Watching your children grow up is amazing, but can often leave you unsure. It’s not uncommon for parents to find themselves wondering how to respond when their child or teen is acting out or showing signs of stress.

Dr. Rebecca Nelson, PhD, Developmental Psychologist within the department of Pediatrics, recently talked with parents facing these tough situations in an online chat, and addresses more of these questions below.

What are some common signs of stress seen in a teenager (adolescent)? How can I recognize stress and anxiety in them?
First, anxiety and stress are terms used interchangeably. Both are reactions involving thoughts, emotions, and physiological responses – like change in heart rate. Anxiety involves our anticipation of perceived threat, and stress is our response. We strive for resilience, which is sustaining good, healthy functioning despite negative experiences and setbacks. Common signs of stress are shown across emotional, verbal, and behavioral domains. Emotionally, feelings may be closer to the surface giving the sense of fragility with increased sensitivity, reactivity, irritability, impatience, anger, crying or fluctuating moods. Verbally, display any of the classic Flight, Fight or Freeze responses. For example, there may be refusal to talk about the topic that is making them anxious or stressed (avoidance), or they might become argumentative (fight). Other verbal expressions might include connotations of helplessness - not knowing what to do” (freeze). Behaviorally, one might see new, unproductive, repetitive behaviors meant to self-soothe or stimulate. These could be regressive behaviors, such as increased dependent or clingy behaviors (e.g., not wanting to be alone, seeking continual reassurance and validation). Change in sleep and eating habits are common in stressed teens, and can include difficulty settling and maintaining sleep or sleeping more than usual, comfort eating with weight gain, or decreased appetite, etc. Somatic behaviors, such as stomach and headaches, and other bodily aches and issues without identifiable medical causes are also signs of stress in some individuals. Obsessive behaviors or thoughts can be signs of stress (e.g., nail picking or biting, masturbation, etc.). Before assuming these are anxiety and stress related, it is important to observe ad monitor your teen’s behavior, talk with them and share your concern and gain more information. If symptoms interfere with their or family functioning, reassure your child that you love them and will do all that you can to help them, and contact your child’s pediatrician for an appropriate referral.

Can you provide some tips for an anxious child before they go to school in the morning? How does a parent reassure their child their day will be okay before they go out the door? This happens daily.
Overall, consistent and predictable routines communicated with sensitivity are the best ways to provide anxious children a sense of control. Anxious children generally don’t do well with big surprises, last minute rushed plans or unfamiliar change in routines. It’s best to prepare them beforehand as much as possible. This can mean going over the next day’s plans step-by-step, sometimes repeatedly until they are comfortable. Asking your child to repeat what’s going to happen the next morning and school day can be helpful for them and is known as “mental rehearsal.” Young children who are developing memory and verbal skills are reassured well with simple visual cues. Picture timelines and basic calendars, or even photo reminders can be posted on a refrigerator or at the child’s eye level for easy reference. Also, a favorite little cuddly in a backpack can go a long way to assist with the home to school transition.

I have a 14 year old daughter who gets very anxious and testy when trying to get things done - for example a project for school. She sometimes asks for help but then when I try to help she gets frustrated with my suggestions and will say "never mind". Any suggestions?
First, when kids get anxious about something like schoolwork, it means they care. We don’t stress about things we don’t care about, so it’s great that your daughter wants to do well in school. Second, it is not uncommon for this type of tension to occur between children and parents given that parent-child relationships are emotionally weighted. Likely, your daughter is trying you out as a schoolwork “helper,” and then deciding it is not working for her. This is all part of her becoming an independent problem solver. She is on track developmentally. Give her space to figure out her work on her own or let her ask someone else.

My seven-year-old son with Sensory Processing Disorder (tactile & vestibulomotor) has difficulty with routine transitions: Home-to-school in the morning, home-to-activity. He becomes angry, cries and yells. Is there anything that we can do to prevent these outbursts or help him during them?
Based on the limited provided information, if your son was formally diagnosed with Sensory Processing Disorder (SPD,) and assuming he is working with an occupational therapist (OT), have a frank discussion with his therapist about his ongoing challenging behaviors: difficulty with transitions and outbursts. You may want to inquire if a board-certified behavior therapist (BCBA) may be helpful in facilitating more adaptive behaviors. You may want to have a discussion with your child’s pediatrician regarding the overall developmental profile of your son, and the next steps if no or limited progress has been made since starting occupational therapy, especially if it has been some time. An older, but still relevant and helpful book is “The Sensory Sensitive Child: Practical Solutions for Out-of-Bounds Behavior” by Karen Smith, PhD and Karen Gouze, PhD.