For the Love of Health

Parenting the Teenage Mind With Confidence with Dr. Narpinder Malhi

• ChristianaCare • Season 3 • Episode 19

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0:00 | 19:29

Raising teenagers has always been difficult, regardless of the generation. But life in the modern world has introduced a whole new of challenges to navigate, for both adolescents and their parents.

It's more important than ever to stay on top of your teen's mental health and wellbeing. While that may be easier said than done, ChristianaCare psychologist Dr. Narpinder Malhi joins us to share a few clear signs that tend to tell the truth fast, to help you avoid guesswork and spiraling. From getting enough sleep and developing daily routines to limiting screen time and sugar intake, Dr. Malhi walks us through a practical, evidence-informed way to understand adolescent mental health without turning your home into a therapy office.

In addition to discussing six lifestyle pillars that influence mood and behavior, we also cover when to seek professional help based on impairment and duration, the warning signs parents often miss in high-functioning kids, why teen symptoms can show up as irritability or stomach aches, and how evidence-based therapy and medication can work together when symptoms are moderate to severe.

If you've ever worried about stigma or wondered what's "normal teen stuff" versus a real mental health concern, this episode will give you a steadier map. Listen now for a conversation that may just help save a life.

Narpinder Malhi, M.D., is director of Child and Adolescent Psychiatry Clinic and Multidisciplinary Autism Program. She has authored articles in Psychiatric Times on worldwide events and its impact on psychiatrists.


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Three Parent Check-In Questions

SPEAKER_01

How is your kid sleeping? What are they doing day-to-day life? Who do they talk with?

SPEAKER_00

You're listening to For the Love of Health, a podcast about delivering care and creating health, brought to you by Christiana Care. Hello, everyone, I'm Jason Tekarski.

SPEAKER_02

And I'm Megan McGerman. Welcome to For the Love of Health, brought to you by Christiana Care.

SPEAKER_00

Raising teenagers has always been tough, regardless of what generation you're talking about. But the addition of screen time and social media has introduced a whole new set of challenges.

Six Lifestyle Pillars That Matter

SPEAKER_02

That's why it's more important than ever to stay on top of your adolescent's mental health and well-being. We understand it's it's a bit of a puzzle, probably a 1,000, 5,000-piece puzzle. So we've brought in an expert to help us figure all of this out. We're joined by Christianity care psychologist, Dr. Narpinder Mully. Narpinder, thank you for taking time to join us today. Well, thank you so much for having me here. I think factors that contribute to mental health, different for everyone, different for every age group, and can be a little tricky, especially in that adolescent age group. What are those pillars you are looking at from a professional lens that impact mental health in this adolescent age group?

Sleep Diet Exercise Social Buffers

What Clinicians Ask Parents First

SPEAKER_01

When you talk about the pillars, research have laid out pillars of lifestyle that greatly impact our mental health, not just in adolescents, but in adults as well. And there are six pillars that we have recognized: diet, exercise, sleep, stress management, social connection, and reduction in substance use. And these pillars are kind of interconnected with each other. I'll start with sleep. If you ask an adolescent, 75% of them would say that, oh, sleep is really important for us. But then they're chronically sleep deprived. Many of them are scrolling on the phone at night, do not have good sleep hygiene, and they have to wake up early in the morning for going to high school, right? And then if you have a poor sleep, that affects your mood. And when it affects your mood, that affects your whole functioning in the school and performance. Similarly, diet, we have seen that sweetened beverages can have a negative impact on your mood. And whereas eating healthy food such as fruits, vegetables, can really be have a positive impact on psychological well-being. And exercise, really important one, but always underrated. Not doing aggressive exercise, just 20-25 minutes, moderate exercise can make a measurable impact on your mental health well-being. So one of the other things that I want to talk about is the social connections. In addition to our family relationships, having one positive social relationship outside, either with your peers or any mentors or coaches, can really buffer our adolescent from the negative impact of all the mental health risk factors. And clinically, I ask simply to the parents, how is your kid sleeping? What are they doing day-to-day life? Who do they talk with? What are the things they do to enjoy, like have fun? So these are the simple things that we ask. But in addition to that, there are also scales that are available. Pediatricians use them, such as PHQ 9, GAT-7, to monitor some of the negative impacts of these symptoms of mental health.

