What Does an Adolescent Psychiatrist Do? Mental Health in Adolescence

What Does an Adolescent Psychiatrist Do?

An adolescent psychiatrist is a medical doctor who specializes in the diagnosis, treatment, and follow-up of mental health conditions in young people between the ages of 12 and 18. Having completed medical school and specialized training in child and adolescent psychiatry, the adolescent psychiatrist possesses in-depth knowledge of both brain and nervous system biology and the psychological developmental processes of adolescents. This dual expertise makes the adolescent psychiatrist a uniquely qualified health professional capable of providing both medication management and psychotherapy.

The scope of practice for an adolescent psychiatrist is extensive. The diagnosis and treatment of numerous mental health conditions — including depression, anxiety disorders, eating disorders, attention deficit hyperactivity disorder, behavioral disorders, substance use, post-traumatic stress disorder, obsessive-compulsive disorder, and psychotic disorders — all fall within the adolescent psychiatrist's area of expertise.

Assoc. Prof. Mehtap Eroglu summarizes the role of the adolescent psychiatrist as follows: "The adolescent psychiatrist cares for both the mind and the heart of the young person. Adolescence is a period during which the brain undergoes intensive restructuring, hormones shift, and the search for identity reaches its peak. Understanding the mental health issues that arise during this period requires an integrated assessment of both biology and developmental psychology."

The daily practice of an adolescent psychiatrist encompasses clinical interviews and assessments, diagnosis, treatment planning, psychotherapy, medication management and monitoring, family counseling, school coordination, and crisis intervention. Assoc. Prof. Eroglu, who practices adolescent psychiatry in Ankara, emphasizes that each adolescent requires an individualized treatment plan and that a standardized approach does not work for this age group.

Common Mental Health Conditions in Adolescence

Adolescence is one of the developmental periods with the highest risk for the emergence of mental health conditions. According to the World Health Organization, half of all mental health disorders begin before the age of 14. Common mental health conditions in adolescence include:

**Depression:** Depression during adolescence presents a different clinical picture than in adults. In adolescents, depression manifests through irritability rather than persistent sadness, loss of interest, declining academic performance, social withdrawal, changes in sleep patterns, appetite changes, loss of energy, and feelings of worthlessness. Self-harm behavior and suicidal thoughts are the most serious complications of adolescent depression.

**Anxiety disorders:** Social anxiety disorder, generalized anxiety disorder, panic disorder, and specific phobias are commonly seen during adolescence. Test anxiety, shyness in social settings, and performance anxiety are frequently encountered anxiety symptoms among adolescents.

**Attention deficit hyperactivity disorder (ADHD):** ADHD diagnosed in childhood may continue into adolescence, and there are also cases where ADHD first becomes apparent during the adolescent period. In adolescence, ADHD is associated with academic failure, impulsivity, risky behaviors, and low self-esteem.

**Eating disorders:** Anorexia nervosa, bulimia nervosa, and binge eating disorder frequently begin during adolescence. Body image concerns, dieting behavior, and guilt associated with eating are early warning signs.

**Behavioral disorders:** Oppositional defiant disorder and conduct disorder are seen more frequently, particularly in male adolescents. Opposition to authority, rule-breaking, aggression, and behavior that violates social norms are prominent features.

**Substance use disorders:** Adolescence is a period during which experimentation with tobacco, alcohol, and illicit substances commonly begins. The developmental characteristics of the adolescent brain make young people more vulnerable to substance dependence.

**Post-traumatic stress disorder:** This may develop following traumatic experiences such as physical or sexual abuse, neglect, natural disasters, accidents, or witnessing violence. Flashbacks, nightmares, avoidance behavior, and hyperarousal are the core symptoms.

**Obsessive-compulsive disorder (OCD):** Characterized by unwanted, repetitive thoughts (obsessions) and repetitive behaviors (compulsions) performed to neutralize those thoughts. OCD symptoms during adolescence can severely impair academic and social functioning.

