Adolescence is a season of change. Hormones shift, friendships rise and fall, school demands increase, and independence grows. Some irritability, mood swings, and withdrawal are expected—it’s part of the developmental process. But sometimes, what looks like “just being a teen” is actually a sign of something deeper.
The challenge for families and educators is learning how to tell the difference. A helpful rule of thumb is to look for the 4 D’s: Duration, Depth, Domains, and Danger.
The 4 D’s Guide
- Duration: Symptoms last most days for at least two weeks (not just a bad afternoon or a tough weekend).
- Depth: Emotions feel “stuck”—sadness, emptiness, rage, or anxiety that doesn’t lift with distraction or support.
- Domains: Struggles show up in multiple areas of life—home, school, friendships, sleep, and appetite.
- Danger: Signs of self-harm, suicidal talk, reckless behavior, or substance misuse signal immediate concern.
When one or more of these “D’s” is present, it may be more than ordinary teen moodiness and time to seek help.
Red Flags by Category
Depression
- Loss of interest in once-enjoyed activities
- Hopeless or self-critical talk (“I’m a burden,” “Things will never get better”)
- Major changes in sleep (too much or too little) or appetite
- Falling grades or loss of motivation
- Increasing isolation from friends and family
Anxiety
- Avoiding school, activities, or social situations
- Frequent panic episodes or “meltdowns” when overwhelmed
- Constant worry or “what if” thinking
- Physical complaints: stomachaches, headaches, muscle tension, nausea
ADHD / Executive Dysfunction
- Chronic lateness or repeated missing assignments
- Difficulty starting or finishing tasks despite effort
- Emotional blowups after school due to all-day strain
- Forgetfulness that disrupts daily functioning
Bipolar Spectrum Disorders
- Distinct periods of high or irritable mood that stand out from the teen’s usual self
- Needing far less sleep but still feeling energized
- Fast, pressured speech and racing thoughts
- Risky behaviors: reckless driving, spending sprees, unsafe sexual activity
Eating Disorders
- Rapid or unexplained weight loss or gain
- Strict food rules or rituals (cutting food into tiny pieces, skipping meals)
- Excessive exercise, even when injured or exhausted
- Preoccupation with body image
Obsessive-Compulsive Disorder (OCD)
- Intrusive, distressing thoughts that won’t go away
- Repetitive rituals (hand washing, checking, counting) that consume large amounts of time
- Intense anxiety if routines or rituals are interrupted
Trauma / PTSD
- Nightmares or flashbacks
- Avoidance of reminders (places, people, situations)
- Hypervigilance, startling easily, always “on edge”
- Sudden anger or withdrawal without clear reason
Psychosis (rare but serious in teens)
- Hearing voices or seeing things others don’t
- Believing things that aren’t real (delusions)
- Disorganized speech or behavior that doesn’t make sense
- Needs urgent psychiatric evaluation
What Parents & Educators Can Do
- Document patterns: Keep notes on dates, examples, and changes over time—it helps professionals see the bigger picture.
- Start a caring conversation: Instead of demanding answers, share observations gently (“I’ve noticed you’ve been sleeping more and skipping friends lately, and I’m worried about you.”).
- Involve school supports: School counselors, 504 plans, and IEPs can help address academic and emotional needs.
- Seek professional evaluation: If the 4 D’s apply, reach out to a child and adolescent psychiatrist, therapist, or pediatrician.
- Respond quickly to danger: For immediate risks like self-harm, suicidal thoughts, or inability to keep the teen safe—call 911 or go to the ER. In the U.S., families can call or text 988 anytime for crisis support.
For Families in South Dakota
At Elevate Minds Psychiatry, we understand how overwhelming it can feel to sort out normal teen challenges from more serious concerns. Our team provides comprehensive evaluations and treatment for teens—in Sioux Falls and Yankton, as well as statewide in South Dakota, Minnesota, Nebraska, Iowa, and Washington through telehealth. We coordinate with schools, offer therapy and medication management, and walk alongside families so no one has to navigate this alone.
(Educational content only; not a diagnosis. If you’re in immediate danger, call 911. For 24/7 support in the U.S., call/text 988.)