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Teen Talk for International School Nurses by Katy Harris www.family-sos.org Teens, like adults, must deal with life stressors such as academic pressure, peer pressure, family dysfunctions, emotional concerns and growing up processes. They respond by becoming sad, frightened, anxious or angry in varying degrees. When one of these or a component of these emotions reached a degree that interferes with their daily life, normal functions and their capacity to take pleasure, action should be considered Common human traits • Control… Defiance, hostility, self harm, substance abuse, over-striving, eating disorders, gaming addictions • Avoidance… isolation and withdrawal from family or friends, drinking, drugs, social dependency, running away WE ALL NEED TO belong, to feel heard, feel capable, make choices, cope with mistakes and obstacles and keep going…......its hard! Over the age groups • Pre/early teens… bullying, social unease, cyber-issues, family stresses and classroom/peer anxieties • Mid-teens… body image, sexual orientation/health, academic decline, family dysfunction, dating difficulties • Late-teens… Academic pressure, relationship struggles The teen brain • Increases lymbic system – emotional tone/overload thus they feel things more intensely • Decreases executive function – and at the same time they have less ability to manage cognitive load and the organization of problem solving The expatriate community • Excellence is expected they need to hear that there is no failure but teachers and parents offer fear as a motivator! • Parents fail to share their vulnerability so feelings of shame about having low mood/ability/confidence/coping adds to the mix • Academic achievement is all and schools reinforce the erroneous idea that, without good grades, entrance to college/uni is not going to happen – despite the fact that many kids deter further study and succeed later • Peer groups and unstable as children leave and filter in, constantly changing the dynamic and adding social stress at an emotionally sensitive time of life • Singapore seems safe and teen-dangers are minimized by the press, police and parents Main sources of referral • Teachers Noticing failing grades, social withdrawal, excessive fatigue and emotional reactivity or ‘flat-line’ responses and ‘don’t care’ attitudes or disruption and aggressive responses • School nurses Seeing minor ailments, hearing complaints and concerns of social safety or exclusion, peers reporting of ‘others’ or seeking help for ‘others’, or advice regarding ongoing family/home issues Two main categories • School stuff -struggles with peers, siblings, parents, teachers, subjects, balancing ECAs and workload = dissatisfaction and disconnect • Personal – struggles with emotional states, feelings of failure, key relationships, identity issues, health and mental equilibrium = frustration and feeling the need to escape • Third culture kids – job losses, impending transitions, parental absence, financial concerns Transition to independence • Breaking the bounds of mother-love they are programmed to part but mothers hold on! • Their parental role models are usually successful and they fear failure • Belonging within the ‘tribe’ is essential but today’s tribe is a shifting social community, not a stable one • False Evidence Appearing Real – face the worse that can happen – chase the fear towards recover • Anxiety is the concerns we are not facing – those hidden from view, which need to surface • Depression occurs when anger turns in, or anxiety has no outlet, or hopelessness overwhelms FAMILY CONFLICT • Conflict centre around everyday family life organisation, personal responsibility, money, social balance, returning home on time, homework, grades, family outings, school trips and holidays, CHOICE • Inter-personal relations – this is the time when rumbling relationship problems explode as teens resist ‘given’ roles/reasoning • Teens want choice – good parents offer LIMITED choices, including the choice to mess up or manage things badly • Teens want to understand boys capacity to understand others’ perspectives increase, whilst girls sometimes decrease! • Teens want freedom but freedom is not the same as free-to-roam, it is freedom to error and pick up, and accept consequences and stay hopeful Talking to parents • Parents who want their children in counseling should consider the value of family therapy – the teen is not responsible for the whole issue • Parents need to seek advice and support themselves before putting the ‘label’ on their kids (they are bigger and should do the work) • But too often teens are categorized as difficult and the dillema of being in counseling can exacerbate the inter-personal issues • Parents who are losing control need to take ownership of their own panic with gentle guidance Talking to teens • • • • • No empathy overload, (multiple solutions including worst) Stay practical (use scales and ratings) Be future focused (in 10 years time, advice to self) Harness strengths and coping Sort and seek input from their support people (with permission or encourage the teen to approach them) • Allow slow reveal – be patient and persist • Use self disclosure, metaphor and ‘stories’ (rapport over time means more than ‘fix it’ advice Suicide Continues to be the 2nd leading cause of death for those between 15-25 (after accidents) BUT suicidal ideation is where we can help….. KNOW risks (impulsivity/mental health issues in the family/chronic depression/public humiliation/major break up/substance abuse/peer isolation/high expectations,LGBT RED FLAG COMMENTS No one cares, i wonder who would come to my funeral, nothing matters, no one would miss me anyway, they’d be better off without me, i wish i could sleep and not wake up ESTABLISH degree of planning CONTACT family and medical practitioners Panic problems • Many teens don’t anticipate well, and then feel a sense of startle and panic as they face big things – exams, friends leaving, break ups • Encouraging them to turn towards the fear allows more reality checking to take place • Plans are the opposite of panic, especially if shared/supported(with parents or a good friend) • Help them remember past coping, believe in selfmanagement, work towards positive outcomes and encourage them to believe –THERE