Spreading First Aid for Teens’ Mental Health by Training Adults to Help

MindShift

iStock/Anna_Isaeva

During the vulnerable transition from childhood to young adulthood, many kids grapple with low self-esteem, anxiety and depression. According to the National Alliance on Mental Illness, 20 percent of adolescents between the ages of 13-18 live with a mental health condition. In fact, a recent study found that nearly 25 percent of teenage girls and almost 10 percent of teen boys suffer from depression by the age of fourteen.

When kids struggle, their emotional problems often unfold in the classroom, affecting their ability to concentrate and straining interactions with teachers and peers. Left untreated, mental health concerns can contribute to high school dropout rates. A 2001 survey conducted by the Department of Education found almost 50 percent of students age 14 and older with mental illness withdraw from school, and a recent study, published in the journal BMC Public Health discovered males with psychological disorders are five times more likely to quit attending school.

While educators often want to assist these students, many feel unsure of what to say, especially during a mental health crisis. But a community-wide intervention called Mental Health First Aid seeks to equip teachers, parents and caregivers with the information and skills they need to intervene during a mental health emergency.

MHFA training, referred to as “CPR for the mind,” teaches educators and caretakers how to recognize, understand and respond to signs of psychological distress. Educators across the country can receive “Youth” First Aid training, a unique version of MHFA teaching individuals how to recognize the psychological challenges that adolescents face.

“The course taught me how to get students the help they need, especially in an emergency,” says Tori Wardrip, an art teacher at Lewis and Clark Middle School in Billings, Montana.

Wardrip completed the training in June. The full-day course taught her several First Aid skills, including how to recognize the signs of a panic attack, psychosis and PTSD. She also learned how to assess for suicide risk by asking questions like, “Are you having thoughts of hurting yourself?” and “Are you in danger?”

Spreading the Word

Since 2013, more than 200,000 educators have been trained in Youth Mental Health First Aid, according to Betsy Schwartz, vice president of public education at the National Council for Behavioral Health; hundreds of middle schools, high schools and 27 state departments of education have implemented it. Schwartz says the results have been positive, resulting in $30 million in grant funding from the Substance Abuse and Mental Health Service Administration’s (SAMHSA) Now is the Time Project AWARE grant initiative.

The initiative also has garnered support from pop star Lady Gaga, who wants to help break silence around mental health. In 2012, the singer and her mother, Cynthia Germanotta started the “Born This Way Foundation,” a nonprofit organization committed to raising awareness about mental wellness, especially for young people. Recently, the foundation partnered with the National Council for Behavioral Health to sponsor Mental Health First Aid training across the nation.

The program trains people how to support and de-escalate an emergency crisis by using a five-step action plan, called ALGEE, according to Schwartz. “ALGEE stands for assessing for suicide risk/self-harm, listening nonjudgmentally, giving reassurance and information, encouraging professional help, and encouraging self-help and additional support strategies,” says Schwartz.

She adds that educators and caregivers who participate in the daylong YMHFA training learn how to recognize risk factors and warning signs of youth mental health challenges. Individuals are also informed about the prevalence of mental illness among adolescents, learning how protective factors, like available mental health resources, can contribute to psychological resilience.

During training, YMHFA participants practice these skills by role-playing with each other. Similar to medical First Aid training, role-play mimics realistic emergencies, allowing people to rehearse what they might “say” and “do” in an actual mental health crisis.

While the training focuses on mental wellness, instructors also discuss topics, like bullying and attention difficulties, teaching educators how these behaviors contribute to mental health concerns, like depression, suicidality and eating disorders.

At Lewis and Clark, Wardrip has put her new knowledge to good use. Since completing the training, she has become the “go to” person for the faculty’s behavioral health questions, serving as a bridge between educators and counselors.

She’s also using her new knowledge to teach students how to look out for each other.

“This year, using my First Aid training, I plan to teach my kids how to recognize the signs of a mental health emergency. If a peer is in danger, I want them to know how to get help,” she says.

Additional Resources

recent report, released by the “Born This Way Foundation,” found that even though adolescents value their psychological well-being, less than half are talking about their mental health. However, research shows teaching kids how to find psychological resources can make a world of difference, helping to break the shame and stigma that surrounds mental illness.

Schwartz says, educators and caregivers who participate in the daylong YMHFA training will learn five First Aid skills, including:

  1. Recognizing risk factors and warning signs of youth mental health challenges
  2. Understanding the prevalence of mental health conditions among young people
  3. Understanding protective factors that contribute to psychological resilience
  4. Learning the ALGEE five-step action plan
  5. Identifying community resources that can help support adolescents and their families

With support from the Born This Way Foundation, the National Council for Behavioral Health hopes to train 150,000 additional educators, parents and caregivers before the end of 2017.

Educators who are interested in setting up a YMHFA training can find courses here. See Lady Gaga and Prince William chat on FaceTime about mental health from earlier this year:

Juli Fraga is a psychologist and writer in San Francisco. You can find her @dr_fraga on Twitter.  

Advertisements

Things Parents Of Children With ADHD Wish Someone Had Told Them

HealthCentral

iStock-660743358.jpg
Credit: istock

Parenting a child with ADHD isn’t always easy. Because every child with ADHD is unique and comes with a different set of challenges, there isn’t a roadmap to tell you what to do. Every day, it seems, you are faced with a new set of trials to overcome. When you finally think you have control of one issue, a different one pops up.

The following are six things parents of children with ADHD wish that someone had told them when their child was diagnosed.

YOU ARE THE EXPERT AND THE ADVOCATE

When your child is diagnosed with a medical condition, you might expect doctors to understand how the condition impacts everyday life. But not every doctor understands ADHD.

Some doctors might diagnose based on a few questions, and some might suggest medication without a thorough evaluation. Some might not understand that ADHD is more than just the major symptoms. While doctors today are more knowledgeable about ADHD than 10 or 20 years ago, you as the parent still need to be the expert.

Read everything you can about ADHD and how symptoms manifest in children. Read the pros and cons of medication and other treatment methods. If your doctor can’t provide answers, ask for a referral to a specialist. As the parent of a child with ADHD, it isn’t enough to rely on others for answers — you need to seek them out.

YOUR CHILD NEEDS AN ADVOCATE

Children with ADHD are often seen as lazy. They are frequently immature for their age, and they may need extra assistance or accommodations in school to help them succeed. Some children may need extra help navigating social situations.

When you have a child with ADHD, your job of parent extends to the role of advocate. You might need to regularly meet with teachers, attend IEP or Section 504 meetings, discuss treatments with doctors, explain your child’s behavior to classmates’ parents, and work to find social settings where your child feels comfortable. In each of these situations, you are the parent and the advocate. By acting as both, you can make sure your child has every chance of success.

YOU SHOULD BE ON THE LOOKOUT FOR OTHER CONDITIONS

ADHD rarely travels alone. Learning disabilitiesanxiety, and depression are common coexisting conditions.

Sometimes symptoms or challenges from these conditions overlap, and it is hard to know which condition is at the root of some behaviors. Your child has the best chance at success in life with an accurate diagnosis and treatment.

It’s worth your while to know the major symptoms of conditions that are associated with ADHD. That way, if you have a concern, you can immediately bring it to the attention of your child’s doctor or school and have it addressed.

SCHOOLS DON’T ALWAYS AGREE WITH YOUR ACCOMMODATION REQUESTS

To you, it might seem like common sense that your child needs extra time for tests, an aide to help him stay focused, that he not be denied recess to complete work, or any other accommodation you believe will help. But schools don’t always agree.

Meetings about ADHD accommodations can sometimes become contentious, and sometimes parents end up frustrated with the process. It helps to understand the laws regarding accommodations and commonly-used accommodations in other schools.

As a parent of a child with ADHD, you should become especially familiar with the laws governing IEPs and Section 504. It is going to be up to you to request evaluations and meetings, and to advocate for your child every step of the way.

YOUR CHILD IS GOING TO BE FRUSTRATING, BUT HE IS STILL JUST A CHILD

There are going to be days when you are pretty sure your child is being purposely defiant. You might think, “she must have heard me and is clearly ignoring me,” or “he can’t possibly have forgotten to do that, he is being stubborn.” If your child has ADHD, he probably isn’t being defiant on purpose.

She probably isn’t “acting out to get your attention.” Your child isn’t trying to be ADHD. Your child has ADHD.

Children who are impulsiveforgetfuleasily distracted, and can’t sit still for very long have symptoms of ADHD.

As a parent, it’s your job to love your child anyway. It’s your job to remember that as frustrating as it can get, your child is still just a child. He or she still wants your acceptance. In one way, it isn’t any different than any other child; love is what your child needs most.

YOU SHOULD TAKE TIME TO CELEBRATE YOUR CHILD

It’s easy to get caught up in the constant cycle of trying to improve your child’s behavior, improve grades, to get your child to listen when spoken to, and get along with siblings.

When you have a child with ADHD, there is always something that can be improved. But don’t forget to celebrate your child’s successes, no matter how small, and his or her unique way of looking at the world. Take the time to enjoy your child’s sense of humor, enthusiasm for life, endless curiosity, and boundless energy.

