Back when I was a junior doctor, I did a job working in A&E covering the child and adolescent mental health service. A 17-year-old girl was brought in one evening convinced she was dying. Her chest was tight, her heart was hammering, she had pins and needles in both hands, and she was certain she was having a heart attack. Her ECG was normal and so were her bloods.

What she was having was a panic attack.

Her mother stood at the end of the trolley looking utterly bewildered as to why this would have happened.

I asked if there had been any stressors of late and her mother shook her head.

Two weeks previously she had got her A-level results and they weren’t what she hoped for, but she’d taken it in her stride.

In fact, her mother said, she’d shrugged and simply said she was pleased to have them done, then went out with friends. She’d been cheerful ever since. The truth was though, she had not been fine at all. She’d just been very good at appearing to be.

Last Thursday was A-level results day, and this Thursday it’s the turn of GCSEs, which means that for the next fortnight, a great many families will be watching a teenager for signs of distress. Most parents know to worry about the child who cries, takes to their bedroom and stops going out.

Quite rightly, those are the ones who get a cup of tea and an arm round the shoulder. But the ones I worry about are the teenagers whose parents tell me they actually took a crashing disappointment very well.

After receiving disappointing A Level or GCSE results, many youngsters may feel they have let their parents down, but will be unlikely to admit they are struggling

That’s not to alarm people – plenty of youngsters don’t get the results they hoped for and cope fine with a let-down and change of plans. But for some, disappointment gets tangled up with shame. They feel it reflects on them as a person.

‘I didn’t get the grades’ becomes ‘I am the sort of person who doesn’t get the grades’, and then, most painfully of all, ‘I have let my parents down’.

A teenager who believes they have failed you is often the very last teen who will admit to you they are struggling, because talking about it means dragging up the thing they are working hardest not to think about.

What’s more, they can feel that admitting feeling disappointment or shame adds an extra burden to their parents, which they would then feel even more guilty about.

So, instead, they perform. This is why some of the signs worth watching for are actually the opposite of what you might expect.

Here’s what to look out for…

• Unnecessary reassurance. If your child keeps telling you they are fine when you have not asked, or tells you to stop worrying when you have said nothing, that is worth noticing. Unprompted reassurance is usually meant to close a conversation down rather than open one up.
• Being overly cheerful. Coming to terms with a setback tends to happen in waves, with good days and bad ones, and cheerfulness that switches on within hours and never dips afterwards is often maintained by effort.
• Being overly busy. The teenager who is suddenly up early, out constantly, picking up extra shifts and filling every hour looks like the picture of resilience, and sometimes that is exactly what it is. But an empty afternoon is where difficult thoughts come to the fore, and so people can create a frantic schedule to avoid this.
• Being controlled. When a young person loses control over one part of their life, they will often grip another part very tightly indeed. That might be the gym, or what they are eating, or how they look, or a bedroom that has never been tidy in its life and is suddenly immaculate. I have seen more than one eating disorder take hold in the weeks immediately after a set of exam results.
• Losing their temper. Anger is far easier for an adolescent to show than shame, and so the row will almost never be about the results. I once treated a boy who arrived in A&E with a broken hand after punching a wall during an argument with his brother about the television, three weeks after results day. It was not about the television.

If you do spot something, resist the urge to sit them down for a talk. Adolescents disclose far more easily side by side than face to face, so the car, the dog walk and the washing up are all better. And ask about the practical before the emotional. ‘What are you thinking of doing?’ tends to open a conversation, whereas starting with questions about how they are feeling risks them closing down.

There’s often a temptation to step in and try to fix things yourself, but resist this.

It takes the situation out of their hands at precisely the moment they most need to discover that they can find a way through something themselves.

Avoid minimising things by saying ‘It’s not the end of the world’. Remind them of the things they have succeeded at in life and encourage them to think constructively and focus on what opportunities and options they do have.

If you’re worried about a young person, Papyrus HOPELINE247 offers free, confidential support on 0800 068 4141, or text HOPE to 88247. Lines are open 24 hours a day, every day of the year.

Lucy's gift to her loved ones

I loved watching Lucy Davis as Dawn in The Office. For me, she made the show. I was very sad to hear last week that she has been diagnosed with stage four breast cancer.

She is 53, and was diagnosed a year and a half ago. The cancer has spread to her spine, right hip and ribs, and she has said it is incurable.

The Office star, Lucy Davis, announced that she has incurable cancer but said she is 'at peace' and wants to continue acting

Lucy has said she is at peace, that humour is what she has found most helpful, that she asked her family and friends to take the mickey out of her as much as possible, and that she wants to carry on acting and campaigning for animals rather than be treated as a patient.

She has told everyone how she wants to be treated, which is a gift to the people who love her, and they should accept it.

We should take her advice about symptoms too. What prompted her to see a doctor was a tiny hard spot. So you should get anything unusual looked at.

Since last October, every GP practice in England has had to keep its online request form open from 8.30am to 6pm, Monday to Friday. The intention was reasonable but it hasn’t gone entirely to plan.

While GPs may be seeing more people, a smaller proportion are being seen in person. My worry is what gets lost along the way. Every online request has to be read and sorted by somebody clinical, which is time taken away from seeing patients. And a form cannot tell you important clinical details.