IS NO FAILURE, only mistakes and re-directions. Key ingredients • • • • • • • Hope looking ahead to what is wanted in terms of ‘feelings and strengths) Resilience picking up and starting again without GUILT Social support including caring friends, extended family, etc Family cooperation working together to joint aims Good school/home communication Practical planning – PROCESS OUT OUTCOME Noticing what works and building in small steps THERAPY • • • • • • • • CBT has good research but is often limited in its value except in expert hands Family therapy not enough well-trained personnel here Expressive therapies useful for those who don’t like to talk Peer support groups schools should have them but don’t Online resources be selective – everything written is not true Inter-schools groups would be WONDERFUL School nurses/teachers first line defense needs good radar! Medications often bridge from uncertainty & low mood to a pick up point ANXIETY ABOUNDS • Anxiety is unconscious fears – and usually presents as control or avoidance • It requires gentle exploration towards uncovering problems both externally in situations and internally in feelings and thoughts • Checking ‘what might happen’ brings the anxiety to consciousness and allows planning • Solutions are not enough – self soothing is key both physically to calm the system and mentally/emotionally to generate self compassionate care • Build the idea of inner strengths – courage is key but if fears are hidden it is impossible to add ‘brave’ DEPRESSION • Depression is a turning inwards of anger – usually and trying to dampen down frustrations • Depressed teens become reliant on things to keep them in the ‘zonk zone’ – where they wont have to face their frustrations/failures • This underlies many other conditions and medication is necessary if external support is not welcomed • Getting parents to understand their role to deflate expectation and increase steps and stages towards feeling better is essential AUTISM/ADHD/learning disorders • Lack of social understanding and impulsivity increase potential exclusion and risk behaviors • Social rules are infinitely changeable at this age – ASD kids need safe supporters to talk through better/worse not right/wrong with DESIGNATED PERSONNEL • ADHD – organizational support is key in early teen years, and strong ongoing monitoring • ADHD/ADD – girls are risk – most girls with inattention manage and mask it until 12-14 yrs LOSS AND GRIEF • Boys extra vulnerable about losing first girlfriends – often minimized by other adults- LISTEN TO THE PAIN! • This is the age where early-years pets depart – this is no small thing! Focus on VALUE as balance to LOSS • Loss of innocence is not to be underestimated & generates big teen behaviors, it requires sympathy and hope • Loss of grades creates grief! Talk about the gap between expectation and reality – the ‘gap’ is the grief-maker, work on 80/20 principle RISK/PREVENTATIVE FACTORS • Preventing initial recurrence pre-planning is everything! • Interrupting the process through which risk operates change of environment/perceptions/people/motivations • Creating buffers against further negative effects careful incentives & managing short term pain for long term gain • Increase self-esteem and self efficacy talk & walk • Key supporters need to stay long-haul usually this cant be parents - sorry Additional notes follow These small notes are only a small attempt to cover some of the areas of concern for this age group SELF INJURY • More common in girls than boys • Affects kids with low ability to express their frustrations or a fear of being angry • Often highly social/high expectation kids feeling overwhelmed and under-strengthened • Mostly parents don’t know – encouraging sharing takes a lot of planned support • Expressive therapies help but medication is often necessary for a short period EATING • Anorexia is usually reported from ‘concerned’ friends, bulemia rarely surfaces in school • These kids want control – usually high achievers who are panicking about growing up, boys, exams or sport and maintain ‘order’ in this one area of their life • Caution about private counselors – the hospitals here have good & group resources • Push parents to get psych support DRINKING • The ‘average’ age expat kids have alcohol is grade 8! • Undiagnosed ADHD kids are often early alcohol abusers – impulsivity and poor organisation • Because this is a ‘cover up’ problem careful investigation is required – focus not on quantity of alcohol but on feelings alcohol creates and mistakes made when it is consumed • Open discussion within pastoral care groups helps bring problems up – ‘safe’ teachers • Parents often minimize this as an aspect of other issues when the child goes out – such as arriving home late or staying out at other people’s homes WE ARE NOT SAFE drugs and gangs • There are gangs here and expat kids both iniciate these and are pulled in • Drugs are available more than we believe • Schools need to encourage open dialogue and good reporting systems – & random checks • Once kids get involved they rarely break loose and moving the child into a more secure environment is the biggest deterrent – wildness programmes and boarding schools GAMING/MEDIA OVER USE • This surfaces as a component of others issues – parental neglect/division, intensity issues such as un-diagnosed ASD, avoidance of workload/underachievers, peer isolation • Radical measures work better than reduction battles – big incentives required • The whole environment at home needs to change and often requires deep investigation into the ‘drive’ for withdrawal • This is a real addition and xxxxx is the best SEXUAL health/identity • It is hard for our teens who have private health care practitioners to know how to handle STDs – thus it helps for each school to know who to turn to for good medical support • Identity issues manifest in this age group and require safe mechanisms/people to talk to – ensuring confidentiality is key Psychiatric referrals Conduct disorder (aggression and defiance)– established before teenage in this population Bi-polar – arises usually in this age group but mania and low energy picked up by family Schizophrenia -shows up 15-15 year age group but again families usually aware Psychosis – often a part of above – but not often dealt with within school