5 Questions to ask if you think you teen needs counseling

• First question was if there is a stressor. There are kids that are by nature anxious, moody or inattentive. You may already have him in treatment for ADHD or another diagnosis. Was there a family crisis like a divorce?. Anxious kids can become more anxious, depressed kids more depressed and so on. A good therapist will be able to assess what is going on.
• Secondly, does your child show evidence of significant moodiness, extreme anxiety, severe depression, etc? Watch your child's daily routine - are they sleeping later than usual, staying in their room, wetting the bed? Or is she so anxious that she can't fall asleep or get her homework done because she is worrying all the time. Be on the lookout for flights of manic energy, sleeplessness and grandiosity. In these instances, you might be up against a bigger problem than mere teenage moodiness. 

• The third question concerns the degree of dysfunction - how bad has it gotten? Psychological problems, whether they are mood or anxiety disorders, attention deficit or other issues, are defined not just by the symptoms but also by how the problem actually impacts basic functionality. If you notice that your son is acting depressed, but he's far from suicidal, he does well in school, he has good friends and an active social life, and he generally gives off an attitude of contentment, you are most likely dealing with normal teenage angst. If your daughter is anxious and complains about the divorce(link is external) or your parenting, but lives life well, she is probably okay. Complaining is not a psychiatric diagnosis. If, on the other hand, your son protests constantly that he's "fine", but you clearly witness that he's having trouble getting out of bed in the morning, his friends are no longer calling, and he's lost interest in what used to give him pleasure, this well may be an actual depression. And some kids become "very good" in divorce, like super kids because they are so anxious. Be aware that your child may be so worried about her situation that she will do anything not to rock the boat. This can be a cause for concern.

• The fourth question is about drugs and alcohol. Is my child self medicating? The typical adolescent in America has access to alcohol and many kinds of drugs. He may claim that marijuana "cuts the edge off" or that drinking lets her bond with her friends. Or, it may all be in secret and behind your back. Be careful. I have seen too many casualties from chemically dependent teens, including poor grades, depression and even fatal car accidents. Twenty five years of practice has made me very sober about alcohol and drugs. If your child is using significantly, normal treatments won't touch the core problem.

• The fifth question is hard to answer for yourself because you as a parent are in the thick of it: how badly are we - as parents - hurting our children because of our inattention, anger, self preoccupation, moodiness or the way we pull them into the middle of our conflict? When this fifth question is answered strongly in the affirmative, you will almost certainly need outside help. In cases like this, it is ashame to medicate a kid when he or she is overwhelmed by realistic pressures from home. Therapy and/or medication takes a back seat to the divorcing parents working on getting their act together and if this can't happen because the acrimony is too intense, then just know that meds and therapy may work, but it is a sad second choice.