Tool: Supporting adolescents in distress

Adolescents’ distress in humanitarian situations

• The disruption, loss and violence associated with humanitarian crises can affect adolescents in different ways.
• Nearly all adolescent girls and boys are likely to demonstrate some initial changes in their behaviour, emotions, thoughts and social relations. This is normal. It is important to remember that most adolescents will get better and will learn how to cope.
• Adolescents react to challenging circumstances in different ways. Some may have more resilience and ‘bounce back’ quickly, while some may have more difficulty functioning and require specialized support.
• The presence of supportive, caring adults or peers can make a significant difference to adolescents in distress.

Common signs of distress in adolescents

Distress can be expressed in many ways, and may vary across cultures. Common signs of distress are often divided into two types:

•  Passive: Adolescents become less active and interested in things, and don’t interact much with others.
• Aggressive: Adolescents become more active, seem to have too much energy and become aggressive, disruptive or rebellious.

Some common signs of distress in adolescents include:

Physical:

• Fatigue / exhaustion and disturbed sleep
• Excessive alertness, on look-out for danger, easily startled
• Constant aches and pains including stomach aches, headaches or dizziness Emotional (feelings)
• Fear, numbness, detachment, depression, sadness
• Intense grief (understands the consequences of loss more than a younger child)
• Guilt or regret, overwhelmed, hopeless
• Anger and irritability, anxiety and panic
• Erratic mood changes

Behavioural:

• Acting withdrawn, numb, not reacting to games or fun activities
• Social isolation, loss of interest in normal activities
• Always looking sad, never smiling, crying a lot, overly clingy or independent
• Change in appetite or eating habits
• Persistent aggressive behaviour with peers or facilitators, either physically or verbally
• Rejection of rules or disruptive behaviour such as non-stop questions or arguments
• Defiance of parents/facilitators/authority figures
• Risk-taking behaviours such as alcohol or substance abuse (linked to self-destructive feelings or feeling invincible)

Cognitive (thoughts):

• Intrusive thoughts or memories of distressing events, nightmares
• Difficulty in concentrating, easily confused or disoriented, poor memory
• Shift in view of world, philosophy, religious beliefs, loss of faith
• Preoccupation with violence, death and killing (including suicide)

Responding to common signs of distress with the Adolescent Kit 

Encourage facilitators to:

• Create an environment where adolescents feel free to talk about their ideas, hopes and worries, without fear of being judged.
• Listen supportively to adolescents and reassure them that their reactions to their circumstances are normal. It is okay to feel afraid, confused, angry or guilty.
• Allow adolescents to discuss their circumstances (if they want to) and help them to find positive ways to cope with challenges in their lives.
• Provide opportunities for adolescents to express themselves but don’t pressure them to relive their experiences or to talk about (or draw pictures of) negative events in their lives if they don’t want to.
• Include time for expressive art, drawing, singing, dancing, writing, story telling and drama to help adolescents to explore their feelings and to gain insight into their needs, concerns, ideas and opinions.
• Include a mix of energetic activities and quiet, restful activities.
• Provide opportunities for adolescents to positively influence what happens to them, for example by including them in efforts to rebuild and rehabilitate their homes and communities (if appropriate).
• Encourage adolescents to support each other through team-building and group activities.
• Observe adolescents carefully and notice persistent signs of distress or worrying behaviour that may require specialized support.

Signs of severe distress in adolescents

Some adolescents may struggle to cope with their distress, and experience great difficulty in their day-to-day lives. These could include adolescent girls and boys who:

• Experience a prolonged, severe emotional reaction to crisis, which gets worse over time and interferes with normal activities such as going to school or working;
• Show signs of distress that last much longer than in other adolescents who have experienced similar events or experiences;
• Become addicted to drugs or alcohol;
• Become excessively aggressive, to the point where they are dangerous to themselves and others;
• Become severely depressed – for example, they may feel sad all the time, cry a lot, stop eating and get increasingly thin, have trouble sleeping and constantly feel tired, and lose interest in most of the things they used to take pleasure in;
• Become suicidal and start talking about not wanting to live -- This is a real risk for adolescents;
• Experience psychosis – In rare cases, adolescents may lose touch with reality and be unable to distinguish what is real and unreal.

Responding to severe signs of distress

Remember! Facilitators are not counsellors. Counselling should only be carried out by trained and experienced staff who can ensure adolescents receive appropriate support and follow-up, and who work within agreed standards.

• Establish and train facilitators on confidential reporting and referral procedures for responding to concerns about adolescents.
• Outline and rehearse steps facilitators should take if adolescents persistently show severe signs of distress. This includes making sure they know who to report their concerns to - for example, their programme coordinator or a case manager.
• Make sure that facilitators are aware of the type of services and support available for adolescents. These could include:
  -  Activities to help adolescents deal with particularly distressing events (e.g. support groups for survivors of sexual violence);
  -  Specialized mental health care in hospitals or health clinics;
  -  Support or counselling from social workers, psychotherapists, counsellors, traditional healers and religious leaders.

See the Connecting adolescents to support tool.