Make a Schedule. Set a regular sleep schedule. Go to bed and wake-up at the same time every night. Continue this routine even on weekends and vacations. I know your teen may not like this idea. Ask your teen to give it a try for a week to see how much better he or she feels. The schedule should not be interupted for more than two consecutive nights. Encourage them to avoid delaying bedtime for more than one hour. Awaken them the next day within two hours of the regular time.The Importance of Light. Teens should be exposed to bright light as soon as possible in the morning, but they should avoid it in the evening. The light signals the brain that its time to wake-up. Keep in mind that electronic light from computers, televisions, video games, etc. has the same effect as light, and therefore should be avoided close to bedtime. Teens should not have electronics in their rooms. Optimize Schedule for Sleep Patterns. Sleep patterns are biological and behavioral. Help your teens understand their circadian rhythms, and encourage them to optimize their schedule throughout the day based on their internal clocks. For example, encourage your teens to participate in stimulating activities or classes that are interactive first thing in the morning and late in the day if possible. Try not to take the most difficult classes at those times. Recognize Signs of Sleep Deprivation. If your teen requires more than one alarm to get up in the morning, if you find yourself shouting at the foot of your teen’s bed most days to get him or her up on the morning or if they are falling asleep during the day, they are almost certainly not getting enough sleep at night. Be in touch their teachers to find out how alert they appear during the day at school. Be aware that many signs of sleep deprivation, like difficulty focusing or remembering, can look a lot like signs of attention deficit hyperactivity disorder (ADHD). Educate Your Teen About Sleep. Help your son or daughter understand inadequate sleep can affect them. Poor sleeping habits can make them more irritable or depressed and can make it difficult for them to get along with others. Grades and relationships can suffer as a result of poor sleep. Nap. Naps are fine if they are not too late and not too long. Naps need to be less than an hour and taken before late afternoon. Keep and Eye On What They Eat and Drink. Caffeine and nicotine are stimulants and should be avoided particularly in the afternoon. Alcohol also can disturb sleep. Wind Down Before Bedtime. Teens should avoid studying, television, computer games, texting, etc. within one hour of going to bed. Don’t let them fall asleep with the television on as the light and sound will inhibit sleep. Get Help. If you think your teenager is not sleeping adequately at night, consult your primary care practitioner or a sleep specialist. Excessive sleepiness during the day and other sleep problems can indicate an underlying, biological sleep disorder, such as narcolepsy, sleep apnea and periodic limb movement disorder, or a circadian rhythm disorder such as delayed sleep phase syndrome. In most cases, symptoms of sleep disorders can be effectively treated.
Unusual changes in eating and sleeping habits
Withdrawal from friends, family, and regular activities
Violent actions, rebellious behavior, or running away
Excessive drug and alcohol abuse
Unusual neglect of personal appearance
Marked personality change
Persistent boredom, difficulty concentrating, or a decline in the quality of schoolwork
Frequent complaints about physical symptoms such as stomachaches, headaches, fatigue, etc.
Loss of interest in pleasurable activities
Not tolerating praise or rewards
Complaints of feeling “rotten inside”
Giving verbal hints such as “Nothing matters,” “It’s no use,” or “I won’t be a problem for you much longer”
Putting his or her affairs in order by giving or throwing away favorite possessions or belongings
Becoming suddenly cheerful after an episode of depression
Diectectical Behavioral Therapy, DBT, is currently the treatment of choice in treating adolescents with multiple problems including depression, self-injury and suicidal ideation.
- Teens and young adults need about 9 hours of sleep per night (compared to 7.5 to 8 for adults), but they get on average 6.9 hours of sleep per night.- According to Dr. Mary Carskadon, adolescent sleep expert at Brown University Medical School, “the same part of the brain that was working when the teens were learning their new skills continues to rehearse and practice when the students sleep. The brain consolidates and improves on what they have just learned…” - The difference between students who get C’s, D’s and F’s go to bed about 40 minutes later and get 25 minutes less sleep than those student’s who get A’s and B’s. - As they mature adolescents experience a phase shift during puberty. The teens who are starting to look like adults fall asleep two hours later than younger children or less mature looking teens. So when your teen tells you he or she can’t fall asleep until 10 or 11pm, they are telling the truth. - One possible reason for this is that the brains sensitivity to light changes during adolescence. Dr. Carskadon has research findings showing that those in middle or late puberty exposed to even dim light in the evening delayed melatonin secretion. This was not true for those in early stages of puberty. - The use of electronics (computer, TV, cell-phone (texting)) right before bed can make it difficult to fall asleep because looking at the screens on these devices is like shining a flashlight into your eyes. For the older teens who are particularly sensitive to light this is especially true. - According to the National Highway Traffic Safety Administration, drowsiness and fatigue cause more than 100,000 traffic accidents each year and young drivers are at the wheel in more than half of these crashes.
