Lydia and Melissa were identical twins. But from the time they were born, their parents realized some significant differences in the girls’ personalities. Lydia rolled with the punches, but Melissa met life’s frustrations with tears, and she always seemed fearful. Even as toddlers, their reactions to stress were not the same.

“If Lydia’s toy was taken away, she would just say, ‘Give that back,’” recalls her mother. “But if the same thing happened to Melissa, she would run into a corner and cry and cry. When I tried to help her handle the situation, she would just say, ‘No!’ and cover her head with a blanket.”

Her parents noticed that Melissa had more difficulty recovering from setbacks—even from ones as simple as falling off her bike. Lydia would fall off and get back up, but Melissa would need additional reassurance from her mom, and her mom would have to put her back on the bike to get her going again.

As the girls grew into their preteen and teen years, life became more complicated. While go-with-the-flow Lydia could bounce back from typical teen setbacks after a couple of days, Melissa would be emotionally hurt for weeks from the normal ups and downs of adolescence. During her long “down” times, which could last as long as six weeks, she would fall apart in every area of her life—physically, emotionally, and academically. With each friend breakup, bad grade, or other trouble during her teen years, Melissa sank lower and lower, until she ended up in a suicidal crisis.

While Lydia’s pattern of dealing with the stress of life was more typical of normal development, Melissa’s pattern pointed to a mental health issue.

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Once children enter puberty and their teen years, it’s not always easy to know what’s normal behavior and what’s not. So how can we tell if our son or daughter may have a mental illness and be at risk of suicide? After all, adolescence can be a dramatic and volatile stage of life even under the best of circumstances. The good news is that you can distinguish between normal developmental challenges and serious mental disorders if you understand what you’re doing. It’s a question of knowing what to look for.

Normal versus Abnormal

Let’s face it. Life can get bumpy at any stage of the journey. Normality is all about a person’s response to the ups and downs of human existence. Growing up is largely a matter of learning how to keep yourself on a relatively even keel.

In the following diagrams, the center, solid line represents a static balance point. The two dotted lines denote a variation of range above and below a balance point that is considered normal functional behavior. Anything outside the dotted lines is considered dysfunctional or disordered.

The emotional and mental fluctuations of a normally functioning person look a lot like the electrocardiographic printout of a normal heartbeat. The axis represents emotional stability. Within a certain narrowly defined range, we expect variation. Everything’s okay as long as the needle doesn’t leap too far above or fall too far below the median.

Keep in mind that each brain is different: children process new information and new situations in their own individual ways. Personality-related factors come into play at this point: some of us are natural-born “Eeyores,” while others are “Tiggers” from the get-go. There’s nothing abnormal about temperamental differences of this kind.

As this second diagram shows, it’s when the pattern becomes erratic that there’s reason for concern. If the jumps and/or the drops get too big, or when they don’t even out after a reasonable period of time, then it’s time to seek help. The goal is to keep the average somewhere within the normal range. To stay in that normal range, you want your children to be able to regulate their emotions and reactions to whatever life throws their way.

Regulation

Psychological health is measured in terms of balance: it’s a matter of staying within the normal range of emotional reactions to life’s situations. So how does the brain of a normally functioning person maintain this delicate balance? What protects us from sliding off into a ditch every time we hit a bump in the road? It’s something called regulation.

People who can stay regulated have these three basic abilities:

1. The ability to maintain an emotionally balanced state.
2. The ability to be solid enough emotionally that they aren’t easily knocked off balance.
3. When they are knocked off balance, the ability to find their way back to emotional stability within a reasonable amount of time.

This ability for regulating our emotions and reactions to life’s situations develops in three stages:

1. Other-regulation (birth to two years of age): At this stage, a child is not able to self-regulate. He must have another person (mother, father, caregiver) to do the regulating for him.
2. Co-regulation (two years old to late teens): During this phase, your child knows how to regulate herself but still needs another person to help her regain her balance when thrown off-kilter.
3. Self-regulation (usually not fully developed until late teen years or young adulthood): That’s right, we don’t full develop this skill until the late teen years. At this stage, teens know how to self-regulate and can maintain emotional balance, except in extremely intense situations where it would be normal for anyone to need another person’s assistance.

