By the time they graduate from high school, as many as 25 percent of students will have experienced some form of depression, a Stanford medical doctor who specializes in adolescent mental health told those attending a Common Ground Speaker Series event at Sacred Heart Prep in Atherton on Jan. 14.
The doctor, Shashank Joshi, spoke as part of a panel discussion titled "Positive Responses to Our Children's Distress Signals," focusing on how to recognize symptoms of unhealthy stress in children, how to reduce the causes of stress, and when to seek help.
Denise Pope, a Stanford University senior lecturer and co-founder of Challenge Success, a nonprofit working to help students succeed, moderated the panel. Dr. Joshi was joined on the panel by fellow Stanford physician Neville Golden. Both specialize in training doctors to work with adolescents, Dr. Joshi in mental health and Dr. Golden in physical health.
"Quite a bit for a teen to handle"
Ms. Pope told the audience that the enduring problems of adolescence including acne, anxiety, bullying and struggles in school are now only a small part of what teens experience. "It can be quite a bit for the typical teen to handle," especially because teens' brains have not matured and will not until they are in their 20s, she said.
Today's students have busy schedules, she said. Surveys of thousands of students have found middle-schoolers average two and a half hours of homework a day and high-schoolers, three hours, Ms. Pope said. High school students also average two daily hours of after-school activities.
"What they're not doing is sleeping," she said. Students report averaging fewer than seven hours of sleep a night, she said. "They need nine."
How we got here
The problems of over-scheduled students are not unique to Silicon Valley, she said. More families with two working parents has led to more after-school extra-curricular and enrichment activities, she said. Many students also now play on, and practice with, both school sports teams and club sports teams.
More students also attend college. "That has caused fear because there's this idea that there are fewer spots at the good colleges," she said, something that is just not true.
"There is a college spot for every single college-bound senior," she said, noting that while 200 colleges are considered highly, highly selective, most parents know about only 10 of them. "Go find the other 190," she urged.
In addition, she said, study after study have found that the college one attends has little correlation with success in life.
Social media adds to stress because it gives a skewed view of the world, she said.
Pressure to make schools more accountable with routine testing ended up adding to pressure on kids, Ms. Pope said, and created a lot of "misconceptions about what you need to do to succeed."
Not all stress is bad stress
While modern life is stressful, not all stress is bad, Dr. Golden said. "You can have a good stress," such as mild performance anxiety, he said. "It actually protects us against harm," he said. "It gives you that fight or flight mechanism." During good stress, stress hormones such as adrenaline, norepinephrine and cortisol increase rapidly and then return quickly to normal, he said.
With chronic stress "or bad stress," the body sustains the levels of cortisol, which can cause sleep disturbances, diet disruption, mental illnesses and physical illnesses such as diabetes and heart disease, he said.
Dr. Joshi said parents sometimes don't know if their child is stressed to the point that they should worry. "How much is too much? It's hard to know," he said. In addition, not every child, even siblings, handles stress in the same way. Parents need to figure out what stresses their children. "Learn not to show that you're worried, because that can set them off," he said.
What to look for?
Clues that stress may be impairing a child include a loss of interest in things they enjoy. "They start withdrawing, especially from friends," he said. "They may not be texting their friends. Then you've really got a problem." Another clue is when children "are no longer themselves," or when a bad or sad mood is prolonged, he said.
Dr. Golden said adolescents probably don't know that what is bothering them is stress. "I've never seen an adolescent who comes in and says, 'Doctor, I'm stressed,'" he said. Instead they complain of headaches, nausea, or being unable to get up to go to school, he said.
Doctors, he said, must rule out medical causes for such symptoms.
Another clue, Dr. Golden said, is when relationships in more than one of the three main spheres of a student's life parents, friends and school change. It is not unusual to have a disruption in one sphere, but if more than one has changed, "I would seek further advice," he said.
What to do?
What should parents do? They should not worry, the panelists said, that talking about mental health issues will bring on even more problems, such as thoughts of suicide. "You're not putting the thought in the teenagers' heads," Dr. Joshi said.
Studies have found that 16 to 18 percent of American teenagers have considered suicide, he said. "That number's been very stable" for years, he said. About 6 to 8 percent of teens have actually attempted suicide, he said, with about 2 percent ending up in emergency rooms.
"It has to be part of the national conversation," he said, including in schools because that is where children spend most of their time.
Dr. Golden said that parents who are worried their children are over-stressed, should first reach out and see "if your child is willing to speak to you."
"If you get shut out, which is most likely," he said, go to your medical provider.
Pediatricians are trained to help
Pediatricians, he said, are trained to spend some time alone with adolescents when doing any sort of medical checkup. "We ask about personal stuff," he said, and the pediatricians won't share it with parents unless kids say they are thinking about hurting themselves or others.