Research and Strategies from Challenge Success: Spotlight on Woodside Priory School

NAIS

“People don’t go to school to learn. They go to get good grades, which brings them to college, which brings them the high paying job, which brings them to happiness, or so they think.”
—Kevin Romoni, Grade 10, Doing School

Kevin was one of five students I shadowed for a year at a high-achieving high school in Silicon Valley. His classmates echoed his belief that future success was inextricably tied to high school performance. This narrow notion of success as defined by grades, test scores, and college admission ultimately took its toll on these teens. The pressure to over-achieve led to high levels of physical and emotional distress and exhaustion.

The students’ stories and voices became a critical call to action and a catalyst to starting Challenge Success, a nonprofit school reform organization that advocates for a more comprehensive definition of success to foster school environments where students thrive both academically and emotionally. Our interventions include the Challenge Success School Programparent education and professional development workshops, and our student survey, the Stanford Survey of Adolescent School Experiences.

Defining the Problems

Since 2007, Challenge Success has surveyed more than 100,000 middle and high school kids in high-achieving public and independent schools across the country. We have found that Kevin’s narrow definition of success is overwhelmingly prevalent. In our fast-paced culture, kids are busy in and out of school, often maintaining schedules that are more hectic than those of the adults around them. Many students and parents feel they have no choice but to continue, day after day, at this frantic pace. They believe the prospect of a good education, future employment, and financial security are at risk if they don’t. But this “more is better” lifestyle takes a toll on student well-being and learning in many ways.

Sleep Deprivation
Our research shows that high school students get, on average, about six and a half hours of sleep each night, even though medical experts recommend eight to ten hours of sleep for healthy development. We know that there is a correlation between sleep deprivation and depression, anxiety, memory function, bullying, and car accidents in adolescents, according to the Stanford Medicine News Center.

Academic Worry and Emotional Distress
Nearly 75 percent of high school students surveyed report being often or always stressed by schoolwork. In fact, the National Association of Health Education Centers reports that academics are the leading cause of stress for middle and high school-aged students, and that prolonged stress can be debilitating.

Academic Disengagement
Almost 40 percent of high school students we surveyed reported “doing school,” working hard but rarely finding schoolwork interesting, meaningful, or valuable. The pressure to perform often leads to a loss of engagement with learning and perpetuates a culture of “robo-students” — students who focus on getting the grades but do not find intrinsic motivation, meaning, or joy in the process. Our research shows that students who are not fully engaged affectively, behaviorally, and cognitively are less likely to achieve in school and more likely to suffer from symptoms such as depression and anxiety.

Cheating and Drug Use
When students are under pressure and lack sufficient sleep, they often engage in cheating behavior. Challenge Success research shows that 88 percent of high school and 75 percent of middle school kids admit to cheating in one form or another. Students tell us that “it’s cheat or be cheated,” and they feel they have no other options but to break the rules. Health professionals have also observed an increase in the overuse of prescription stimulants such as Adderall and Ritalin, known as “study drugs.” Many adolescents believe that study drugs help them stay up and focus, and they are unaware of the severe health risks associated with abusing prescription medications.

All Kids Need Their SPACE in School

So, how do we break this cycle? How do we change our schools to emphasize meaningful and joyful learning and a broader definition of success? Challenge Success has used its research-based SPACE framework to guide solution-focused reform efforts with more than 150 schools in our School Program since 2003.

We typically begin working with our partner schools by surveying students to identify the school’s most pressing concerns, and we ask each school to bring a multi-stakeholder team — administrators, faculty, parents, counselors, and students — to our annual conferences. We encourage each school to examine its specific circumstances and then create a site-specific plan for change with a Challenge Success coach. Each school’s needs are unique and solutions can focus on one or more of the SPACE framework categories. For instance, schools might focus on professional development for deeper, interdisciplinary learning, and they may decide to strengthen teacher-student relationships via advisories.

One School’s Spotlight on the “S” in SPACE

Photo Credits: Woodside Priory School

One NAIS-member school, Woodside Priory, a 6–12 grade day and boarding school of 350 students in Northern California, participated in the Challenge Success School Program for several years. The school has shown extraordinary growth in the “S” category of SPACE, examining “students’ schedule & use of time.” Specifically, Woodside Priory recognized that student engagement and well-being could be improved by addressing two highly interrelated issues: the bell schedule and homework practices.

A Saner School Schedule
The school schedule has a substantial impact on engagement, teaching, and learning; it affects the entire school community and is an important lever for school improvement. Woodside Priory’s leaders recognized the need to make a change to the bell schedule based on results from the Challenge Success student survey. After learning that their students were only getting on average 6.5 hours of sleep each night, they decided to move the start time of the school from 8 a.m. to 8:30 a.m. four days a week, and to start even later (9:45 a.m.) once a week. This allowed students the opportunity for additional sleep each morning, and had the extra bonus of increased professional development time for faculty.

That year, they also changed from a traditional schedule to a modified block schedule. This meant that students had five classes per day for 65 minutes each, instead of seven classes for 45 minutes each. Students felt the benefits immediately. With more time in each class, they had more opportunities to engage deeply with the material and felt less rushed throughout the day with fewer transitions.

The shift to a block schedule also dramatically changed how students experienced homework. In the past, kids typically had homework from seven classes, every night. In a block schedule, students only had homework due for the five classes that met the next day. The result was that students had more control over how they managed their homework load and had more flexibility after school and in the evenings.

Homework: Quality vs. Quantity
Educators, parents, and students often confuse the concepts of “rigor” and “load.” Rigor is associated with depth of learning and mastery of a subject matter. Load is a measurement of the amount of work that is assigned to students. Research shows that students in courses that assign more hours of homework do not necessarily experience greater mastery or in-depth understanding. Because of this, Woodside Priory sought to reduce the daily quantity of homework and increase the quality of their assignments. They decided to place student learning, engagement, and well-being at the forefront of their new approach to homework.

The In-Class Experiment – Homework Week
To get started, Woodside Priory’s Head of Upper School Brian Schlaak asked all teachers in the upper school to allow 30 minutes during each class period to get homework done in class for one week.

Here is what they learned:

  • Teachers learned that students take varying amounts of time to do homework; some get stuck and need help right away, and others are done in ten minutes. This challenged teachers’ assumptions about how much time was actually needed to complete each assignment.
  • Teachers learned that sometimes students don’t understand the purpose of a homework assignment and, as a result, can perceive it as “busy work.”
  • Teachers noted that they saw an increase in the quality of the students’ work — students had time to ask the teacher for assistance during class and they seemed more engaged.
  • Teachers noticed that many students were not using appropriate note-taking methods when reading assignments for class. This observation prompted teachers to support students with additional guidance and study skills to reduce wasted time on tasks and to increase retention and mastery.
  • Students learned that they can be much more productive with homework when they aren’t on social media or other distracting devices, when they aren’t exhausted at the end of the day after sports practices and other extracurricular activities, and when they have a designated amount of time to focus on their work.

Woodside Priory’s Homework Week exercise led to a fruitful discussion and support for teachers to experiment with many different approaches to homework, including: self-graded assignments; revise and resubmit opportunities; homework-free nights, vacations, and classes; and optional homework. Teachers worked on better aligning their homework assignments with the enduring understandings of their courses, and observed which approach to homework seemed best for reducing load while maintaining appropriate rigor.

This year, the school continues to focus on enduring understandings, coupled with authentic assessment work, to eliminate extraneous content and busywork, and they are orienting their curriculum around five learning competencies — communication, collaboration, creativity, critical thinking, and resilience.

Redefining Success

We know that school reform can be a daunting task. Rather than focusing on educational fads, our strategies are founded in educational research and built to have long-lasting effects in schools.

As a result of our work with schools across the country, students:

  • sleep more,
  • cheat less often,
  • engage in learning,
  • worry less,
  • feel supported by teachers, and
  • perform just as well or better in school.

By embracing a new definition of success, we are ultimately defining what we value. Our students shouldn’t have to choose between health or stress, and academic rigor or engagement. By challenging the current, narrow view of success, students, families, and schools can find a healthy balance and thrive.

More information about the SPACE Framework and our research can be found in our book, Overloaded and Underpreparedwhite papers, and vodcasts. Continue this conversation on Facebook and Twitter.

Why Are More American Teenagers Than Ever Suffering From Severe Anxiety?

The disintegration of Jake’s life took him by surprise. It happened early in his junior year of high school, while he was taking three Advanced Placement classes, running on his school’s cross-country team and traveling to Model United Nations conferences. It was a lot to handle, but Jake — the likable, hard-working oldest sibling in a suburban North Carolina family — was the kind of teenager who handled things. Though he was not prone to boastfulness, the fact was he had never really failed at anything.

Not coincidentally, failure was one of Jake’s biggest fears. He worried about it privately; maybe he couldn’t keep up with his peers, maybe he wouldn’t succeed in life. The relentless drive to avoid such a fate seemed to come from deep inside him. He considered it a strength.

Jake’s parents knew he could be high-strung; in middle school, they sent him to a therapist when he was too scared to sleep in his own room. But nothing prepared them for the day two years ago when Jake, then 17, seemingly “ran 150 miles per hour into a brick wall,” his mother said. He refused to go to school and curled up in the fetal position on the floor. “I just can’t take it!” he screamed. “You just don’t understand!”

