Dr. Susan Sparkman, MD

An adolescent with depression would best be served seeing their primary care physician initially for overall health screening (including mental health screening). The adolescent may be able to verbalize feelings of sadness, but depression can present in various ways and the person might not feel "sad." S/He may be angry, agitated, have dropping grades in school with poor concentration, have changes in sleep habits and sleep is not refreshing, become sullen and withdrawn, and have a change in appetite with weight gain or loss. The teen often will not inform their parents of suicidal thoughts. They often will find it helpful to discuss this and other feelings with another neutral adult in whom they can confide, and who can offer help (therapy and possibly medicine if needed). 

Susan Sparkman, M.D.  

This is known as "Elective mutism" or "Selective mutism" when a person (usually a child) refuses to speak in certain places. Does she speak to other people? Friends? Classmates?  Teachers? Has she experienced a stressor or change in her routine? A move? An illness? Upset? This sort of behavior can prompt anger in adults who expect the child to speak when spoken to. Angry responses only causes further silence. I would also say that if you are waiting for her "to grow out of it", you might wait a LONG time. Meanwhile, everyone suffers. She will refuse to let her wants and needs be known. I recommend that you seek psychotherapy for her from someone who understands Selective mutism, and can engage her in ways that promote communication. This might be by play therapy, and/or writing or typing notes for a while. Do not expect 1 or 2 or 5 sessions to suffice. It might take months. 

Susan Sparkman, M.D.   

Adolescents are busy emotionally moving away from family and developing close relationships with peers.   What is your daughter doing on her phone?  Talking or texting with friends, gaming, or on the internet?  Does she have ample opportunity to be involved with friends (in person)?  Going to movies, the mall, a study group, or other activities?   Life provides a time for various activities that helps a person become a well-rounded individual. 

How much time is she spending on the phone?  Some cell phones will now record and report an average daily time spent on the phone (this may be averaged over a week and daily use reported weekly).  A person caught up in various activities often does not realize how much time they are spending with the activity.  So, the report can be a reality check.   I would recommend setting a reasonable amount of daily time on electronics (phone, TV, computer, iPad, etc).  Monitor what is being watched.  Some computer sites are not appropriate for a 15 yo and these should be blocked.  There are ways to have computers shut off after a preset time limit.   Some teens need to relinquish their phone at a consistent preset time every night (maybe 9 or 10pm).  Sleep is important.  It's a family decision if a phone should be allowed at school.  It should be for emergencies only in my opinion.  Otherwise, it's a potential distraction.   If your daughter is indeed spending many hours daily on electronics, I would recommend weaning the time spent from electronics to other activities (sports, hobbies, friend interactions, etc).  An addiction will not be easily and rarely voluntarily given up.  Something is driving this activity in her.  She might find it helpful to talk to a therapist, and / or family therapy might be useful.  Then goals can be discussed with a plan, and follow-up sessions can check on progress or reasons for unaccomplished goals.  I would wonder about an underlying mood problem (anxiety or depression).  This should be evaluated as part of the plan. 

Sincerely,

Susan Sparkman, MD   

Your son may or may not want to talk to you about his feelings, but might welcome the chance to speak with a neutral third party like a therapist, his primary care physician, or school counsellor.  Is he angry around other family members or friends?  Some information that is helpful in evaluating anger is:  sleep -- pattern, number of hours nightly, and is it refreshing?;  have interests changed?;  is he still socializing with friends?;  is there a lot of guilt or shame?;  what is his energy level?;  can he concentrate on school work?;  does he cry or feel like crying?;  what is his appetite?;  has there been a change in weight?;  is agitation present?;  what is his speech like -- slowed or rapid?;  any thoughts of suicide or homicide? One thought that comes to mind is that it is often easier to be mad than sad.  Has there been a loss in his life?  Does he have a best friend?  How is school going?  Are his grades good or falling?  Is he being bullied?  It is one thing to be angry and voice the anger, but another thing to be physically aggressive.  Safety for everyone is most important.   Is there any fun family time?  Is there time for friends?  Is there time for activities / exercise? (this can be a variety of things).  Tensions may be running high in the family.  Don't forget to give positive encouraging comments.  Try to balance positive statements and negative statements.  If anyone is only hearing negativity, it's difficult to have happy feelings.  It might be helpful to ask him,  "If you could change anything in your life, what would it be?"  "Are you worried about anything?"  If he refuses to talk, let him know that you want to help him and you are willing to listen to him, or if he prefers, you are willing to find someone else with whom he can talk.   Has he been checked out by his PCP lately?  Make sure he is physically healthy.  Does he eat a good diet?  Get good sleep?  Sunshine?  Exercise?  Does he have room for a spiritual life?  He might appreciate learning "mindfulness" and taking time to be present in the moment, and learning calming breathing exercises.  There are apps that can be downloaded to help a person practice these.  Some schools are now including mindfulness exercises that help students. I hope these thoughts are helpful and wish you well. 