One Change Can Lift Everything

SPEAKER_00

So let's say we have a parent or a family member of an adolescent, and they are looking at the adolescent and can see that there's some kind of stress or concern going on there. Is there a way for that parent or family member to be able to isolate and identify which of these factors might be causing the most issue for that person?

SPEAKER_01

That's a very good question and could be hard for a parent to tease out on their own. So these behaviors don't track, they don't move along on their own. For example, if you take a sleep, sleep, when the sleep is poor, that affects their mood. And when the mood is impacted, that can lead to poor motivation. And then that will lead to reduction in their movement in day-to-day life. That can lead to fatigue, chronic fatigue, or withdrawal from social connection. So everything is in connection with each other. So single point entry can make a system-wide improvement. So I asked the parent, if you really want to help your child, monitor the sleep for one weekend, see what they're wake what time they're going to sleep, what time they're waking up in the morning, and then how many hours they're sleeping every day. And are there any sleep habits that they need to be monitoring, such as use of screen time before going to bed? Are they scrolling in the bed for hours and hours? So really important to notice that some of these things just do not work alone, but in conjunction with each other.

Screen Time Stats And Risk

SPEAKER_02

You mentioned screen time. I think screen time and social connection can go hand in hand a little bit. What do you recommend to your patients about screen time and using the phone for social connection?

SPEAKER_01

Oh, Megan, that's a tough one. Yes. Kids are not gonna like what I'm gonna say. So I hope they're not listening. There is so much out there these days about screen time. And then parents are like really struggling what actually they should do. If I give you some stats, between the age of 13 to 17 year old, 95% of our children have exposure to one or two social media platforms. That's like scary in itself for young kids like that. And then one-third of our teenagers are consistently using screen time all the time. And this is the stats we are talking about in the United States. And average time that American Academy of Pediatrics recommends is three hours. And what we know from our data is average screen time for our teenagers is close to three and a half hours every day. And when I talk with the parents, I tell them that we are already above that threshold for a risk factor for mental health. So we gotta keep a close eye on what our kids are doing day to day in regard to the screen time.

SPEAKER_00

I feel like there is a question here about is all screen time created equal? Because my generation, I'm a little bit older than Megan. Uh, my kids are late teens at this point. So their main way of staying in touch with their friends is on their phone, sometimes just via texting. For me, it was we were on the phone all night talking to our friends. That's different than social media-ish. Does that still need to be addressed and regulated in the same way as social media access?

SPEAKER_01

That's a very good question. And I do hear that from parents a lot of times that my child only connects through social media or the screen time. That's their way to and the screen time, before we go into more detail, screen time means all kinds of screens. The computer use for homework, and then there are social media use for fun. So whatever we are viewing on the screen. So some content is absolutely needed these days for their education and other things. But when we are talking about social media, that's a different game. So in regard to social media, yes, parents do have a concern, and I don't dismiss that because this is the age we live right now, that our kids are connected through social media. But at the same time, I think we also have to think about that we don't know much. We don't have much information. So if I give you a little stats there, US General uh report, which came in 2023 and then reaffirmed in 2025, said that we don't have enough data, how this is all impacting our children's brain. And there is a part in the brain, something we call prefrontal cortex. And that part of the brain is critical for decision making. And that's not developed until they are like close to 20 or a little bit over 20. For example, compare it with when you give your children permission to drive, like you get do the driving license, and then they slowly introduce their driving. You do the safe driving in low traffic areas in the beginning, and then you see how they are showing the independence, and then do let them go on the highway. So that's how you play here with social media. So you introduce them, delayed access, probably 14, 15, and after that you monitor them, keep that channel of communication open, see what's happening on there in that framework, and then take it from there.

SPEAKER_02

So we're monitoring social media and screen time. What else can parents do at home to help their children just have a positive mindset and be a happy adolescent?