Jake was right — his parents didn’t understand. Jake didn’t really understand, either. But he also wasn’t good at verbalizing what he thought he knew: that going to school suddenly felt impossible, that people were undoubtedly judging him, that nothing he did felt good enough. “All of a sudden I couldn’t do anything,” he said. “I was so afraid.” His tall, lanky frame succumbed, too. His stomach hurt. He had migraines. “You know how a normal person might have their stomach lurch if they walk into a classroom and there’s a pop quiz?” he told me. “Well, I basically started having that feeling all the time.”

Alarmed, Jake’s parents sent him to his primary-care physician, who prescribed Prozac, an antidepressant often given to anxious teenagers. It was the first of many medications that Jake, who asked that his last name not be used, would try over the next year. But none seemed to work — and some made a bad situation worse. An increase in dosage made Jake “much more excited, acting strangely and almost manic,” his father wrote in a journal in the fall of 2015. A few weeks later, Jake locked himself in a bathroom at home and tried to drown himself in the bathtub.

He was hospitalized for four days, but soon after he returned home, he started hiding out in his room again. He cried, slept, argued with his parents about going to school and mindlessly surfed the internet on his phone. The more school he missed, the more anxious he felt about missing school. And the more anxious he felt, the more hopeless and depressed he became. He had long wanted to go to the University of North Carolina at Chapel Hill, but now that felt like wishful thinking.

Not every day was bad. During spring break in 2016, Jake’s father wrote: “Jake was relaxed and his old sarcastic, personable, witty self.” A week later, though, Jake couldn’t get through a school day without texting his mother to pick him up or hiding out in the nurse’s office. At home, Jake threatened suicide again. His younger siblings were terrified. “It was the depth of hell,” his mother told me.

That summer, after two more hospitalizations, Jake’s desperate parents sent him to Mountain Valley in New Hampshire, a residential treatment facility and one of a growing number of programs for acutely anxious teenagers. Over the last decade, anxiety has overtaken depression as the most common reason college students seek counseling services. In its annual survey of students, the American College Health Association found a significant increase — to 62 percent in 2016 from 50 percent in 2011 — of undergraduates reporting “overwhelming anxiety” in the previous year. Surveys that look at symptoms related to anxiety are also telling. In 1985, the Higher Education Research Institute at U.C.L.A. began asking incoming college freshmen if they “felt overwhelmed by all I had to do” during the previous year. In 1985, 18 percent said they did. By 2010, that number had increased to 29 percent. Last year, it surged to 41 percent.

Those numbers — combined with a doubling of hospital admissions for suicidal teenagers over the last 10 years, with the highest rates occurring soon after they return to school each fall — come as little surprise to high school administrators across the country, who increasingly report a glut of anxious, overwhelmed students. While it’s difficult to tease apart how much of the apparent spike in anxiety is related to an increase in awareness and diagnosis of the disorder, many of those who work with young people suspect that what they’re seeing can’t easily be explained away. “We’ve always had kids who didn’t want to come in the door or who were worried about things,” says Laurie Farkas, who was until recently director of student services for the Northampton public schools in Massachusetts. “But there’s just been a steady increase of severely anxious students.”

For the teenagers who arrive at Mountain Valley, a nonprofit program that costs $910 a day and offers some need-based assistance, the center is usually a last resort after conventional therapy and medications fail. The young people I met there suffered from a range of anxiety disorders, including social anxiety, separation anxiety, post-traumatic stress disorder and obsessive-compulsive disorder. (Though OCD and PTSD are considered anxiety disorders at Mountain Valley and other treatment centers, they were moved into separate categories in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders.)

Photo

Sharon McCallie-Steller, a therapist, during a counseling session at the Mountain Valley residential program in New Hampshire.CreditSasha Rudensky for The New York Times

Mountain Valley teenagers spend a lot of time analyzing — and learning to talk back to — their anxious thoughts. During one group session in the summer of 2016 in a sunlit renovated barn with couches, a therapist named Sharon McCallie-Steller instructed everyone to write down three negative beliefs about themselves. That’s an easy exercise for anxious young people (“Only three?” one girl quipped), but McCallie-Steller complicated the assignment by requiring the teenagers to come up with a “strong and powerful response” to each negative thought.

She asked for volunteers. First, residents would share their negative beliefs and rebuttals with the group. Then others would act those out, culminating in a kind of public performance of private teenage insecurity.

Jake raised his hand. By then, he was in his third month at Mountain Valley, and he looked considerably less anxious than several of the newcomers, including one who sat slumped on a couch with his head in his hands. “I’m free to play the part of terrible, evil thoughts for anyone who needs them,” Jake said with a smile. He had already spent weeks challenging his own thinking, which often persuaded him that if he failed a single quiz at school, “then I’ll get a bad grade in the class, I won’t get into the college I want, I won’t get a good job and I’ll be a total failure.”

At Mountain Valley, Jake learned mindfulness techniques, took part in art therapy and equine therapy and, most important, engaged in exposure therapy, a treatment that incrementally exposes people to what they fear. The therapists had quickly figured out that Jake was afraid of failure above all else, so they devised a number of exercises to help him learn to tolerate distress and imperfection. On a group outing to nearby Dartmouth College, for example, Jake’s therapist suggested he strike up conversations with strangers and tell them he didn’t have the grades to get into the school. The college application process was a source of particular anxiety for Jake, and the hope was that he would learn that he could talk about college without shutting down — and that his value as a person didn’t depend on where he went to school.

Though two months in rural New Hampshire hadn’t cured Jake of anxiety, he had made significant progress, and the therapy team was optimistic about his return home for his senior year. Until then, Jake wanted to help other Mountain Valley teenagers face their fears.

Among them was Jillian, a 16-year-old who, when she wasn’t overwhelmed with anxiety, came across as remarkably poised and adultlike, the kind of teenager you find yourself talking to as if she were a graduate student in psychology. Jillian, who also asked that her last name not be used, came to Mountain Valley after two years of only intermittently going to school. She suffered from social anxiety (made worse by cyberbullying from classmates) and emetophobia, a fear of vomit that can be so debilitating that people will sometimes restrict what they eat and refuse to leave the house, lest they encounter someone with a stomach flu.

Jillian listened as Jake and other peers — who, in reality, liked her very much — voiced her insecurities: “I can’t believe how insignificant Jillian is.” “I mean, for the first three weeks, I thought her name was Susan.” “If she left tomorrow, maybe we wouldn’t even miss her.”

At the last one, Jillian’s shoulders caved, and her eyes watered. “I don’t want to do this,” she said, looking meekly at McCallie-Steller.

“If it’s too much, you can stop,” the therapist said, but Jillian considered the offer only long enough to reject it. She straightened her back. “No, I feel like I need to do this,” she announced. “I have a week and a half left. If I can’t get through something like this here …”

Her voice trailed off, but the implication was clear: The real world would be much more anxiety producing — and much less forgiving.

Photo

Jillian in her room in Florida.CreditSasha Rudensky for The New York Times

Anxiety is the most common mental-health disorder in the United States, affecting nearly one-third of both adolescents and adults, according to the National Institute of Mental Health. But unlike depression, with which it routinely occurs, anxiety is often seen as a less serious problem.

“Anxiety is easy to dismiss or overlook, partially because everyone has it to some degree,” explained Philip Kendall, director of the Child and Adolescent Anxiety Disorders Clinic at Temple University in Philadelphia. It has an evolutionary purpose, after all; it helps us detect and avoid potentially dangerous situations. Highly anxious people, though, have an overactive fight-or-flight response that perceives threats where there often are none.

SHARE YOUR STORY ABOUT ADOLESCENT ANXIETY

Has teenage anxiety affected you or a family member or friend? What was the path to recovery like, if there was one? What challenges do today’s students with anxiety face? Please share your experiences. A selection of reader responses will be published in the coming days.

Required fields are marked with an asterisk.

Continue

But sometimes there are good reasons to feel anxious. For many young people, particularly those raised in abusive families or who live in neighborhoods besieged by poverty or violence, anxiety is a rational reaction to unstable, dangerous circumstances. At the Youth Anxiety Center’s clinic in the Washington Heights neighborhood of Manhattan, which serves mostly poor and working-class Hispanic youth, teenagers would object to the definition of anxiety I heard often at Mountain Valley: “The overestimation of danger and the underestimation of our ability to cope.”

“The fears can be very real for our kids,” explained Carolina Zerrate, the clinic’s medical director. “Oftentimes their neighborhoods are not safe, their streets are not safe and their families can feel unsafe if there’s a history of trauma and abuse.” The contemporary political climate can also feel “incredibly unsafe for the community of kids we serve,” Zerrate adds, explaining that many have undocumented family members.

And yet addressing anxiety is low on the priority list in many economically disadvantaged communities. Kids who “act out” are often labeled defiant or aggressive, while those who keep to themselves — anxiety specialists call them “silent sufferers” — are overlooked or mistaken for being shy. “If you go to a public school in a struggling urban area, teachers will talk about drugs, crime, teen pregnancy, violence,” Kendall says. “When you start to talk about anxiety, they’re like, ‘Oh, those are the kids we like!’ ”

Teenagers raised in more affluent communities might seemingly have less to feel anxious about. But Suniya Luthar, a professor of psychology at Arizona State University who has studied distress and resilience in both well-off and disadvantaged teenagers, has found that privileged youths are among the most emotionally distressed young people in America. “These kids are incredibly anxious and perfectionistic,” she says, but there’s “contempt and scorn for the idea that kids who have it all might be hurting.”