Susan Sparkman, M.D.     

What appears to be "hyperactive" can have associated symptoms caused by a variety of things (medical and/or emotional). Both of you would be best served to have her evaluated professionally to see what all might be contributing to her hyperactivity. Sometimes looking at the situation is like peeling through layers of an onion. After the outer layer is dealt with, another layer is revealed. Is she distracted by anxiety or depression or lack of sleep or obstructive sleep apnea or iron deficiency (not necessarily being anemic) or learning difficulties or social worries?  What may appear to be ADHD may or may not be ADHD. Various problems can be driving the behavior, or the above problems may be "co-morbid" (in medical terms). That is, they may exist together. 

Sincerely,

Susan Sparkman, M.D.  

Hello,

In regards to your 12 year old son avoiding making friends, I would not consider this a phase.  It is considered an important developmental step when boys and girls have a (usually same sex) best friend around this age.  They will spend a lot of time together talking, playing, and going places (the mall, movies, games, etc.).  In fact, they often remember each other the rest of their lives even if they lose contact as life leads them down different roads. I wonder why your son wants to be alone?  The reasons can vary with each child:  social anxiety, bullied (in person or on social media), he has not been successful at finding a best friend, etc.  Does he have someone with whom he eats lunch at school?  A group of friends?  Or does he eat alone or avoid lunch all together because he has nobody to sit with?   It is probably worth chatting with his teacher(s) to see if they have noticed his social interactions (or lack of interactions).  Has he changed schools?  Moved?  What grades is he making?  Have these changed?   Is he skipping any classes?  Does he have any physical complaints?What is his mood?  Sleep?  Regular bedtime routine and hours of sleep?  Does he snore?  Is he rested in the morning?  What are his interests?  Energy level?  Any crying or feeling like crying?  Appetite?  Agitation?  Concentration on school work?  Has he thought of hurting himself or killing himself?  (or anyone else)? How much time does he spend on the computer?  iPad?  Cell phone?  Gaming?  Social media?It is up to parents to set limits and help the child follow these limits.  Most cannot just walk away or turn the electronic machine off.  These things are addicting, and once hooked, the person often checks the screen every few minutes.  The person will deny the addiction and argue that they can do without it, but then they continue to frequent the screen if left unchecked.  It is helpful to install a monitor and timer.  You don't want to discover that the child has been viewing inappropriate material or communicating with an older individual (claiming to be much younger).  The AAP (American Academy of Pediatrics) recommends a limit of 1-2 hours daily (between TV, gaming, social media).  "But I have to do my homework online!"  Some parents ultimately need to move the computer / laptop into the family room to help monitor the child's use of the device -- even with controls and monitors on the computer.  Kids get wise to unlocking these devices.   Consider having him evaluated:  initially by his primary care doctor, and then by a mental health specialist.   

Sincerely,

Susan Sparkman, M.D.  

First, have him evaluated by his primary doctor. I would check a urine analysis (UA) for infection or other abnormalities. A physical exam helps check for any physical problem.

Is he urinating more than usual during the day? Diabetes causes increased thirst, hunger, & urine output.

If the above are not a problem, I would have him start “bladder exercises” while he is urinating during the day: Go - Stop - Go - Stop - etc. Do this every time he urinates & for the entire stream. This helps set up a reflex so he will eventually do this even during sleep.

Stretch the size of the bladder by measuring the maximum volume he can hold — I recommend peeing into a small Coke bottle & mark this initially & weekly. Boys find this interesting and are usually very cooperative.

Success is usually gradual. First aim for 1-2 dry nights a week (for 2 weeks). Then, 2-3 dry nights a week. Etc. If the goal is met, offer some small reward. No punishment or humiliation otherwise- just encouragement.

8yo? He can quietly strip his bed & take it to the washroom if he wets the bed. Nothing is said.

Some children respond to a homeopathic medicine = Causticum— 5 pellets dissolved under the tongue (not chewed or swallowed) before bedtime. You might find 15C or 30C (dilution) in a store that has homeopathic medicine.

I will refrain from talking about prescription medicines initially (like Imipramine).

Hope this helps!