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A It is not unusual for teenagers to be up and down with their moods and behaviour, and the impact of the pandemic on young people — their social and educational lives — has been very challenging, but what you describe in your son seems to be greater than could be explained by those factors alone. Indeed, I am concerned that your son is showing signs of depression that has developed after a longer time struggling with anxiety. Therefore, my clinical instinct is that he may have mental health issues and so require specialist assessment and support.
The reason for my directness is that it seems to be clear that after anxiety presenting over recent years as stomach aches and nausea, which was probably related to school — and, indeed, enabled him to avoid school at times — he is now showing significantly withdrawn behaviour that feels more like a clinical depression. My hypothesis is that if he has struggled with school-related anxiety (perhaps because the academic ethos of the school was not right for him to enjoy learning) and then had significant disruption to his education owing to the pandemic, it may have all come to a head now. With needing to catch up and his A-level exams approaching, he is so overwhelmed that he has disengaged and is school-refusing (see youngminds.org.uk).
The disengagement you describe feels like a depression: his normal and developmentally appropriate functioning is consistently reduced; he is isolated and withdrawn from friends, school and family; and he is dropping other activities, such as his music. This is concerning, particularly if you are struggling to engage with him. He may have a serious mental health problem and therefore requires immediate professional intervention. Speak to your GP and also see www.nhs.uk/mental-health.
You clearly feel frustrated and so alternate between a good-and-bad-cop parental approach (encourage and praise/nag and get upset), but this is unlikely to help. Being “on his case all the time” will increase anxiety and low mood. Furthermore, if there is marital discord that he witnesses — particularly if he hears that the “ugly fights” are about him — this will entrench his feelings of unhappiness and despair, and also perhaps engender a sense of guilt for the unhappiness of his parents.
To help you to understand this further, let’s start with the anxiety that he struggled with before the pandemic, which seems to be related to school. The stomach and intestine have their own nervous system — the enteric nervous system — so there is a connection between gut and brain. Therefore stress and abdominal pain are often related, and it is well documented that children and teenagers with school and learning-related anxiety will complain of stomach aches. Such children will often be referred to clinical psychologists by paediatric gastroenterologists who have investigated abdominal pain but found no physiological cause.
I wonder whether your son has seriously struggled with school — the upswing in academic pressure when he transitioned from GCSEs to A-levels seems to correlate with an increase in abdominal pain and an associated increase in school-refusal. That academic leap in learning is the greatest of all educational transitions (greater even than from A-level to university learning) because it needs a significant shift in learning style, requiring greater independent learning.
For children who show a sudden increase in school-related anxiety, a disengagement in learning, perhaps a sudden drop in performance and grades, the question has to be: why? With your son I would want to think about how he learns, whether the learning expectations are ones he struggles to cope with and whether, despite his intelligence, he might have any learning needs that relate to executive function difficulties.
Executive function is a set of mental skills that are essential for us to learn, work and manage everyday life, such as working memory, flexible thinking, planning, organisation, task management and self-control — the management system of the brain. Executive function difficulties can be masked by bright children, especially when their stage of education is more structured and directed. However, such difficulties will reveal themselves when independent learning requirements increase, which puts greater pressure on executive function.
As education becomes more challenging, focus and concentration are compromised, and organisation and task initiation are poor. This can be emotionally challenging and many children will withdraw from learning as they become overwhelmed and feel that they are failing. There may be other reasons behind the anxiety that your son has experienced, but they need to be fully understood and a cognitive assessment with a clinical psychologist would enable this (see bps.org.uk/lists/SRCN).
Therefore, while it is imperative that your son’s present mood and function are assessed for depression and he is treated for this via psychological therapy and perhaps medication, the underlying issues also need to be understood to enable him to understand himself better and get support to achieve his full potential. Depression symptoms won’t get better on their own, and if untreated can get worse or lead to other difficulties.
I also recommend that you and your husband find support to address the causes of your conflict so that the home environment does not exacerbate your son’s difficulties (see relate.org.uk). I wish you all well.