Photo

A resident taking part in equine therapy at Mountain Valley.CreditSasha Rudensky for The New York Times

For many of these young people, the biggest single stressor is that they “never get to the point where they can say, ‘I’ve done enough, and now I can stop,’ ” Luthar says. “There’s always one more activity, one more A.P. class, one more thing to do in order to get into a top college. Kids have a sense that they’re not measuring up. The pressure is relentless and getting worse.”

It’s tempting to blame helicopter parents with their own anxiety issues for that pressure (and therapists who work with teenagers sometimes do), but several anxiety experts pointed to an important shift in the last few years. “Teenagers used to tell me, ‘I just need to get my parents off my back,’ ” recalls Madeline Levine, a founder of Challenge Success, a Stanford University-affiliated nonprofit that works on school reform and student well-being. “Now so many students have internalized the anxiety. The kids at this point are driving themselves crazy.”

Though there are cultural differences in how this kind of anguish manifests, there’s considerable overlap among teenagers from different backgrounds. Many are anxious about school and how friends or teachers perceive them. Some obsess about family conflicts. Teenagers with OCD tend to worry excessively about what foods they should eat, diseases they might contract or whatever happens to be in the news that week. Stephanie Eken, a psychiatrist and the regional medical director for Rogers Behavioral Health, which runs several teenage-anxiety outpatient programs across the country and an inpatient program in Wisconsin, told me that in the last few years she has heard more kids than ever worry about terrorism. “They wonder about whether it’s safe to go to a movie theater,” she said.

When I asked Eken about other common sources of worry among highly anxious kids, she didn’t hesitate: social media. Anxious teenagers from all backgrounds are relentlessly comparing themselves with their peers, she said, and the results are almost uniformly distressing.

Anxious kids certainly existed before Instagram, but many of the parents I spoke to worried that their kids’ digital habits — round-the-clock responding to texts, posting to social media, obsessively following the filtered exploits of peers — were partly to blame for their children’s struggles. To my surprise, anxious teenagers tended to agree. At Mountain Valley, I listened as a college student went on a philosophical rant about his generation’s relationship to social media. “I don’t think we realize how much it’s affecting our moods and personalities,” he said. “Social media is a tool, but it’s become this thing that we can’t live without but that’s making us crazy.”

Photo

A resident meditating during a yoga session at Mountain Valley.CreditSasha Rudensky for The New York Times

In his case, he had little doubt that social media made him more self-conscious. “In high school, I’d constantly be judging my self-worth online,” he told me, recalling his tortured relationship with Facebook. “I would think, Oh, people don’t want to see me on their timeline.”

While smartphones can provoke anxiety, they can also serve as a handy avoidance strategy. At the height of his struggles, Jake spent hours at a time on his phone at home or at school. “It was a way for me not to think about classes and college, not to have to talk to people,” he said. Jake’s parents became so alarmed that they spoke to his psychiatrist about it and took his phone away a few hours each night.

At a workshop for parents last fall at the NW Anxiety Institute in Portland, Ore., Kevin Ashworth, the clinical director, warned them of the “illusion of control and certainty” that smartphones offer anxious young people desperate to manage their environments. “Teens will go places if they feel like they know everything that will happen, if they know everyone who will be there, if they can see who’s checked in online,” Ashworth told the parents. “But life doesn’t always come with that kind of certainty, and they’re never practicing the skill of rolling with the punches, of walking into an unknown or awkward social situation and learning that they can survive it.”

Jean Twenge, a professor of psychology at San Diego State University who researches adolescent mental health and psychological differences among generations, used to be skeptical of those who sounded an alarm about teenage internet use. “It seemed like too easy an explanation for negative mental-health outcomes in teens, and there wasn’t much evidence for it,” she told me. She searched for other possible explanations, including economic ones. But the timing of the spike in anxious and depressed teenagers since 2011, which she called one of the sharpest and most significant she has seen, is “all wrong,” she said. “The economy was improving by the time the increase started.”

The more she looked for explanations, the more she kept returning to two seemingly unrelated trend lines — depression in teenagers and smartphone adoption. (There is significantly more data about depression than anxiety.) Since 2011, the trend lines increased at essentially the same rate. In her recent book “iGen,” and in an article in The Atlantic, Twenge highlights a number of studies exploring the connection between social media and unhappiness. “The use of social media and smartphones look culpable for the increase in teen mental-health issues,” she told me. “It’s enough for an arrest — and as we get more data, it might be enough for a conviction.”

Last fall, at a high school near the New Hampshire-Vermont border, I watched Lynn Lyons, a psychotherapist and author, deliver bad news to a packed auditorium of teachers and counselors. “We’re not getting the job done,” she said, pacing the stage at Fall Mountain Regional High School, where she had been asked to lead a professional-development training session about anxiety.

More than a decade ago, the school would have been unlikely to invite her to speak. Anxiety was barely on the radar of most educators back then, according to Denise Pope, another founder of Challenge Success, the Stanford-affiliated nonprofit. Pope remembers facing skepticism when she sounded the alarm about growing anxiety among teenagers. “We don’t have to convince them anymore,” she told me. “Schools are coming to us, eager for help.”

A gregarious speaker, Lyons kept her audience entertained by calling anxiety “the cult leader” — for its ability to convince people of falsehoods about themselves — and telling funny stories about overinvolved parents. But her main point was clear: In a seemingly well-meaning effort to help kids avoid what makes them anxious, administrators actually make anxiety worse. “Anxiety is all about the avoidance of uncertainty and discomfort,” Lyons explained. “When we play along, we don’t help kids learn to cope or problem-solve in the face of unexpected events.”

Photo

Kids hanging out in the lounge after lunch at Mountain Valley.CreditSasha Rudensky for The New York Times

She pointed to the increasing use of “504 plans,” a popular educational tool that allows for academic accommodations for students with physical or mental disabilities. Though 504 plans for anxiety vary by student, a typical one might allow a teenager to take more time on homework and tests, enter the school through a back door — to avoid the chaos of the main entrance — and leave a classroom when feeling anxious.

Lyons believes in the necessity of 504 plans, and she is in agreement with many of the recommendations of Challenge Success, including later school start times, less homework and more project-based learning. But Lyons worries that too many 504 plans are “avoidance-based and teach zero skills.” She gave the example of a plan that allows a student to leave a classroom anytime he feels overwhelmed. Often, a teenager “can go wherever he wants and stay there for as long as he thinks he needs,” she said. Instead, she argued, a school should have a policy in place for the student to seek out a guidance counselor or nurse and do some role-playing that helps the student “externalize his worry,” similar to how Mountain Valley teenagers are taught to observe their thinking and talk back to it. Then the student should return to his regular classroom as soon as possible, Lyons said.

“If anxiety could talk, it would say, ‘You know, let’s just get out of here. We don’t have to do this!’ ” Lyons said from the stage. “But in order to retrain the brain, in order to create that message that says that even though I’m uncomfortable I can do this, we need to stop treating these anxious kids like they’re so frail, like they can’t handle things.”

Lyons sees a connection between how some schools deal with anxious students and what she worries is a generation of young people increasingly insistent on safe spaces — and who believe their feelings should be protected at all costs. “Kids are being given some really dangerous messages these days about the fact that they can’t handle being triggered, that they shouldn’t have to bear witness to anything that makes them uncomfortable and that their external environments should bend to and accommodate their needs,” she told me.

Among many teachers and administrators I spoke to, one word — “resiliency” — kept coming up. More and more students struggle to recover from minor setbacks and aren’t “equipped to problem-solve or advocate for themselves effectively,” a school counselor in suburban Oregon told me. In the last few years, the counselor said, she has watched in astonishment as more students struggle with anxiety — and as more of those “stop coming to school, because they just can’t.”

Photo

A Mountain Valley resident doing art therapy.CreditSasha Rudensky for The New York Times

Some schools have taken drastic measures to accommodate what one administrator called “our more fragile students.” At Roxbury High School in Roxbury Township, N.J., there are two dedicated classrooms for anxious teenagers, including one next to a mural of Edvard Munch’s painting “The Scream.” These students typically avoid the mammoth school cafeteria in favor of eating lunch in one of the classrooms, as they did on the day of my visit last May. They had just finished gym class, an anxiety-producing event for some even as the school did all it could to reimagine the concept. Music blasted throughout the gym as the teenagers halfheartedly played something vaguely approximating a game of volleyball. The ball was allowed to bounce once before being struck — not that anyone was keeping score.

I couldn’t help wondering what Lyons, and other therapists I spoke to who worry that schools inadvertently worsen anxiety, would think of this approach. Some of the programs’ teenagers hoped to go to college, where no special classrooms would await them. How was this preparing them for that?