SPEAKER_01

Oh, that's that's a very heavy question. Yes, there is so much we can do at home. So I would say that routines are underrated. Uh, having the same consistent sleep schedule, going to bed on time, wake up same time, like limiting the screen time for uh screen time in the bed. And those are some of the important things to keep in mind. And then another thing I tell the parents is that you have to practice yourself what you teach your kids. You can be scrolling in bed if you ask your kids not to scroll. So you have to show how how you are handling those things in your life before you tell your kids not to do it. And beyond that is the communication. I think it's really important when we give permission our kids to use social media to ask them what's happening. Is are there any things that they have seen that are concerning? How they can talk about it with you. So you can help them regulate if they're really disturbed by something going on in social media. So I think those are some of the things that parents can create that safe space in the house to help their kids uh navigate this complex world of social media.

SPEAKER_00

All right, let's move to the next step. You've, as a parent, been keeping an eye on and monitoring, and regulating and helping your kids who understand what's happening with their screen time and social media and all of that. You've been watching their diet, their sleep. You're starting to notice some things. What is that warning sign for a parent that says this might be starting to be more than I can handle myself and it's time to get a professional involved?

Teen Anxiety Depression Warning Signs

SPEAKER_01

So, in regard to that, I think if you're talking about disorders, when it gets to the point of like, oh, we need more professional help, like we have done everything at home. Now it's time to get outside the home. So important to keep in mind two things. One is impairment, and then second is duration. The reason I say is that DSM5, which is like the book of mental health disorder, has put forward these criteria and the time and the impairment, like the duration of symptoms and the impairment it's causing, is really important to make any diagnosis for any mental health disorders. So, in regard to impairment, I would say to the parents, watch for how it's impacting their life in school, how it's impacting their life at home, and how it's impacting their relationships. So those are really important things to keep in mind. For example, a really good performing child has now has a school avoidance issues, which you have never experienced before, or their grades are dropping, or they are not going out to hang out with their friends anymore. So those are the things that I would say that should concern you and should be something that you look into it that, oh, should we need more help in those cases? So another thing to keep in mind is that for parents that do not compare the symptoms you see in children with adults, they can look like very, very different. For example, when children are adolescents, they this our youth are struggling with the mental health issues. Some of the symptoms that we commonly see is irritability. They may not come to you and say, Oh, I'm very, very sad. They come, they can come across as very angry, very irritable. And then you may see reduction in their performance in school, like grades are dropping. And then another thing, atypical symptoms such as like excessive sleeping or increase in appetite. That's out of their norm, poor exercise, like they don't want to engage in the sports, they love to do it, and now they're gaining weight. So some of these symptoms are really like pertinent to our youth population. And similarly with anxiety, frequent trips to nurses station in the school. And that's what the feedback you got from your teacher. For some reason, kid is having a lot of stomach aches all the time, or headache, or irritability. They're just cranky, don't want to talk with anybody, just sit alone in the cafeteria on their own. So, not common to their like regular behaviors, but really adrift from what they do every day. So, those are some of the things I tell the parents to keep an eye on. Uh, so that's when you think about, okay, let's go and get some help.

SPEAKER_00

Are there any signs that parents or caretakers regularly miss that a professional would come in and look at later and say, hmm, this this was going on. If we had caught this earlier, we might have seen this.

SPEAKER_01

The commonly missed sign is in the high-functioning kids, where they are so hard on themselves that they put mask their symptoms to the point that either parents or teachers are never able to pick on those symptoms, and now we are in crisis. So, in those cases, I recommend the parents to have that common channel of communication open, like how they are doing check-ins regularly on day-to-day life, so that you know that if there is something wrong, you can pick on easy earlier than later.

SPEAKER_00

There is a stereotype of the teenager who knows everything and their parent knows nothing. We we've heard that one plenty before. How do you work with a teenager or the family in that situation where they've kind of done their own research and decided what they have, what their issue is, based on what their friends have are dealing with who have been diagnosed with these things, or what they've read online or seen on social media before they've even come into your office?

