In a study of female college students 7 out of 10 endorsed having experienced inappropriate sexual touching in their childhood. Based upon this data, one might expect there to be a colossal incidence of PTSD in these women. However, this study also found that only 2 or 3 of these women felt they suffered enduring psychological repercussions. In other words, wrong things happen but the event alone does not predict the outcome on one’s psyche.
Many of you will have heard about the ACES Study, which stands for the Adverse Childhood Experiences Scale. In this study adults completed surveys on which they endorsed whether they had experienced a series of ‘adverse’ events in their childhood, including: abuse, emotional neglect, parental mental illness, parental divorce, or a family member imprisoned. Predictably, the greater number of adverse events, the more dysfunctional (emotionally, socially, physically, or cognitively) the person was likely to become in adulthood. In fact, these events often led to unfavorable structural changes in the brain and a lowered immune system, in addition to predicted mood and concentration problems. Interestingly, on the other end of the spectrum, those who endured no adverse events were often found to have little ability to cope with any adversity. In fact, those who endured just one or possibly two adverse events, often coped the best later in life. In short, living through a modicum of adversity fosters resilience.
The pandemic has certainly been such an adverse event. And most of us are aware that the numbers of children and youth with mental health problems has sky rocketed, even in highly advantaged families. The aforementioned data may help us to understand why this is so. The children who have received a trophy just for showing up, whose parents made sure they avoided any discomfort due to their love, privilege, and ability to care for them, lack in the development of grit and problem-solving ability.
I have recently been deluged by inquiries for evaluations for youth who are convinced they “have anxiety, or ADHD, or depression.” In many respects it is a quantum leap forward for our society that youth themselves are requesting help. But I believe that our systems are not always doing them a favor by quickly assigning diagnoses, nor by offering changes in their school setting and expectations. We need adults to help youth to assess their feelings carefully and with nuance, and to level-set expectations. A very stressful event is likely to cause a transient disruption in emotions. This truth is also relevant in academia -i.e., not every teen will understand Chemistry, no matter how hard they try, and this alone does not implicate abnormality.
We all know that parents and youth have been seeking mental health services in record numbers. That youth feel free to self-identify with possible mental health issues reflects a huge advancement in the de-stigmatization occurring in our culture. In fact, my friend and colleague who is a Psychologist and Regional Director with Kaiser Permanente, shared that they have 200 open positions for mental health professionals in Northern California. They are trying desperately to hire to address the increased demand for mental health services, but many clinicians have decided they prefer to work remotely from home instead of for an organization.
As youth continue to self-identify as: anxious, trans, on the spectrum, depressed, etc, we need to help them understand what those terms really mean. Feeling worried and sad during a pandemic may just be normal, not necessarily a sign that they ‘have anxiety.’ I am concerned that many young people will go forward thinking of themselves as having conditions which are intransigent when in fact they are situational. Additionally, in our efforts to be helpful we professionals are apt to quickly label, diagnose, and offer extra help. Each of these steps may or may not be indicated, but each warrants careful consideration, lest we handicap our youth by having them think of themselves as innately and irreparably broken and in need of help.
Conversely, when a youth suffers from enduring emotional or cognitive difficulties he or she is likely to have a condition which warrants assessment, diagnosis, and intervention. But even in this process it is important to convey a sense that the student may not always have the condition, nor require extra help. In fact, most conditions require a combination of understanding and then ‘pushing against’ the symptoms. For example, treating anxiety requires facing ones fears, albeit with support and knowledge.
In a study regarding extra time on tests, in a population of students carefully diagnosed with learning disabilities, it was found that approximately half of them did not in practice use this extra time. In other words, the correlation between the condition and the remedy is not a straight line. Similarly, one must remember that a condition does not equate to a disability. Think about it, nearly all of us have a ‘condition’ of some sort, be it seasonal allergies, migraines, IBS, autoimmune disorders, ad infinitum. Most of these conditions, however, do not result in a need for accommodated testing nor any change in our environment. Thus, the proper diagnosis of a condition needs to be followed by careful consideration of implementation of changes/accommodations. To hand out accommodations which are not needed is to create a sense of self as less capable than one really is. To foster resilience is to say, “No, really, you can do this. You have as good a shot at this as anyone.”