Many pediatricians working with adolescents go through a checklist with the acronym of HEADDSS, which stands for Home, Education/Employment, Activities, Drugs, Depression, Sexuality and Suicide, Dr. Golden said. Teens are asked if they feel safe at home, about their school, job, other ways they spend their time, and about their alcohol, drug and sexual habits.
He said doctors also ask: "Have you ever felt so bad that you wanted to hurt yourself in any way, or thought the world might be a better place without you?"
Surprisingly, kids do tell their doctors the truth, he said, perhaps because they know parents won't find out. "Adolescents are surprisingly honest, they really are," Dr. Golden said.
Dr. Joshi said that a study of students about to enter ninth grade found that girls with concerns said they were more likely to talk to teachers, counselors or parents. Boys, he said, were more comfortable with a doctor because they tend to "medicalize" their symptoms.
How to prevent stress?
The panelists also had ideas on ways to prevent stress.
Sleep is very important, Dr. Golden said, with between eight and a half to nine hours needed each night. Instead of staying up studying, "it's better to just forget about it and get some sleep," he said. "Grades have been shown to improve with more sleep."
Dr. Golden said the sleep cycle of adolescents, researchers have found, is different from that of both adults or younger children. They need to stay up later and sleep later, he said. Teens who start school later are more likely to eat breakfast, get more sleep, and get better grades, he said.
Ms. Pope said that the panelists, all parents themselves, understand that many of those things aren't easy to achieve. Starting when children are young makes it easier, she said. "Parents of younger kids, you can really get into the habit early on because you do have control," she said, adding that younger children need 10 hours a night of sleep. "You get in the habit that sleep is absolutely critical."
For older students, "you can have an appropriate consequence when they don't get the sleep they need," she said. Ms. Pope said she takes her teens' car keys if they don't get at least seven hours of sleep. "There are more accidents now for teenage drowsy drivers than teenage drunk drivers," Ms. Pope said.
A tool that can used to make a student's life a little more sane is to put everything the teen does, including homework, sleep and meals, into a schedule. "Nobody signs off on a more-than-24-hour day," she said.
At tinyurl.com/Alm-116, a scheduling tool can be found on the Challenge Success website.
Play time, down time and family time
Ms. Pope suggest another acronym, PDF, which stands for play time, down time and family time. "They need that to protect them from the adversity we've been talking about," she said.
Play time is not organized sports. "The key there is free and unstructured," she said. For older kids, play time is often social media, she said. "Play time has to happen every day. ... Down time has to happen every day, too." When students get home from school, instead of being quizzed about what they learned that day, "they need to chill," she said. "They're learning and thinking about their identity. They need time to do that."
Family time, when the whole family is together, should happen at least five times a week for 20 or 25 minutes. "It doesn't have to be a meal, but dinner is pretty convenient," she said, and it should be technology-free.
Dr. Golden, who works with kids with eating disorders, agreed. "Family meals reduce the risks" of eating disorders, he said. "You get them used to this idea of sharing their feelings and their moods."
Another resource is Stanford University's Resilience Project, which urges students and others to share their failures. "Making mistakes is absolutely a part of life," Ms. Pope said. "I think that it's kind of important to embrace the mistakes."
Common Ground Speaker Series
The Common Ground speaker series is in its 14th year. The all-volunteer organization has 29 member schools representing 10,000 families. Events are free to parents, faculty and staff from member schools as well as faculty from non-member schools. This school year, the organization will have 11 events with the theme of wellness on 11 school campuses.
Resources for parents, students and educators
● ChallengeSuccess.org has information for parents and educators, including a blog, links to classes and resources. "We provide families and schools with the practical, research-based tools they need to create a more balanced and academically fulfilling life for kids," the website says.
● The Challenge Success site lists a set of "Do You Know" eye-opening statistics about children and teens, from preschoolers to college students. Click on links on the page to download PDFs with more facts on modern children's lives.
● The Stanford University Student Resilience program website emphasizes the importance of failure in the learning process.
● Sources of Strength is a program started in North Dakota in 1998 that works to prevent suicide, violence, bullying and substance abuse by training students as peer leaders who work with trusted adults.
● Bring Change 2 Mind works "to end the stigma and discrimination surrounding mental illness" its website says. Actress Glenn Close was a co-founder.
● Denise Pope's latest book, "Overloaded and Underprepared: Strategies for Stronger Schools and Healthy, Successful Kids," written with Sarah Miles and Maureen Brown, can be found at a San Mateo County library, Keplers.com and Amazon.com.
●The documentary "Unmasked" by Palo Alto High School student filmmakers Andrew Baer and Josh Yuen is on YouTube. "This film is an honest effort to bring the topic of suicide out of darkness so that we can open new paths of conversation and work together to find solutions," the directors say.