muscle tension, or problems sleeping. In addition to genetics, brain chemistry, personality, and life events, teens can experience feelings of anxiety that are fueled by high expectations and pressure to succeed, a world that feels less safe than it used to, and digital media sites where teens tend to compare their life and social situations to what others are posting. According to the National Institutes of Health, nearly 1 in 3 adolescents ages 13 to 18 will experience an anxiety disorder. Between 2007 and 2012, anxiety disorders in children and teens went up 20%.30 Some teens like the pressure and need it to meet deadlines. Others shut down or avoid situations that would otherwise help them learn to manage events that challenge them and build resilience.
Post-Traumatic Stress Disorder (PTSD)
To develop PTSD, an individual must have been exposed to actual or threatened death, serious injury, or sexual violence either directly or indirectly. Someone with PTSD can be jumpy, irritable, violent, or have trouble sleeping and concentrating after experiencing or witnessing a harmful, terrifying, or upsetting event.31 Any kind of extreme stress can lead to PTSD. For teens this can be the result of physical, emotional, or sexual abuse, undergoing major surgery, loss of a loved one, community violence or unrest, or natural disasters.
The prevalence of trauma exposure among youth is a major public health concern. Youth who have been exposed to trauma, whether a one-time event or repeated, can respond by withdrawing from others or they can be the students who threaten others or start fights. Youth affected by trauma can also have a decreased IQ and reading ability, lower grade-point average (GPA), more days of school absence, and decreased rates of high school graduation.32,33 Evidence suggests that youth exposed to trauma have decreased social competence and increased rates of peer rejection.34 Like conduct disorder symptoms, the behavior of these students often challenges the patience of educators. In these cases we encourage teachers to think, “What happened to you?” instead of “What's wrong with you?”35 If you notice students exhibiting characteristics that may indicate any of these mental illnesses, do refer them to your counseling staff for assessment because they may need additional intervention to be successful in school.
NOTES
2 2. Twenge, J. M., Cooper, A. B., Joiner, T. E., Duffy, M. E., and Binau, S. G. (2019). Age, period, and cohort trends in mood disorder indicators and suicide-related outcomes in a nationally representative dataset, 2005–2017. Journal of Abnormal Psychology 128(3): 185.
3 3. Plemmons, G., Hall, M., Doupnik, S., et al. Hospitalization for suicide ideation or attempt: 2008–2015. (2018). Pediatrics 141(6): e20172426. doi:10.1542/peds.2017-2426. https://pubmed.ncbi.nlm.nih.gov/29769243/
4 4. Seabrook, E. M., Kern, M. L., Rickard, N. S. (2016, Nov 23). Social networking sites, depression, and anxiety: A systematic review. JMIR Mental Health 3(4): e50. doi:10.2196/mental.5842 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5143470/
5 5. Primack, B. A., Shensa, A., Escobar-Viera, C. G., Barrett, E. L., Sidani, J. E., Colditz, J. B., and James, A. E. (2017, Apr). Use of multiple social media platforms and symptoms of depression and anxiety: A nationally representative study among US young adults. Computers in Human Behavior 69, 1–9. https://doi.org/10.1016/j.chb.2016.11.013
6 6. Kessler, R. C., Angermeyer, M., Anthony, J. C., et al. (2007). Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization's World Mental Health Survey Initiative. World Psychiatry 6(3): 168–76.
7 7. Rose, M. E. (2018). Are prescription opioids driving the opioid crisis? Assumptions vs facts. Pain Med 19 (4, April): 793-807. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6018937/; or Manchikanti, L., and Singh, A. (2008). Therapeutic opioids: a ten-year perspective on the complexities and complications of the escalating use, abuse, and nonmedical use of opioids. Pain Physician 11(2 Suppl): S63–S88 https://pubmed.ncbi.nlm.nih.gov/18443641/
8 8. Elofson J., Gongvatana, W., Carey, K. B. (2013, Jul). Alcohol use and cerebral white matter compromise in adolescence. Addictive Behaviors 38(7): 2295–2305. doi: 10.1016/j.addbeh.2013.03.001. Epub 2013 Mar 15. PMID: 23583835; PMCID: PMC3699185
9 9. Ammerman, S. (2014). Marijuana. Adolescent Medicine: State of the Art Reviews 25(1):70–88. PMID: 25022187