“Some will say that this feeds the monster,” concedes Patricia Hovey, director of special services at Roxbury High. “But you’ve got to start where the kids are, not where you are or where you want them to be. We’ve got to get them in the building. Many of our students simply don’t come to school if they have to spend all day in” general-education classes. Once the students are in school, Hovey explained, staff members can help them build the confidence and skills to eventually transition to Roxbury’s regular classes — and stand a chance at navigating college or a job once they graduate.

Even with the promise of a special classroom, getting anxious kids to Roxbury High each morning demands a herculean effort from the program’s teachers and therapists. During my visit, I watched them text and call several no-show students in an effort to coax them out of bed. They also regularly communicate with parents, talking them through what to say to a teenager who refuses to leave his room. Paul Critelli, one of the program’s teachers, told me that many parents feel overwhelmed trying to get two or three kids ready for school each morning, and that their instinct is often to “sacrifice the anxious kid” in order to avoid morning hysterics and keep the family train running on time.

Mostly, though, Critelli wants to talk to the anxious students. “What’s the issue today?” I heard him ask during a phone call with a sophomore boy, who had missed his scheduled bus and was presumably speaking to Critelli from underneath his sheets. The call was a “Hail Mary,” as Critelli put it, because while he suspects that the boy sleeps with the phone “right next to his face,” he rarely responds when he’s feeling anxious. “I appreciate you picking up — you don’t normally do that,” Critelli told him, mixing in positive affirmation with a call to action. The school would be sending another bus, and Critelli expected him to be on it.

Critelli looked for any opportunity to push students out of their comfort zones. During an informal study period after lunch, I watched him confiscate cellphones he said the teenagers were using to “hide from, control and avoid” their feelings; scoff at a student who claimed to be too anxious to return a book to the school library; and challenge a particularly reserved boy who said he had nothing to work on.

Critelli looked at him incredulously. “Dude, you’re failing physics,” Critelli said. “What do you mean you don’t have anything to do?”

“There’s nothing I can do — I’m going to fail,” the student mumbled.

“So you’re just accepting that you’re going to fail?” The boy looked at his hands. “Here’s an idea,” Critelli continued. “You can email your teacher and say, ‘What can I do to improve my grade? What extra work can I do?’ ”

Critelli surveyed his classroom of anxious teenagers. “I’d love to see you advocate for yourselves!”

Photo

A Mountain Valley teenager during equine therapy.CreditSasha Rudensky for The New York Times

Jake is a remarkably minimalist emailer and texter, eschewing exclamation points and emojis in favor of an almost old-fashioned formality. It can be challenging to gauge his moods that way, so I checked in with him regularly by phone in the months after he left Mountain Valley. He usually sounded content when we spoke, an impression confirmed by his parents, who were relieved by the changes they saw in him. In the fall of his senior year, Jake was regularly attending school — on some days he “even enjoyed it,” he told me with a laugh.

While he was careful not to overschedule himself, anxiety still sometimes overtook him. One weekend, he had to leave a Model United Nations conference after he became anxious and his stomach started cramping. “That was really disheartening, but when I struggle now it doesn’t last long, and I can usually get myself out of it pretty quickly,” he said, by talking back to his negative thoughts.

Jake also confessed to some worry about his application to attend U.N.C. He had decided to be transparent with the school about his anxiety disorder, partly because it helped explain his junior-year absences and grades and partly because the months he had spent challenging his beliefs and ideas at Mountain Valley perfectly fit the application essay prompt: Reflect on a time when you challenged a belief or idea.

In 650 thoughtful and sometimes uncharacteristically dramatic words, Jake explained that in middle school he had “aced the tests and seemed to many as the bright future of the American ideal.” But then came high school and fear of failure, the debilitating worry that he might not be good enough. He explained that going to treatment helped him change his perspective on learning and life. “Just being able to type this very essay would have been impossible months ago due to my fear of judgment,” he wrote. “College is the next step in my journey to find a true sense of self, both academically and personally. The future has reopened its doors.”

The doors had not reopened quite as wide for Jillian, whom I visited on an oppressively humid spring afternoon in Florida. It was a school day, but Jillian wasn’t at school. Instead, she was on the screened-in back patio of the townhouse where she lives with her mother, Allison. A talented artist, Jillian loves theater and special-effects makeup design, and she was hard at work on an outfit for a “Walking Dead” costume contest at a local car dealership.

While she painted her costume to make it appear blood-soaked, we half-watched an episode of the Netflix series “13 Reasons Why” on her laptop. Jillian told me she could relate to many of the series’s themes, including cyberbullying. In middle school, she made a profile page on ASKfm, a social-networking site favored at the time by mean girls and their unsuspecting prey. Jillian was quickly targeted. “I’d get 30 mean questions or messages a day,” she said. “Most of them were like, ‘Just kill yourself.’ ”

Nothing like that happened at the small private high school Jillian attended after leaving Mountain Valley. Though the school is known for its flexibility and willingness to work with nontraditional students, Jillian still struggled to feel comfortable there. She didn’t want to open up and be known as “the anxious girl.” There were other students at school who had severe anxiety and depression — “It’s like the flu broke out here with anxious kids this year,” the headmaster told me — but Jillian didn’t feel comfortable hanging out with them, either. Several had yet to go to treatment, and “I don’t want to go backward,” she told me. But the end result, unsurprisingly, was that most students never got to know Jillian.

Her longtime pattern of missing school began again. She had the tools to challenge her anxious thoughts, but using them every day proved exhausting. “There’s feeling a weight on your chest, and there’s the feeling of 16 people sitting on top of each other on your chest,” she said. “As soon as I’d wake up, it was absolute dread.”

Needing to get to her job 40 minutes away each morning, Allison, who had sold her previous house in order to afford Mountain Valley, had little time to coax Jillian out of bed. They argued constantly. Jillian thought her mother — who was severely depressed during a year when Jillian was younger and especially needed support — could be insensitive. Allison struggled with when (and how hard) to push her daughter. She knew Jillian had a serious disorder, but she also knew it wouldn’t get better by letting her hide out in her room. Allison also couldn’t be sure when Jillian was genuinely paralyzed by anxiety and when she was “manipulating me to get out of doing whatever she didn’t feel like doing,” she said.

“The million-dollar question of raising an anxious child is: When is pushing her going to help because she has to face her fears, and when is it going to make the situation worse and she’s going to have a panic attack?” Allison told me. “I feel like I made the wrong decision many times, and it destroyed my confidence as a mother.”

Allison sometimes wondered how her own anxiety issues might have genetically predisposed her daughter to anxiety. Allison had done enough Google searches to know that anxious teenagers tend to come from anxious parents. Research points to hereditary genes that predispose children to an anxiety disorder, and studies have found that an overbearing or anxious parenting style can induce anxiety and risk-aversion in kids. In the parents’ workshop I attended in Oregon, Ashworth, the therapist, spent a lot of time urging family members to work on their own anxiety issues.

He also cautioned parents not to accommodate their children’s avoidance strategies. Families of children with OCD will routinely open doors for them, cook only the two or three specific foods they’ve agreed to eat and avoid saying certain words or sounds. Families of socially anxious kids will let them stay in the car while they go shopping, order for them at restaurants and communicate with a teacher because they’re afraid to. “So many teens have lost the ability to tolerate distress and uncertainty, and a big reason for that is the way we parent them,” Ashworth said.

While Ashworth can be blunt, he is also disarming and funny, with a self-deprecating sense of humor that appeals to both parents and their cynical children. Like many therapists who work with anxious teenagers, he tries to model a “let’s not take life — and ourselves — too seriously” approach. He also has an almost endless empathy for the challenges that these teenagers and their families face. He knows, for example, that raising a severely anxious child can feel counterintuitive. How, for example, do you set and enforce limits with an anxious teenager? If you send him to his room, “you’ve just made his day,” Ashworth told the parents in his workshop, who nodded knowingly.

Though Jillian had returned from Mountain Valley a more confident person with a nuanced understanding of her issues (and with her emetophobia largely under control), treatment didn’t solve her school struggles. As she fell further behind, her morning battles with her mother became increasingly untenable. In consultation with the school, Allison agreed to let Jillian drop out and study for the G.E.D. But Allison wasn’t happy about it; she considered it a momentary concession. “We basically said, ‘O.K., anxiety, you win.’ ”

Jillian was relieved never to have to set foot in another high school. “I’m just a lot more relaxed now,” she told me in her messy bedroom, where the walls were adorned with “Star Wars” posters and the bookshelf overflowed with young-adult fiction and sci-fi, as well as a worn copy of “Chicken Soup for the Teenage Soul.” Near her bed were two prescription bottles — one for Prozac and another for Klonopin, a benzodiazepine tranquilizer. Jillian had been prescribed a number of drug combinations over the years, and while none were panaceas, she believed she would be “a lot worse if I wasn’t taking them.”

Though she spoke to a therapist once or twice a week online, Jillian otherwise ignored the structured daily schedule — including yoga, studying and cleaning her room — that she had agreed to with her mother. Jillian told me she often felt lonely at home, and she spent much of her days texting friends from around the country, some of whom she met at “Star Wars” conventions or on social media.

At the same time, Jillian was trying to make new friends. I watched her joke with fellow contestants at the costume contest (where she walked away with a $250 prize), and she was practically a social butterfly at a film event she attended with her mother. Bored with our company after the screening, Jillian spotted two teenagers talking to each other in a corner.

