Article: The Many Faces of Mood Dysregulation in Adolescents and Middle Schoolers

JennaZucchiBy Dr. Jenna Zucchi, Psy.D.

Middle school and adolescence can be a particularly challenging time, not only for kids but for parents as well. Emotions often run high within a rapidly changing landscape that affects all areas of the adolescent’s life: school pressures increase, peer pressures take on new and challenging twists and all amidst mood altering hormonal changes. Parents may begin to notice an increase in feelings of sadness, irritability, anxiousness or increased anger as their child tries to navigate the changes. Social skills difficulties in elementary school may begin to pose bigger problems with friends as relationships become more complicated. Similarly, shy or anxious kids without the needed skills to navigate the bumpy terrain may feel overwhelmed and start to avoid social situations in general, or may even begin to avoid school. Some adolescents resort to substance use in order to fit in or to try to manage their feelings. All of this is further compounded by difficulties which may be occurring within the home.

When a person feels like they are often overwhelmed and unable to control their mood, this is referred to as “Mood Dysregulation” and usually results in behavior changes as mentioned above. Sometimes it can be hard to tease out what is normal developmental upheaval that the child is able to cope with and when it is a good time for parents to intervene and obtain additional professional support. Often, this support may involve providing skills so that their child has the tools necessary to tolerate his/her distress and learn to control emotions versus being controlled by them. A consultation with a professional can help in deciding steps to take that will be of the most benefit to the child and the family as well.

Clearly every child (and adult for that matter), has times when they feel sad or discouraged and may act irritably. However, if there is a persistent pattern of sadness, hopeless thoughts, lack of interest in previously enjoyed activities and/or sleep and eating disturbances, a mood disorder such as Depression, Dysthymia, or Bipolar Disorder may be present and early intervention and treatment are essential. A misconception about childhood and adolescent mood disorders is that these disorders present as they do in adults. The youth’s specific developmental stage plays a key role in how symptoms manifest. For instance, depression in children and adolescents may look less like sadness and more like anger, irritability and frustration. There may be angry outbursts at home, a refusal to go to school or join in family or extracurricular activities that were once enjoyed. The adolescent may withdraw, spending much time alone in their room or sleeping much of the day. Mood disorders may also manifest in somatic complaints: stomach aches, nausea, headaches and fatigue. These symptoms can affect all areas of the child/adolescent’s life resulting in poorer academic performance, difficulties in maintaining relationships with friends and furthermore, can interfere with desires, needs and dreams.

A child or adolescent struggling with Mood Dysregulation and/or an actual Mood Disorder may say he or she feels sad or guilty or may even deny experiencing any difficulties at all. Young people often have a hard time identifying and expressing their feelings. As stated, it is also hard for parents to discern what is or is not a normal stage of development. Additionally, these behaviors present in a range of intensity and can be subtle. Checking in with your child and being involved in daily activities can help a parent to identify patterns and changes. Contact with teachers, coaches and pediatric appointments can assist in detection. Early intervention and treatment can provide the child/adolescent with the skills needed to face this challenging time and can help him or her to identify, untangle and cope with negative thoughts and feelings.

At The Koch Center, we understand the complexities involved in working with children and adolescents exhibiting Mood Dysregulation. Our first step is a thorough assessment to begin to understand the pertinent issues and to devise a treatment plan to address them. Treatment recommendations are customized and vary according to the needs of each individual and his or her family. Our Dialectical Behavior Therapy (DBT) skills groups are often very effective in teaching parents and the child specific skills and strategies that help one to tolerate distress and regulate emotions so that the individual feels in control of his or her feelings, not controlled by them. Our staff includes professionals skilled at providing individual and family therapy as well as parenting guidance. When appropriate, our social skills programs can help in terms of fitting in with peers and our child and adolescent psychiatrists are available for medication consultation and treatment when indicated. Due to the increase in rates of school avoidance and refusal, we have instituted a specific DBT School Refusal Program to help families and kids return to school and attend regularly. For more information or to schedule an evaluation for your child or adolescent, please call 201-670-6450 ext. 1 or visit our website www.kochcenter.com.

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