Drawing on her clinical experience in Ankara, Assoc. Prof. Mehtap Eroglu notes that mental health conditions in adolescence frequently co-occur (comorbidity). "Anxiety frequently accompanies a depressed adolescent, and depression frequently accompanies an adolescent with ADHD. For this reason, a comprehensive psychiatric evaluation is essential for developing the correct treatment plan."

When Is an Adolescent Psychiatrist Needed?

Every adolescent may experience occasional mood fluctuations, conflicts with family, or stressful periods. These are a normal part of adolescence. However, certain situations warrant professional evaluation:

**Significant and unexplained decline in academic performance:** A sudden drop in grades, loss of interest in schoolwork, or school refusal in a previously successful adolescent may signal an underlying mental health condition.

**Significant changes in social relationships:** Withdrawal from one's friend group, joining a new and risky peer group, avoidance of social activities, or excessively confrontational relationships are changes that require evaluation.

**Significant changes in sleep and appetite patterns:** Excessive sleeping or insomnia, notable weight loss or gain, and sudden changes in eating habits should be carefully monitored.

**Self-harm behavior:** Self-harm behaviors such as cutting, burning, or scratching the arms or legs are a serious warning sign that requires immediate professional intervention.

**Suicidal thoughts or attempts:** Talking about death or suicide, giving away possessions, saying goodbye, or making a direct suicide attempt constitutes a crisis requiring emergency psychiatric evaluation.

**Substance use:** Professional evaluation should be conducted when use of alcohol, tobacco, or illicit substances is identified.

**Behavioral problems:** Persistent lying, stealing, physical aggression, illegal behavior, or excessive risk-taking require evaluation.

**Excessive anxiety or panic attacks:** Anxiety that restricts daily life, frequent panic attacks, or obsessive thoughts are conditions that require professional help.

Assoc. Prof. Mehtap Eroglu notes that parents frequently ask, "Is this a normal part of adolescence or is it a problem?" "The general rule is this: If the adolescent's behavior is disrupting their daily functioning, negatively affecting their relationships, or has persisted for more than one month, a professional evaluation should be conducted. When in doubt, consulting a professional is always the right step."

What Happens During the First Appointment?

The first visit to an adolescent psychiatrist can be both exciting and anxiety-provoking for the adolescent and the family alike. Knowing what to expect during the initial appointment helps reduce this anxiety.

**Before the appointment:** The first appointment typically lasts 60 to 90 minutes. Some clinics send questionnaires and history forms to the family in advance. It is helpful to bring the adolescent's school reports and any previously completed tests or reports.

**Parent interview:** A portion of the initial appointment is conducted with the parents. During this portion, information is gathered about the adolescent's developmental history, medical history, family history, onset and course of symptoms, school performance, and social relationships. The parents' observations and concerns are heard.

**Adolescent interview:** A significant portion of the appointment is conducted one-on-one with the adolescent. This portion is designed so the adolescent can share their own experiences, thoughts, and feelings in a safe environment. The psychiatrist communicates with the adolescent at eye level, without judgment and with empathy. Making the adolescent feel comfortable during this interview is critically important to the success of treatment.

**Mental status examination:** During the interview, the psychiatrist systematically evaluates the adolescent's mood, thought processes, perceptions, cognitive functioning, and behavioral characteristics. This evaluation is conducted through clinical observation and structured questions.

**Additional assessments:** When necessary, psychological tests (intelligence tests, personality tests, neuropsychological tests), blood tests, or imaging studies may be ordered. These tests are performed to support the diagnosis or to rule out possible organic causes.

**Feedback and plan:** At the end of the initial appointment, the psychiatrist shares their preliminary assessment with the family. Information is provided about the diagnosis, treatment options, and recommended plan. Questions from the family and the adolescent are answered.

Assoc. Prof. Mehtap Eroglu states that the initial appointment forms the foundation of treatment: "The first appointment is not merely an information-gathering process; it is a trust-building process. When the adolescent feels safe and understood, it directly impacts their engagement with treatment. For this reason, we do not rush the first appointment and make space for the adolescent to tell their own story."

Treatment Methods

The adolescent psychiatrist may employ various treatment methods individually or in combination, depending on the adolescent's diagnosis and individual needs.