Normal Development

The development of healthy mental and emotional balance begins with your child’s secure attachment to you, which we considered in part one. As your child grows and develops, and as he achieves a certain measure of self-mastery and begins to spread his self-regulatory wings, you’ll likely begin to see a marked decrease in negative reactions to new, strange, or upsetting situations. This decrease will show up in each of the following areas:

Frequency: The number of negative reactions will lessen until they almost stop altogether as your child adjusts.

Duration: With each episode, your child’s negative reaction to the situation will get shorter until such reactions stop.

Intensity: Over time, the intensity, or “size” of the negative reaction, will diminish until it fits or matches the intensity of the situation, or disappears altogether.

If you see no decrease in the frequency, duration, and intensity of your child’s reactions over a period of time, it’s a warning sign that normal development may have stalled in some way. Just make sure you take into consideration your child’s personality traits and compare her to herself, not to other children. Bear in mind, too, that while children can often learn a new skill, response, or mode of behavior very quickly, this does not necessarily mean that they will remember to use that skill when it’s called for, or that they will have the maturity to understand when to use it without prompting.

Abnormalities

What might hinder the natural development of your child’s mental and emotional regulation? Once again, the roots of the problem are found in a child’s early attachment to parents. If you see signs of dysfunction in this area, it would be wise to have your child checked out by a qualified professional as early as possible. Here are some signs that the normal attaching process has somehow been derailed:

• Your child is often emotionally disconnected from himself, from others, and from what’s going on around him. He avoids or seems indifferent to his caregiver or her presence or absence. He regularly seems to be off in his own world.
• She tends to keep people at a distance relationally. She avoids letting others get too close to her emotionally.
• He values success and power more than relationships and exhibits a need to win at all costs.
• She is overly dependent emotionally, clingy, or always fearful of being rejected or abandoned. Her feelings are easily hurt, and she thinks it’s always her fault.
• He is anxious, confused, uncertain of what to do, or constantly afraid of doing the wrong thing.
• She has a “push-pull” relational style: “Get away from me! Don’t leave me!”
• He lacks a strong sense of self. As a result, he sticks to himself, is often a loner, has few or poor peer relationships, and doesn’t play well with others.

Developmental Issues versus Mental Health Issues: What’s the Difference?

Knowing the difference between normal development and mental health issues can be difficult when your kids hit the teen years, because the normal adolescent experience can actually mimic the symptoms of serious mental illness. There are several reasons for this.

1. Brain development. A teenager’s brain is not yet fully mature. On average, development of the brain’s prefrontal cortex is not complete until sometime in the mid-twenties. As a result, a great deal of adolescent behavior looks irrational (or semi-rational).
2. Physical development. Like brains, individual bodies grow and develop at different rates. For example, physical problems of various kinds, visual difficulties, or problems with hearing can create frustration or depression.
3. Hormonal issues. During puberty a child’s brain and body are awash in a flood tide of hormones. These hormones stimulate growth and regulate sexual development. Unfortunately, they can also create chemical imbalances in the brain and produce wildly fluctuating emotions. This is particularly true in the case of teenage girls. Moms who have experienced postpartum depression or who know what it’s like to feel out of sorts during their menstrual cycle can keep an eye out for similar symptoms in their growing daughters.
4. Inability to regulate emotions. Kids are unable to regulate emotional ups and downs without another person’s help at least until their late teens. Sadness, withdrawal, malaise, or anxiety in an adolescent may simply mean that you need to ask questions and get more actively involved in your teen’s life. Remember, at this age your teen tends to view everything—a breakup with boyfriend, the loss of a family pet, or a tiff with a sibling—as a major crisis.
5. Parental expectations. Finally, as parents we need to make sure we aren’t driving our children to despair by expecting too much of them. We need to allow each of our kids to grow at their own pace. Pushing them to excel in academics or sports or to develop at an accelerated rate will probably do more harm than good. Parental pride is fine in its proper place, but your child’s well-being needs to always be your number-one consideration.

Sorting It Out

Distinguishing between normal and abnormal during the grow ing stages of your child’s life can be a delicate business. Immaturity, disappointment, self-doubt, and a host of other normal adolescent afflictions can easily cloud the picture. But that doesn’t mean that parents can’t help their kids sort things out and come up with a workable plan for keeping the emotional boat upright and afloat. We most certainly can. It’s just a matter of staying aware and involved.