“O.K., I’m going to go mingle,” she announced.

Photo

A Mountain Valley teenager talking to a passer-by during exposure therapy.CreditSasha Rudensky for The New York Times

On a busy weekday morning last May, a new crop of Mountain Valley residents were discovering that a key component of their treatment would involve repeatedly making fools of themselves. On the Dartmouth College campus, eight teenagers wore hand-painted white T-shirts that read “Ask Me About My Anxiety” and “I Have OCD.” They were encouraged by the therapy team to come up with scenarios that would make them uncomfortable. One teenager considered approaching random guys on campus and saying, “You must be a Dartmouth football player.” Later that afternoon, a second group of teenagers arrived. One feigned a panic attack at Starbucks. Another ordered nonsensically at a restaurant.

“What do we need to do to make your anxiety higher?” McCallie-Steller, the therapist, asked several teenagers as they prepared for their morning of exposure therapy. First developed in the 1950s, the technique is an essential component of cognitive-behavioral therapy (CBT) for anxiety, which a vast majority of researchers and clinicians believe is the most effective treatment for a range of anxiety disorders. In a large 2008 study of anxious youth published in The New England Journal of Medicine, more improved using CBT (60 percent) than the antidepressant Zoloft (55 percent), though the most effective therapy (81 percent) was a combination of the two.

But while exposure therapy has been proved highly effective, few teenagers receive it. “We’re much more likely to medicate kids than to give them therapy,” says Stephen Whiteside, director of the Child and Adolescent Anxiety Disorders Program at the Mayo Clinic. “And when we do give them therapy, it’s unlikely to be exposure. With a few exceptions, we’re not treating people with what actually works best.”

Part of the reason is that exposure work is hard. Anxious people aren’t typically eager to feel more anxious. “It’s also uncomfortable for many therapists,” Whiteside told me. “Most people go into therapy or psychology to help people, but with exposure therapy you’re actually helping them feel uncomfortable. It’s not much fun for anybody. It’s much easier to sit in a therapist’s office and talk about feelings.”

Researchers are trying to better understand how exposure works in the brain and to fine-tune its application for anxiety treatment. At U.C.L.A., scientists at the school’s Anxiety and Depression Research Center discovered that the more anxious a person feels going into an exposure exercise, and the more surprised he or she is by the result, the more effective it is at competing with an original negative association or traumatic memory. (That’s why McCallie-Steller did her best to ramp up the teenagers’ anxiety before they began their exposure work.) Other researchers are focused on virtual-reality-aided exposure therapy, which allows people to encounter the sources of their anxiety in a therapist’s office.

For two Mountain Valley 14-year-olds on the main quad at Dartmouth, the sources of their distress were numerous. One, a brown-haired boy who embarrassed easily, suffered from a dispiriting combination of social anxiety, OCD, binge-eating and depression. It was a lot to work on in three months, and he was often overwhelmed by the magnitude of the project. On this day, he had agreed to tackle his social anxiety by sitting next to a stranger on a park bench and striking up a conversation.

Earlier, another Mountain Valley teenager took part in a similar exercise, during which the stranger opened up about his own struggles with anxiety. The teenagers were sometimes surprised that others could relate to their issues. As one girl handed out fliers about anxiety on campus, she sometimes asked people, “Can I tell you about anxiety?” More than a few students — including one who looked as if he might actually be a Dartmouth football player — responded with some version of “Trust me, I know all about it.”

The brown-haired boy was highly anxious about his exposure. He bombarded the therapist, Bryan Randolph, with questions in a seeming attempt to run out the clock until they had to return to Mountain Valley. “Can I just sit on the bench for a minute?” he asked Randolph. “And can I sit down and then start talking? I mean, do I need to ask, ‘Do you mind if I sit there?’ It’s weird to just sit there, have a conversation, then get up and come running back to a group of people.”

“Even better — let’s make it weird,” Randolph told him.

The boy shook his head. “Maybe the guy’s on break and doesn’t want to be bothered.”

“Maybe,” Randolph said. “He might hate you. He might get real mad at you.”

“That’s terrifying,” the teenager confessed. “And what if we’re so close on the bench that we’re touching?”

“That would be awkward,” Randolph said with a half-smile.

The boy craned his neck to get a better look at the man. “Is he sitting in the middle of the bench?”

“I don’t know — he might be,” Randolph told him. “But are you going to ‘what if’ this to death, or are you going to do it?”

He eventually shuffled off toward the stranger, allowing Randolph to turn his attention to the other 14-year-old, Thomas, who stood sheepishly on a nearby corner holding his sign: “I’ve Been Bullied. Ask Me.” The “Ask Me” was hard to make out, because Thomas had also included many of the insults peers have hurled at him over the years, including “B*tch,” “F*ggot,” “Ur Fat” and “Kill Yourself.” Holding the sign on a busy corner had been Thomas’s idea; he thought it might ratchet up his anxiety and force him to interact with strangers, while having the potential added benefit of educating people about bullying.

Randolph and I watched dozens of students walk by, some giving Thomas’s sign a glance but most never slowing their stride. He had been bullied for years, and now he was being ignored. I felt anxious just looking at him.

Eventually, an attractive couple in their mid-20s stopped to read the sign. They smiled, Thomas beamed and after a minute or two of conversation they all hugged. “Oh, my God, that was the greatest,” Thomas announced upon his return.

I asked him what they’d talked about. “The muscular dude said he’s been bullied, too, in middle school, and that bullies get nowhere in life,” Thomas told us. “Then the girl said, ‘You’re really brave. Can I give you a hug?’ ”

“That’s not what you were expecting, huh?” Randolph said. “Instead of being mean to you, people actually treated you with compassion.”

“Yeah, it was awesome,” he said. “I feel so good!”

The brown-haired boy, meanwhile, returned from his brief visit to the bench: “It was sooooo awkward,” he reported. “The guy just kept texting. He was probably like, Why is this kid asking me questions?”

“And what if he was?” Randolph asked him. “You’re not responsible for what he’s thinking.”

The boy appeared to consider Randolph’s point as they made their way back to the van that would return them to Mountain Valley. Sometimes, Randolph told the boys, “exactly what you think will happen happens. Other times, the exact opposite of what you think will happen happens. Either way, it’s all manageable.”

The subject line of Jake’s email to me last winter read simply, “College Results.” I opened it: “Hey Benoit, I just wanted to tell you that I was accepted to U.N.C. Chapel Hill. Jake.” I emailed back to say that he could stand to sound a little bit more excited, to which he replied, “Trust me, I’m pretty excited!”

Last month, I visited him during his fourth week of college classes. It was a Sunday, and Jake met me outside his dorm wearing khaki shorts and a Carolina Panthers jersey. He looked happier than I’d ever seen him. “Let’s walk,” he said, leading me on a tour of campus and nearby Chapel Hill, where he went record shopping (he left with a Parquet Courts album) and played touch football with a few of his friends.

Photo

Teenagers at the chicken coop at Mountain Valley.CreditSasha Rudensky for The New York Times

Since leaving Mountain Valley, Jake had prioritized his social life. “The health of my relationships with people is just as important as academics,” he told me on a bench overlooking the main quad. He had said something similar at Mountain Valley, but back then it sounded theoretical, aspirational. It felt true now. He had made new friends on campus and was keeping up with old ones from home — and some of his peers from Mountain Valley — via text and Snapchat, the only social-media platform he regularly uses these days. “My junior year, when things got really bad, I told myself that I didn’t need to hang out with my friends a lot, that all that really mattered was how well I did at school,” he said. “I don’t think like that anymore.”

That’s not to say that Jake doesn’t study. He does — usually days before he needs to. “Procrastination isn’t a good idea for me,” he said. But he was actually enjoying several of his college classes, especially Intro to Ethics, for which he was reading Plato’s “Republic.”

Jake had experienced only one intense bout of anxiety at U.N.C. For his info sciences course, he turned in an assignment online but realized days later that there had been a technical glitch and it hadn’t gone through. He said he felt “a sudden burst of anxiety” — his chest tightened, and adrenaline coursed through his body. What had he done? He sent a panicked email to his professor and told a friend who also has anxiety issues that he was “freaking out.” Then he took a nap, which had long been one of his coping strategies. When he awoke, the professor had emailed saying it wasn’t a big deal. “That ended that crisis,” Jake told me.

For the most part, Jake felt he was managing his anxiety. Over the summer, he met twice with Jonathan Abramowitz, a psychology professor who leads the university’s anxiety and stress lab, but Jake had put off finding a regular therapist for the school year. His parents kept bugging him about it. “I just haven’t felt like I need it here,” Jake told me. But then, a few beats later, he added: “I know I need to stop making excuses and just do it.”

Photo

Carrying apples to the pasture to feed the cows on Mountain Valley’s campus.CreditSasha Rudensky for The New York Times

I was curious how much of Jake’s newfound contentment had to do with being at U.N.C., with getting into his dream school. After all, a major component of his treatment at Mountain Valley was learning to accept that his value didn’t depend solely on academic achievement. How would he have reacted if his application was one of the 74 percent that U.N.C. rejected last year?