**Psychotherapy:** The most commonly used therapeutic approaches during adolescence include:

Cognitive Behavioral Therapy (CBT) has a strong evidence base for the treatment of depression, anxiety disorders, and OCD. It helps the adolescent recognize their thought patterns and develop more functional ways of thinking. Dialectical Behavior Therapy (DBT) is effective for adolescents who exhibit emotional dysregulation, self-harm behavior, and borderline personality features. Interpersonal Therapy addresses the adolescent's relationship difficulties and develops their social skills.

**Medication:** The adolescent psychiatrist is the only mental health professional authorized to prescribe medication when needed. Antidepressants (SSRIs), anxiolytics, ADHD medications (methylphenidate, atomoxetine), mood stabilizers, and antipsychotics are medication classes that may be used during adolescence. Medication is always administered under close monitoring and at doses appropriate for the adolescent's developmental characteristics.

Assoc. Prof. Mehtap Eroglu notes that families frequently express concerns about medication: "When necessary, medication is an effective tool that can significantly improve an adolescent's quality of life. However, it is not required in every case. The decision to prescribe medication is made on an individual basis, considering the diagnosis, symptom severity, and the adolescent's level of functioning. When medication is started, side effects are closely monitored and the duration of treatment is planned."

**Family therapy:** During adolescence, changes in family relationships can be both a cause and a consequence of mental health conditions. Family therapy helps improve family communication, develop conflict resolution skills, and establish healthy boundaries.

**Group therapy:** Social skills groups, anger management groups, or diagnosis-specific support groups enable adolescents to receive peer support and develop their social skills.

**School interventions:** When necessary, the adolescent psychiatrist coordinates with the school to facilitate appropriate educational accommodations for the adolescent. Individualized education plans, testing accommodations, and guidance support fall within this scope.

Adolescent Psychiatrist vs. Psychologist

Understanding the differences between an adolescent psychiatrist and a psychologist is important for directing families to the appropriate professional.

**Adolescent psychiatrist:**
- Is a medical school graduate with specialized training
- Has the authority to prescribe medication
- Has the authority to conduct medical examinations and order diagnostic tests
- Can provide both biological and psychological treatment
- Can manage psychiatric emergencies
- Can make hospital admission decisions

**Psychologist (clinical psychologist):**
- Is a psychology graduate with a master's or doctoral degree in clinical psychology
- Does not have the authority to prescribe medication
- Is an expert in the administration and interpretation of psychological tests
- Can provide psychotherapy
- Cannot order medical tests

**Collaborative model:** In many cases, the adolescent psychiatrist and psychologist work together. The psychiatrist manages the medication regimen and coordinates the overall treatment plan, while the psychologist conducts regular psychotherapy sessions. This team approach ensures that the adolescent's biological and psychological needs are comprehensively addressed.

Assoc. Prof. Mehtap Eroglu offers the following guidance: "If you suspect your adolescent may have a serious mental health condition or if symptoms are severe, it is recommended that the initial evaluation be conducted by an adolescent psychiatrist. Following the assessment, the psychiatrist may recommend psychotherapy, medication, or both, and can refer you to an appropriate psychologist when needed."

Confidentiality and Trust

In adolescent psychiatry, confidentiality and the therapeutic relationship are cornerstones of treatment. An adolescent who does not feel safe will not openly share their feelings, and treatment will not be effective.

**Principle of confidentiality:** The adolescent psychiatrist maintains the confidentiality of information shared by the adolescent within legal and ethical boundaries. How much information will be shared with the family is determined together with the adolescent at the beginning of the treatment process. This agreement forms the foundation of the trust relationship.

**Limits of confidentiality:** However, certain situations require a breach of confidentiality. These include: when the adolescent is at risk of self-harm or suicide, when there is a risk of harm to others, when there is suspicion of abuse or neglect, and when there are mandatory reporting obligations. The adolescent is informed about these limits at the beginning of treatment.

**Balancing communication with parents:** The adolescent psychiatrist maintains a delicate balance between sharing necessary information with the family and protecting the adolescent's right to confidentiality. While the general course of treatment, general recommendations, and risk situations are shared with the family, the details of session content remain confidential.

