This is the final article in a series about parenting adolescents.

Q: What are some mental, emotional and behavioral concerns that might need to be referred to professional health-care providers?

A: An agency in Louisville, Ky., called Seven Counties Inc. published an article elucidating adolescent emotional and behavioral symptoms that might need to be referred to health-care providers. These symptoms include:

* A frequently sad, tearful, sullen, angry or irritable mood.

* An inattentiveness to personal hygiene such as bathing or brushing teeth.

* A loss of interest in previously enjoyable activities.

* Withdrawal from friends and families resulting in social isolation.

* Difficulty completing chores, schoolwork or work responsibilities.

* Significant decline in academic performance.

* Trouble at school or frequent arguments with parents and siblings.

* Changes in sleep habits, too much or too little.

* Changes in eating habits -- too much or too little.

* Frequent aches and pains such as headaches, migraines, stomach aches, back pain.

* Odor of alcohol or a chemical smell such as marijuana.

These symptoms could mean teens are struggling with problems such as depression, anxiety, drug abuse or eating disorders. Parents need to check out their concerns with health-care providers who can refer adolescents and families to appropriate services.

Regarding anxiety, adolescents with anxiety disorders appear anxious most of the time. They worry about failing, making mistakes and embarrassing themselves. Sometimes they avoid activities in which they fear they will make mistakes or embarrass themselves. Sometimes teens stop going to school and will not leave the safety of their homes. Or they might check and recheck doors or locks. Some develop panic attacks, which are symptomatic of different types of anxiety disorders.

Not only troubled teens but seemingly happy and well-adjusted teens can develop drug-abuse problems. Common drugs abused are alcohol, illegal drugs and tobacco. Signs of impaired behavior include slurred speech, difficulty staying on task, problems maintaining sensible conversations, stumbling, losing one's balance, falling and seeming to be disconnected from others.

Even if parents do not directly observe any of the above behaviors, adolescents might become more secretive regarding their abilities and avoid home and family more than usual. Parents can take teens to agencies that test for drugs or administer over-the-counter drug tests. Alcohol can only be detected within a few hours of intake whereas marijuana stays in the system nearly one month after use.

Another concern about adolescents is depression that can be mistaken for teen moodiness. Data from the National Institute of Mental Health reports that only one in three teenagers with depression gets the treatment they need. Besides a depressed mood that indicates depression, frequent bouts of anger and irritability can also be signs of depression. Other signs are changes in sleep, appetite and disregard for personal hygiene and personal appearance, as mentioned previously.

One of the main signs of depression is a feeling of hopelessness. Sometimes feeling that kind of despair causes youth to consider suicide to end their suffering. The majority of teen suicides are completed under the influence of alcohol or other drugs.

Suicides can be impulsive or planned ahead of time. Teens at risk for suicide are victims of abuse, victims of bullying, and teens who feel isolated and alone. There is no single cause of teen suicide. The third leading cause of death in youth ages 15 to 24 is suicide.

There are risk factors for teen suicide parents need to recognize. First, adolescents who are struggling with emotional and behavioral problems or who use alcohol or other drugs have increased risks for suicide. Comments made by teens about dying and suicide should always be treated seriously. These comments might be verbal or written in emails, journals, text messages or websites.

Some teens might not talk suicide but might plan their funerals, wills or giving away prized possessions. When a depressed teen starts to feel better, has an increase in energy and seems better, that teen might have made the decision to attempt suicide. Their turn for the better is relief, knowing there is going to be an end to their suffering.

Many parents do not want to bring up the subject of suicide for fear of making things worse. Actually, the opposite is true. If parents initiate discussions with their teens regarding suicide, the teens are relieved someone wants to help. If no one ever approaches them or talks to them about their depression and suicidal thoughts, they think no one cares or understands their pain.

Regarding the general health of adolescents, parents need to teach their teens how to manage their own health care. Teens need to start with basic needs: exercise, rest, nutrition and personal hygiene. By late adolescence, many youth are living on their own and need to be fully responsible for their own health. Parents can help teens make responsible decisions about their own health care.

No matter which particular description fits an adolescent, there are basic recommendations that apply to all parents. They need to take the long view and remember their priorities are to prepare their teens to be competent, responsible, caring adults.

Parents can be the most helpful when they can keep a positive, loving, open relationship with adolescents who can be testy, hostile, moody, irritable and challenging. The adolescent process does end eventually.

Judy Caprez is associate professor of social work at Fort Hays State

University. Send your questions in care of the department of

sociology and social work.