It was clear that Jake had thought about the question. “I would have been disappointed, but I really think I would have been O.K.,” he told me. “There are other schools in the world where I would have been happy. I definitely wouldn’t have believed that a couple years ago, but a lot’s changed.”

Before walking back to his dorm, where Jake’s friends were waiting for him, we stopped at the Old Well, a campus landmark where legend has it that students who drink from it on the first day of classes will get straight A’s that semester. The old Jake might have been first in line. But the new Jake? He hadn’t bothered to show up.

The weaker sex? Science that shows women are stronger than men

The Guardian

A woman carrying a man across her shoulders
 Making a stand: women are better survivors than men. Photograph: Phil Fisk for the Observer

Four years ago, completely spent, blood transfused into me in a frantic effort to allow me to walk, I lay on a hospital bed having given birth the day before. To the joy of my family, I had brought them a son. Blue balloons foretold a man in the making. Not just the apple of my eye, but the one who would one day open jam jars for me. The hero who would do the DIY and put out the rubbish. He who was born to be strong because he is male.

But then, physical strength can be defined in different ways. What I was yet to learn was that, beneath our skin, women bubble with a source of power that even science has yet to fully understand. We are better survivors than men. What’s more, we are born this way.

“Pretty much at every age, women seem to survive better than men,” says Steven Austad, an international expert on ageing, and chair of the biology department at the University of Alabama. For almost two decades, he has been studying one of the best-known yet under-researched facts of human biology: that women live longer than men. His longevity database shows that all over the world and as far back as records have been kept, women outlive men by around five or six years. He describes them as being more “robust”.

Robustness, toughness or pure power – whatever it’s called – this survival ability cracks apart the stereotype. The physically strong woman is almost a myth. We gaze upon great female athletes as though they’re other-worldly creatures. Greek legend could only imagine the Amazons, female warriors as powerful as men. They break the laws of nature. No, we everyday women, we have just half the upper body strength of men. We are six inches shorter, depending on where we live. We wield power, but it’s emotional and intellectual, we tell ourselves. It’s not in our bodies.

Not so, says Austad. He is among a small cadre of researchers who believe that women may hold the key to prolonging life. In extremely old age, the gap between the sexes becomes a glaring one.

According to a tally maintained by the global Gerontology Research Group, today, 43 people around the world are known to be living past the age of 110. Of these supercentenarians, 42 are women. Interviews with the world’s current oldest person, 117-year-old Violet Brown, who lives in Jamaica, reveal she enjoys eating fish and mutton. She once worked as a plantation worker. Her lifestyle betrays few clues as to how she has lived so long. But one factor we know has helped is being a woman.

An 'elderly' man crouching on a zimmer frame with an 'elderly' woman leaning on it to leap up and over him
Pinterest
 Grey power: 42 of the 43 people over the age of 110 are women. Photograph: Phil Fisk for the Observer

Yet there is bizarrely little research to explain the biology behind this. What scientists do know is that this edge doesn’t emerge in later life. It is there from the moment a girl is born. “When we were there on the neonatal unit and a boy came out, you were taught that, statistically, the boy is more likely to die,” says Joy Lawn, director of the Centre for Maternal, Adolescent, Reproductive, and Child Health at the London School of Hygiene and Tropical Medicine. She explains that, globally, a million babies die on the day of their birth every year.

But if they receive exactly the same level of care, males are statistically at a 10% greater risk than females. What makes baby girls so robust remains mostly a mystery. Research published in 2014 by scientists at the University of Adelaide suggests that a mother’s placenta may behave differently depending on the sex of the baby, doing more to maintain the pregnancy and increase immunity against infections. For reasons unknown, girls may be getting an extra dose of survivability in the womb.

Wherever it comes from, women seem to be shielded against sickness later on. “Cardiovascular disease occurs much earlier in men than women. The age of onset of hypertension [high blood pressure] also occurs much earlier in men than women. And there’s a sex difference in the rate of progression of disease,” says Kathryn Sandberg, director of the Centre for the Study of Sex Differences in Health, Ageing and Disease at Georgetown University.

Austad found that in the United States in 2010, women died at lower rates than men from 12 of the 15 most common causes of death, including cancer and heart disease, when adjusted for age. Of the three exceptions, their likelihood of dying from Parkinson’s or stroke was about the same. And they were more likely than men to die of Alzheimer’s disease. “Once I started investigating, I found that women had resistance to almost all the major causes of death,” he says.

The world’s oldest person Violet Brown sitting with a care giver either side of her at her home in Jamaica
Pinterest
 Age of reason: Violet Brown, centre, the world’s oldest person, was born in Jamaica in 1900. Photograph: Raymond Simpson/AP

Even when it comes to everyday coughs and colds, women have the advantage. “If you look across all the different types of infections, women have a more robust immune response,” adds Sandberg. “If there’s a really bad infection, they survive better. If it’s about the duration of the infection, women will respond faster.” One explanation for this is hormones. Higher levels of oestrogen and progesterone could be protecting women in some way, not only by making our immune systems stronger, but also more flexible. This may help maintain a healthy pregnancy. A woman’s immune system is more active in the second half of her menstrual cycle, when she’s able to conceive.

On the downside, a powerful immune response also makes women more susceptible to autoimmune diseases, such as rheumatoid arthritis and multiple sclerosis. The body is so good at fighting off infection that it attacks its own cells. And this may explain why women tend to report more pain and sickness than men. “This is one of the penalties of being a better survivor. You survive, but maybe not quite as intact as you were before,” says Austad. Another factor is simply that men are dying more. “Part of the reason there are more women than men around in ill health is to do with the fact that women have survived events that would kill men, so the equivalent men are no longer with us,” he adds.

When it comes to biological sex difference, though, everything isn’t always as it seems. At least some of the gaps in health and survival may be social, reflecting gender behaviour. Women may be more likely to seek medical help, for instance. Men may have less healthy diets or do more dangerous work. Nonetheless, Austad and Sandberg are convinced that nature accounts for a good deal of what we see.

If they are right, this raises a deeper scientific conundrum. Our bodies adapted over millennia to our environments. So what could it have been in our evolutionary past that gave the female body a little more of this magical robustness? How and why would one sex have developed a survival edge over the other?

Studies of hunter-gatherer societies, who live the way we all may have done before fixed settlements and agriculture, provide a few clues. Many anthropologists studying tribal communities in Africa, South America, Asia and Australia believe early humans lived fairly equal lives, sharing responsibility for food, shelter and raising children. The Flintstones model, with wife at home and husband bringing back the bacon, just doesn’t stand up. Instead, the evidence shows that women would have done at least the same physical work as men, but with the added burden of bearing children.

“There’s a general consensus now that hunting-gathering societies, while not perfectly egalitarian, were less unequal, particularly with regard to gender equality,” says Melvin Konner, professor of anthropology at Emory University in Atlanta, who has spent years doing fieldwork with hunter-gatherers in Africa. “Because of the scale of the group dynamics, it would be impossible for men to exclude women.”

The more research that is done, the more this is reinforced. Even hunting – that prototypical male activity – is being recast as a female one, too. Anthropologist Rebecca Bliege Bird, a professor at Pennsylvania State University, offers me the example of the Martu, an aboriginal tribe in Western Australia. “When Martu women hunt, one of their favourite prey are feral cats. It’s not a very productive activity, but it’s a chance for women to show off their skill acquisition.”

Paula Radcliffe running and smiling, holding up her T-shirt to show her belly at five months pregnant
Pinterest
 Keep on running: Paula Radcliffe continued to train through her two pregnancies. Photograph: Getty Images

Indeed, women are known to be particularly good at endurance running, notes Marlene Zuk, who runs a lab focusing on evolutionary biology at the University of Minnesota. In her 2013 book Paleofantasy, she writes that women’s running abilities decline extremely slowly into old age. They’ve been known to go long distances even while pregnant. In 2011, for example, Amber Miller ran the Chicago marathon before giving birth seven hours later. World record holder Paula Radcliffe has trained through two pregnancies.

Why, then, are we not all Amazons? Why do we imagine femininity to mean small, waif-like bodies? The lives of most ordinary women, outside the pages of magazines, destroy this notion. Visiting India’s cities, I see female construction workers lining the streets, hauling piles of bricks on their heads to building sites. In Kenya, I meet female security guards everywhere, patrolling offices and hotels. Out in rural areas, there are women doing hard physical labour, often hauling their children in slings. Our ancestors would have done the same.

In evolutionary terms, these were the circumstances under which our bodies were forged. For an enormous chunk of early human history, as we migrated through Africa to the rest of the world, women would also have travelled hundreds or thousands of miles, sometimes under extreme environmental conditions. “Just reproducing and surviving in these conditions, talk about natural selection!” I’m told by Adrienne Zihlman, an anthropologist at the University of California, Santa Cruz, when I visit her at her home in San Francisco.

Zihlman has dedicated her career to understanding human anatomy, and in particular the evolution of women’s bodies. “Women have to reproduce. That means being pregnant for nine months. They’ve got to lactate. They’ve got to carry these kids. There’s something about being a human female that was shaped by evolution. There’s a lot of mortality along the way that really can account for it.”