“A child born today will live to be about 80 years old, on average. But the challenge is getting them through 16, 17, 18, 19 – the most hazardous time of their lives. A kid with a car, a kid with a gun, a kid with a bottle – any one of these combinations is much more of a risk than a terror attack or a flu from [overseas].”Timothy Egan, NY Times, 6/09/14 OpEd, P. A15
FACTS ABOUT ADOLESCENT SUICIDE Annually: - 19% of high school students seriously consider suicide (1 in 5). - 8.8% attempt suicide. This adds up to 1 million teens, of whom 700,000 require medical attention. - Up to 11% of teen suicide attempters will eventually die by suicide. (Diekstra, 1989; Shaffer et at., 1988) - In a typical US high school classroom, two girls and one boy will make a suicide attempt this year. - Between 31-50% of all adolescent suicide attempters re-attempts suicide (Shaffer & Piacentini, 1994) - 27% (males) and 21% (females) of adolescent suicide attempters re-attempt within 3 months of their first attempt (Lewinsohn et al., 1996). - The risk of suicide increases significantly as an adolescent accumulates more problem behaviors (violent behavior, substance use/abuse, self-injury, risky sex, etc.)
WHAT IS THE ANSWER? Dialectical Behavioral Therapy (DBT) is designed to treat patients who are struggling with multiple problem behaviors that make them at high risk for suicide.
In initial studies DBT with Adolescents is more effective than treatment as usual at the following: - Decreasing inpatient hospitalizations - Increasing treatment retention (many teens drop out in the early stages of most other treatment programs). - Reducing suicidal ideation, depression, anger, anxiety and emotional sensitivity - Reducing symptoms common in a borderline personality disorder (confusion about self, interpersonal chaos, emotional dysregulation, impulsivity). Rathus & Miller, 2002
An adolescent brain is developing at about the same rate a 2 year old brain develops. Additionally, due to school hours, activities and homework most teens don’t get enough sleep so adolescence is like the terrible two’s the second time around, but this time in a sleep deprived state. Try to look at your teen’s outbursts, insults, etc. like toddler tantrums. They are caused by spikes in anger when any slight is even perceived. During these spikes he or she is literally not thinking straight. You may notice that 30 minutes later (or less) he or she will likely be fine…as if nothing happened. This occurs because the teen has cooled down and returned to an emotional baseline. Just as with toddler tantrums these outburst are not about you and shouldn’t be taken personally. Of course, not taking it personally is easier said than done. So the real question is how not to take it personally? Here some tips:
Practice, practice, practice. Remind yourself everyday that this is a developmental phase not a personal assault on you…no matter how good he or she gets a pushing your buttons.
Vent. Just because it’s not personal does not mean it’s not uncomfortable. Talk to your partner, talk to a family member, talk to a friend or talk to a therapist to help put things in perspective.
Use what he or she gives you. The pain that you are feeling can inform you about what is going on within your teen’s mind. That rage, hopelessness, frustration, fear, etc. will give you a picture of the turmoil your teen is feeling. Hopefully, this will allow you to be more empathetic and less hurt or angry.
Don’t engage. When your teen starts to yell, say hurtful things, be disrespectful don’t reciprocate. You don’t want to say something you will regret.
Consequences. There should be consequence for negative (and positive) behavior. This helps to empower you as a parent and it helps your teen know what to expect. (see my tips on creating consequences for assistance in this area).
Seek help. If your teen’s outburst seem unusually frequent or intense. If his or her behavior has changed significantly in a short amount of time. If you’ve noticed changes in eating or sleeping habits, decreased interest in previously enjoyed activities, change in friends, increase isolation, etc. Trust your instincts and seek professional help.