August 02, 2007


When to Worry: How to Tell if Your Teen Needs Help—and What to Do About It. By Lisa Boesky, Ph.D. AMACOM. $17.95.

      Just about every parent worries about just about every teenager. The physical, psychological, hormonal and emotional changes that come with adolescence uproot and disturb teenagers’ sense of themselves, their role in the family, their relationships with peers, their understanding of who they are and where (and with whom) they fit in, and much more. Turmoil comes with the territory – and parents, observing what is happening and trying to keep themselves and the rest of the family on a more-or-less even keel, inevitably worry.

      Much of the time, though, worry is counterproductive. Many of the upheavals of adolescence are entirely normal and to be expected. They are a necessary part of a person’s growth from childhood dependence to adult independence – the difficulty being that teens are in a halfway state in which neither parents nor the teens themselves fully comprehend just where things lie on the dependence-independence scale. And it is precisely because of the uncertainty of who and what a teenager is at any given time that some worries about teens are entirely reasonable. Lisa Boesky, a clinical psychologist specializing in troubled teens, aims in When to Worry to separate times of legitimate concern from ones in which worries, however natural, are unnecessary.

      She is mostly successful, thanks to an easy-to-follow format that lays out “worry signs” as bullet-point lists and also explains, in short paragraphs, what factors in a teen’s life may put him or her at risk in particular ways. Boesky starts by acknowledging that emotional, social, intellectual and other changes cause teens to behave in ways that are very different from the way they acted when younger – but that difference is not necessarily risk. She then considers a number of behaviors that may be worth worrying about and may require parental (and professional) intervention. Among them are being too moody, breaking rules or laws, obsessing, using alcohol and other drugs, being too concerned about food and body image, self-mutilation through cutting or burning, and losing touch with reality. To decide if a teen is too defiant, for example, look for signs that he/she gets angry and resentful at least four times a week; deliberately annoys others four or more times a week; talks back to or argues with adults two or more times a week; purposely refuses to follow rules two or more times a week; etc. Many of these sound like normal teen behaviors – and what if the teen gets angry four times in a single day? Does that count as one instance or four? Here is a weakness of Boesky’s book: the line between normal development and an out-of-control situation is always thin, and she does not make it much clearer for the distressed parents likely to consult this book (why two times or four times for some behaviors instead of, say, three?).

      But When to Worry can be very helpful if parents look at Boesky’s signs cumulatively rather than in isolation. In the defiance example, for instance, she points to such additional worry signs as aggression, property destruction, lying or stealing, and violating major rules. If enough of Boesky’s areas of concern seem applicable to your teenager, it makes sense to move on to her suggestions about what to do – although, again, not all the ideas will be practical for every family or in every situation. Thus, for defiance issues, she says to hold teens accountable (but how exactly does one remove a teen, who may be taller and heavier than his/her parent, from a situation such as attendance at church or a social function?); present a united front (but it is one thing to say parents should do this “even if you have different opinions,” and another to do it); have mental-health professionals, teachers and other adults “provide rewards and discipline for the same behaviors that parents are working on in the family home” (again, how can parents make this happen?); and so on. Boesky’s suggestions are well meant, well thought out and, in a perfect world, should go a long way toward moving teens back toward a path in which rebellion remains within societally acceptable limits. But of course the world is not perfect, and families whose teens are pushing things too far live in especially imperfect situations. This makes it particularly difficult to try to implement Boesky’s suggestions. But it must be said that her ideas are worth trying, even if parents can use them only part of the time or in some limited number of situations. When to Worry may be better at analyzing worrisome vs. merely irritating behavior than at providing families with strategies for handling highly troubled teens – but there are no easy solutions to the problems on which Boesky focuses, and her book can at the very least be a starting point for discussions with doctors, teachers, therapists and even, perhaps, with teenagers themselves.

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