A friend’s 12-year-old daughter came home from school with a small book about puberty the other day. The pamphlet went over the expected adolescent body changes that were awaiting her daughter. But it also tackled changes to mood and attitude that may also occur as a child hits the teen years.

The pamphlet said teenagers were likely to be “moody” and “irritable.” That parents should not be surprised if their adolescent became quick to anger—or to cry. It said adolescence is a time of “impulsivity” and increased “risk-taking” behaviors. The pamphlet was clear that these changes were just part of growing up. But it was hard for my friend not to notice that the adjectives used in this pamphlet also sounded a bit like symptoms associated with depression, anxiety, and other mental health disorders. And it made her wonder, with so many changes coming, how is a parent to know when a teenager is going through the normal angst of adolescence or when they might be struggling with a mental health issue?

Dr. Stephanie Hartselle, a pediatric psychiatrist and member of the American Academy of Child and Adolescent Psychiatry (AACAP) says the pamphlet isn’t exaggerating about the changes you see in normal teens. They can be overwhelming.

“Absolutely, the hormones are descending. And you’ll notice moodiness, the pushing of boundaries. And that’s there for a reason. What adolescents are doing is preparing to discover who they are cognitively. Their brains are preparing for adulthood,” she says. “And in some ways, there’s a mismatch between their emotional brain and their logical brain. It’s important to know. Because what we should be doing as parents of teens is working to put ourselves out of a job—to let them grow up so that they don’t need us to parent them anymore.”

Hartselle says that emotional outbursts, getting tearful over seemingly nothing, grumpiness with boundaries, being more isolated and some risk-taking behavior is all par for the course. It may not be pleasant for parents but it is well within the range of normal.

“What many parents don’t realize is that teenage depression and anxiety doesn’t look the same as adult depression and anxiety. Adults look sad. We look anxious. We look the way you would imagine a depressed or anxious person would look,” she says. “But teens don’t look that way. They tend to be more withdrawn or angry. In fact, problems with anger is one of the big signs of depression in teens, especially teenage boys.”

Understanding that there is a difference in presentation is important—and can help tell parents when they just need to sit back and weather the storm and when it’s time to seek outside assistance.

“That anger is something to look at, definitely. But if you see them having problems with sleep, if the way they are eating changes dramatically, so they are gaining or losing a lot of weight, if they are isolating so much you can’t get them out of their room for anything, or if their socializing has changed a lot, then perhaps it’s also time to take a closer look,” Hartselle says. “It’s always something you can discuss with your pediatrician or with a local counselor or psychiatrist and see what might be going on. And don’t be afraid to ask for help. Because if there is a problem, catching it early can make a huge difference. If you get involved early, there’s a really good chance that you can help turn things around for your child.”

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