16 year old is very withdrawn and aggressive towards his mum

I am writing to you because I am very concerned about my 16-year-old nephew who seems to have completely withdrawn from the world. His mother is a single parent and is really struggling with him.

He spends the whole day in his room playing video games and does not go out or seem to have any friends. He sleeps funny hours and can be up most of the night in his room or watching TV downstairs and then sleeps for hours during the day. In the last school term he missed loads of days at school and seems to have effectively dropped out. He is due to start back this September [but] my sister is not sure she can get him to go. He does not talk to my sister and the only communication she gets out of him is the odd grunt. If she confronts him about staying in his room, he can get aggressive and abusive towards her.

I had not realised how bad it got until I visited him last week and witnessed one of his outbursts. I tried to reason with him to support his mother but he just blanked me. My sister broke down later as she described how stressed and worried she was. I am very concerned for both of them. I remember him as a happy-go-lucky child a few years ago and I used to have a great relationship with him. What can I do to help them?

The situation for your nephew and sister does sound worrying and you are right to be concerned. In a way it is good that you witnessed the difficulties when you visited and that your sister confided in you as this means things are now out in the open so there is an opportunity to try to get some help for them both.

Often families suffer in silence for long periods and don’t tell other family members (perhaps out of embarrassment or a belief that they should be able to cope by themselves) so it can be relief when someone is finally told.

As a concerned family member who knows both your sister and your nephew well, you do have an important role in helping them. The fact that your sister told you first and the fact that you have previously had a good relationship with your nephew is significant and I would suggest that you try to stay involved.

Your nephew does seem to be displaying some worrying symptoms and behaviours. Some of what he is displaying are normal teenage challenges such as withdrawing from parents, being rude and so on.

However, the fact that his sleep is disrupted and that he is very isolated and not attending school are particularly worrying. You would have to wonder what is going on to cause his poor mood and lack of engagement and that at the very least it is possible he could be depressed or stressed or even have more serious mental health problems.

The fact that he is not communicating about what is going on and does not have any positive outlets or social activities is a further concern. Although he is not communicating with your sister about what is happening, I imagine it must be very stressful for him as well as being difficult for your sister living with this situation.

In moving forward, the key is to try to keep the lines of communication open with your nephew. Are there times when he is more open to talk than others (perhaps later in the evening)? Are there any positive things that he does engage with inside or outside the home that your sister could encourage and build upon? Does he ever come down for dinner or watch a TV programme with your sister? Are there friends who he is still in contact with or any activities he is still interested in outside the home that you could make a special effort to encourage? Are there any rules that help such as your sister insisting he come down for his dinner or TV or that video games are disconnected at night?

There may be an opportunity to re-engage in school with the new term starting and this is something that should be explored.

As a concerned aunt you may have a particular role in helping them, both in supporting your sister practically and emotionally but also in engaging your nephew. Perhaps he might be more likely to talk to you or perhaps he might agree to go somewhere with you outside the home, etc.

It is also important for your sister to directly speak to your nephew about the problems and to discuss what help is needed. Picking a good time to have this conversation is crucial and it may be helpful for you to be involved as his aunt. The important thing is to listen and be empathic and to try to help him talk about what is going on for him.

I would also suggest that your sister seek some professional help at this point. In the first instance, she may wish to contact her GP and to discuss the ongoing situation with him/her. The GP should be able to make a referral to your local adolescent mental health service who should be best placed to assess your nephew and to provide support to the family.

An alternative source of help may be your nephew’s school. They may have access to a school counsellor or educational psychologist and may also have knowledge of local resources. You could also consider contacting the National Educational Welfare Board, newb.ie, which has a responsibility to support families when the children are struggling to attend school.

You should, of course, discuss with your nephew about getting help and explore these options with him.

Even if he is reluctant to attend any outside services initially, your sister may make the contact in the first instance (with your support if that helps) and she should get advice on how to involve and engage your nephew.

Dr. John Sharry, Irish Times Newspaper, September 2012. John writes in The Irish Times Health Plus every Tuesday.