When I gave birth to my son, I did the most physically demanding thing a human can do. Yet I am considered the weaker sex. Zihlman reminds me that my body was made strong by the struggles of countless generations of women who went before. “There is something about the female form, the female psyche, just the whole package, that was honed over thousands and thousands, even millions, of years to survive,” she smiles. I happen to remember, in that moment, that at home I do all the DIY.

Myths and misses: five more things you didn’t know about women and men

Separate symptoms Women and men present different symptoms for the same medical conditions. Women are more likely to have insomnia and fatigue in the weeks before they have a heart attack, rather than the chest pain commonly experienced by men.

Changes of life Women in India, Japan and China experience far fewer menopause symptoms than western women who commonly report hot flushes, night sweats, depression and insomnia. Scientists at King’s College London argue this could be due to women lumping together their experience of growing older with the menopause.

Casual sex Women are choosier but not more chaste than men. A study by two German researchers, Andreas Baranowski and Heiko Hecht, found that women want casual sex just as much as men and were as likely as males to have sex with a stranger, as long as it was in a safe environment.

Boys’ toys A 2010 study by Professor Melissa Hines at the University of Cambridge found that girls on average were genetically predisposed to prefer dolls while boys liked to play with mechanical toys such as trains.

Risky business Testosterone is associated with higher levels of optimism, rather than aggression. Saliva samples taken from traders on the London Stock Exchange confirmed they had higher than average testosterone levels. Scientists from Britain, the USA and Spain concluded this increase made the traders more optimistic so more likely to take big financial risks.

Inferior: How Science Got Women Wrong – and the New Research That’s Rewriting the Story by Angela Saini is published by Fourth Estate at £12.99. To order a copy for £11.04, go to bookshop.theguardian.com

Main photograph: Acrobats JD and Nikki; Stylist Hope Lawrie; special effects make-up Julia Bowden

Get Happy: Four Well-Being Workouts

Photo

CreditCharlie Riedel/Associated Press

Relieving stress and anxiety might help you feel better — for a bit. Martin E.P. Seligman, a professor of psychology at the University of Pennsylvania and a pioneer in the field of positive psychology, does not see alleviating negative emotions as a path to happiness.

“Psychology is generally focused on how to relieve depression, anger and worry,” he said. “Freud and Schopenhauer said the most you can ever hope for in life is not to suffer, not to be miserable, and I think that view is empirically false, morally insidious, and a political and educational dead-end.”

“What makes life worth living,” he said, “is much more than the absence of the negative.”

To Dr. Seligman, the most effective long-term strategy for happiness is to actively cultivate well-being.

In his 2012 book, “Flourish: A Visionary New Understanding of Happiness and Well-Being,” he explored how well-being consists not merely of feeling happy (an emotion that can be fleeting) but of experiencing a sense of contentment in the knowledge that your life is flourishing and has meaning beyond your own pleasure.

To cultivate the components of well-being, which include engagement, good relationships, accomplishment and purpose, Dr. Seligman suggests these four exercises based on research at the Penn Positive Psychology Center, which he directs, and at other universities.

Identify Signature Strengths

Write down a story about a time when you were at your best. It doesn’t need to be a life-changing event but should have a clear beginning, middle and end. Reread it every day for a week, and each time ask yourself: “What personal strengths did I display when I was at my best?” Did you show a lot of creativity? Good judgment? Were you kind to other people? Loyal? Brave? Passionate? Forgiving? Honest?

Writing down your answers “puts you in touch with what you’re good at,” Dr. Seligman explained. The next step is to contemplate how to use these strengths to your advantage, intentionally organizing and structuring your life around them.

In a study by Dr. Seligman and colleagues published in American Psychologist, participants looked for an opportunity to deploy one of their signature strengths “in a new and different way” every day for one week.

“A week later, a month later, six months later, people had on average lower rates of depression and higher life satisfaction,” Dr. Seligman said. “Possible mechanisms could be more positive emotions. People like you more, relationships go better, life goes better.”

Find the Good

Set aside 10 minutes before you go to bed each night to write down three things that went really well that day. Next to each event answer the question, “Why did this good thing happen?”

Instead of focusing on life’s lows, which can increase the likelihood of depression, the exercise “turns your attention to the good things in life, so it changes what you attend to,” Dr. Seligman said. “Consciousness is like your tongue: It swirls around in the mouth looking for a cavity, and when it finds it, you focus on it. Imagine if your tongue went looking for a beautiful, healthy tooth.” Polish it.

Make a Gratitude Visit

Think of someone who has been especially kind to you but you have not properly thanked. Write a letter describing what he or she did and how it affected your life, and how you often remember the effort. Then arrange a meeting and read the letter aloud, in person.

“It’s common that when people do the gratitude visit both people weep out of joy,” Dr. Seligman said. Why is the experience so powerful? “It puts you in better touch with other people, with your place in the world.”

Respond Constructively

This exercise was inspired by the work of Shelly Gable, a social psychologist at the University of California, Santa Barbara, who has extensively studied marriages and other close relationships. The next time someone you care about shares good news, give what Dr. Gable calls an “active constructive response.”

That is, instead of saying something passive like, “Oh, that’s nice” or being dismissive, express genuine excitement. Prolong the discussion by, say, encouraging them to tell others or suggest a celebratory activity.

“Love goes better, commitment increases, and from the literature, even sex gets better after that.”

Stressed-Out High Schoolers Advised To Try A Nap Pod

NPR

Listen·3:193:19

Hannah Vanderkooy demonstrates the napping pod she uses at Las Cruces High School in Las Cruces, N.M.  Joe Suarez for NPR

 

When 18-year-old Hannah Vanderkooy feels extremely tired or anxious, she heads to a spacelike capsule for a nap — during school. Like many teens struggling to get good grades and maybe even a college scholarship, Vanderkooy doesn’t get enough sleep.

And she’s not alone. Various studies indicate that chronically sleepy and stressed-out teenagers might be the new normal among U.S. adolescents who are competing for grades, colleges and, eventually, jobs.

Studies have shown teenagers actually need between nine and 10 hours of sleep a night. But the vast majority (69 percent) aren’t getting it.

Enter “napping pods.” They’re essentially egg-shaped lounge chairs that recline, with a circular lid that can be pulled over the chest to shield against light.

“It just sort of envelops you in a really nice darkness, with soft lighting behind you,” says Vanderkooy, a frequent user of the pods. She says she typically gets only four to five hours of sleep a night.

There’s soft music playing in the pod and “you just feel extremely relaxed,” she says. The 20-minute experience is a wonderful “oasis” amid all the worry and stress of school, she says.

Las Cruces High School has one napping pod, which students use for 20 minutes when they are tired, stressed or angry.

Joe Suarez for NPR

“Being a senior, I have to apply for scholarships, do all my homework,” she says — noting that she’s taking three advanced placement courses. “So my sleep cycle has just sort of become this night-owl life, and it’s just kind of the new normal.”

A nap can’t substitute for a good night’s sleep, but it certainly can help, says Dr. Nitun Verma, a sleep specialist and spokesperson for the American Academy of Sleep Medicine.

A short nap for a teenager “can give a boost to memory and attention during the day, and it can increase school performance,” he says, adding that in a perfect world, schools would roll back their start times.

As it is now, the average school starts at 7:30 in the morning while the start time recommended by researchers at the Centers for Disease Control and Prevention is 8:30 a.m. or later. On top of that, teens’ circadian rhythms work against them — coaxing them to stay up late and then sleep late. So they are already sleep-deprived and “waking up much earlier than normal,” Verma says.

Several public schools in New Mexico are trying to tackle the problem by providing napping pods for their students.

“We know lack of sleep changes mood and makes you more anxious,” says family nurse practitioner Linda Summers, who is an associate professor at New Mexico State University’s school of nursing in Las Cruces.

Summers also works with the nearby Las Cruces High School health center, and has seen firsthand the effects of sleep deprivation on students there. So she decided to apply for a federal health grant to buy the pods, which, at the time, cost $14,000 each. They were installed in four high schools.

Vanderkooy is a senior at Las Cruces High School. She says she typically gets only four to five hours of sleep a night. Joe Suarez for NPR

 

And while the Las Cruces school napping pods were bought to remedy sleep deprivation, Summers says, “it also turns out to be good for anger and stress.”

Even if kids don’t fall asleep, but simply “zone out,” she says, they emerge saying they feel “refreshed and calm.” This led Summers to embark on a study looking at the emotional impact of pods.

She recruited students who reported feeling “agitated or upset about something,” and had them describe their feelings before and after spending 20 minutes in the pod.

“They all felt more rested, happier and more in control of their emotions,” she says, “after just 20 minutes.” Summers now writes prescriptions for the nap pod for students who are anxious, angry or just plain sleepy.

The findings haven’t been published yet, but they have been accepted for publication by a peer-reviewed journal. Summers says the teachers and school nurses she works with already see the pods as a big success. Each capsule is sort of a “therapeutic study hall,” she says, that helps students focus better when they’re in the classroom.

Vanderkooy recalls falling asleep in one of her classes and being told by her teacher that she “really, really” needed to go take a nap.

“I came back and I was awake and attentive,” she says, able to take out her notes and proceed — “just like a normal class.”