SPEAKER_01

I think, Jason, that's a very great question because we do see that in our clinic as well. You're talking about child having self-diagnosed disorder, but we also see with the parents also coming along with their own information, thinking that my child has this disorder as well. In those cases, I think evaluation is the first point where we start. We start from our clinical interview, taking collateral from the school, and going through the screening process very thoroughly. And then educating the child. Like sometimes the symptoms can look so similar with each other. For example, we talk about focus problems. Anyone who is having focus problems might think, oh, I have ADHD because my friend has ADHD or someone else they know have ADHD. But there are so many other things that can also affect your focus. For example, anxiety can affect your focus, depression can affect your focus. So getting the clinical expert opinion and doing a thorough evaluation, and then at the same time, educating. That's really, really important for our youth to know what actually is going on and how can we help them.

Treatment Choices And Stigma

SPEAKER_00

We also know there's a big push to get the stigma of mental health and mental health treatment removed so that people just accept it, part of their treatment plan. What do you say to parents who have that hesitancy about be it therapy or medication to help their child as well?

SPEAKER_01

So, first of all, I want to say that there are so many evidence-based treatments available these days. So we are not in short of those. So we have seen through research and aggressive research that therapy works mostly for mild symptoms. But when we have moderate to severe symptoms, that's where medications and therapy together play such a wonderful role to bring our kids to back to where they should be. And for hesitant parents, I always ask the question: if your child has a broken bone, would you hesitate to get the help? Now, with our so much research that's out there, and with the brain scans, we can see how depression and anxiety they have a neurobiological substrate. Through these scans, we can see how it affects the brain. So acting earlier is a much better solution compared to waiting another year. So let's get the help that your child needs. And then regarding stigma, that's also a very interesting question. I think that is access to care is greatly impacted by stigma, by the awareness of the parent themselves, how these mental health conditions should be treated in itself. So I tell the parents untreated symptoms will follow their child for a long period of time compared to one that gets treated and that would never come back again. So those are the things that I tell the parents. In addition, there are some stats also, like diagnosis of depression at age of 15, which is untreated, is a high risk factor for reoccurrence of another depression symptoms at age of 25. So really important to address these conditions earlier so we have lesser and lesser chances of reoccurring in the future.

Hope Prevention And Parent Advocacy

SPEAKER_02

What is that final takeaway message you want parents to understand about mental health in their kids?

SPEAKER_01

Hope. That's the one thing that I want the parents to hold on to. So I can give you a little bit of background why I said that hope is the one thing. So one thing we have seen is that even pre-pandemic and post-pandemic, suddenly we haven't come back to our normal baseline, how the anxiety depression was before and how the anxiety depression is now these days. But we have seen that prevention works. If we get help earlier, kids do get better. So we are slowly moving the needle, although, yes, it is slow moving, but still going in the right direction. And then another thing I would say is parent advocacy. The cases where we have seen that the parents have reached out to help, those are the ones where the child is able to get help. So really important for parents to stay engaged with their medical professionals, either pediatricians or anyone else that they are in contact with, so they can get the resources where to go, who to ask, and how to get help for their children. So those are some of the things that I would say that are going in the right direction. But beyond that, it's the family environment. It's a space in the house. Listen to your child. Ask them how actually they are doing, how they are doing, rather than labeling it anything. Because teenagers may not like that if you tell them how you're feeling. They want to tell you by themselves how they are feeling. So I think those are important things. And if they share some things with you, I tell the parents, don't panic, don't dismiss, don't walk away. And if you are worried, trust your instinct. Go, pick up the phone, call your pediatrician. They definitely know resources. They can connect to you with the right people and get the help that your child needs.

SPEAKER_02

Narpender, thank you so much for your insight. I think you have helped a lot of families today.

SPEAKER_01

Oh, thank you. It was such a pleasure to talk with you guys. You have asked such a meaningful and thoughtful questions. I'm really glad to be here. Thank you.

SPEAKER_02

Check out the show notes for this episode for more information on Christiana Care Behavioral Health Services.

SPEAKER_00

Make sure to keep up with For the Love of Health. Just search for Christiana Care on your favorite social media platform.

SPEAKER_02

We'll be back in two weeks with another great conversation.

SPEAKER_00

Until then, thanks again for joining us for the Love of Health.

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Megan McGuriman

Co-host