Assoc. Prof. Mehtap Eroglu emphasizes that the trust relationship is the most critical component of treatment: "Adolescents may have difficulty trusting adults. The psychiatrist must be patient in earning the adolescent's trust, keep their word, and always be honest. The principle of confidentiality is the most important tool in building this trust. When the adolescent knows that what they say will not be relayed to their parents, they begin to share their true feelings and thoughts."

Recommendations for Parents

To support your child's mental health during adolescence, consider the following recommendations:

**Keep lines of communication open:** Even when talking to your adolescent becomes difficult, do not give up on your efforts to communicate. Adopt a stance that is nonjudgmental, curious, and attentive. Asking your adolescent "How are you feeling?" is far more effective than saying "Why are you doing this?"

**Know the difference between normal and abnormal:** Mood fluctuations, pursuit of independence, and family conflict are normal in adolescence. However, symptoms that disrupt daily functioning, persist for more than a month, and escalate in severity require professional evaluation.

**Avoid stigmatizing:** Mental health conditions are medical matters, not matters of willpower. Instead of telling your child "pull yourself together," "you are exaggerating," or "there is nothing to be ashamed of," offer supportive messages such as "I am concerned about you" and "we can find a solution together."

**Monitor social media use in a balanced way:** Excessive social media use has been associated with depression, anxiety, and body image concerns in adolescents. Rather than imposing a complete ban, help them develop healthy usage habits.

**Pay attention to your own mental health:** Adolescence is a challenging period for parents as well. Invest in your own stress management, social support network, and professional support when needed. A healthy parent is the strongest protective factor for an adolescent.

**Normalize professional help:** Frame your adolescent's visit to a psychiatrist not as "illness" or "abnormality" but as "an investment in health." Just as we consider it normal to see a doctor for physical health, seeking professional support for mental health is a natural step.

Assoc. Prof. Mehtap Eroglu offers this final reminder to parents: "You do not have to be a perfect parent. Being a good enough parent, standing by your child, and asking for help when needed takes courage. Whether in Ankara or wherever you are, you are not alone in the face of the challenges of adolescence."

Expert Opinion

According to Assoc. Prof. Mehtap Eroglu, adolescence is a critical developmental period that holds both great opportunities and significant risks. "Adolescence is the period during which the brain undergoes its second major developmental leap. The right intervention during this time can shape the adolescent's entire life trajectory. This is why it is so important to take mental health issues that arise during adolescence seriously, rather than dismissing them as 'teenage angst,' and to seek professional support when needed," she states.

Having practiced child and adolescent psychiatry in Ankara for many years, Assoc. Prof. Eroglu emphasizes that the trust relationship is the foundation of everything in adolescent psychiatry: "When adolescents find an adult who understands them, does not judge them, and respects them, they demonstrate an incredible capacity for healing. The most important skill of an adolescent psychiatrist is the ability to build this trust relationship."

Assoc. Prof. Eroglu also reflects on the increasing demand for adolescent mental health services in recent years: "The digital age, social media pressures, academic competition, and the effects of the pandemic are exposing today's adolescents to unprecedented sources of stress. At the same time, however, awareness about mental health is also growing. Young people and families are seeking help more consciously. This is a positive development, and as adolescent psychiatrists, we strive to respond to this need in the best way possible."

In Summary

An adolescent psychiatrist is a specialist physician who addresses the mental health needs of young people between the ages of 12 and 18 through a holistic approach. The adolescent psychiatrist plays a critical role in the diagnosis, treatment, and follow-up of numerous mental health conditions specific to adolescence, including depression, anxiety, ADHD, eating disorders, and behavioral problems. The ability to provide both medication management and psychotherapy makes the adolescent psychiatrist uniquely qualified. Early diagnosis and treatment of mental health conditions during adolescence is an investment that directly impacts the young person's future life. Families in Ankara who are concerned about their adolescent's mental health can seek professional evaluation and support by consulting a child and adolescent psychiatrist. It should be remembered that seeking help is not a sign of weakness but a sign of responsibility and courage.