NYC-Parents in Action Fall Seminar 2017: EMOTIONAL WELL-BEING BEGINS AT HOME
By Melanie Wells
Teen anxiety may be up, but there is help, and hope. That’s the encouraging message the 300+ parents who attended Parents in Action’s Fall Seminar, a collaborative event with The Jed Foundation (JED), heard on October 25th.
A trend many parents have noticed - an increase in anxiety disorders among teens and young adults - was confirmed. But the good news is, experts have gotten better at clinically identifying young people in crisis, and today’s youth are more open to talking about their emotions than those even just ten years ago. To concerned parents, eager to know what they can do, an impressive panel of experts from JED and Columbia University offered data, anecdotes, gentle humor, sympathy, and sound advice.
JED, a nonprofit “that exists to protect emotional health and prevent suicide for our nation’s teens and young adults,” provided three of the four panelists, with a fourth from Columbia University.
Moderated by John MacPhee (Executive Director, JED), the panel, collectively, offered a dazzling breadth of expertise: Nance Roy, Ed.D., Chief Clinical Officer, JED; Victor Schwartz, MD, Chief Medical Officer, JED; and Anne Marie Albano, Ph.D., ABPP, Director of Columbia University’s Clinic for Anxiety and Related Disorders, all engaged in a lively conversational presentation, prompted by questions posed by John MacPhee.
John MacPhee: What, currently, are the most common teen mental health issues?
Victor Schwartz: After ADHD (about 10%), the big issues are “mood disorder and anxiety disorder, with increased rates of diagnosis over the past ten years.” Mood disorders include problems such as depression, he added, noting also increased reporting of thoughts of self-harm among young people, though the rate for suicide is still significantly lower than in older people.
Anne Marie Albano added: “Anxiety disorder comes in many forms – phobias, separation anxiety, generalized anxiety, OCD.” First onset of anxiety can show up in a child as young as six years, who, by high school age, she said, may exhibit several types of anxiety at once. In the high school years, as many as one in four teens suffer from some kind of anxiety disorder.
Nance Roy: The problem doesn’t go away with the end of high school: “Anxiety disorders now surpass depression” among college students, she noted.
JM: What other stressors afflict teens today, or exist in combo with an anxiety diagnosis?
VS: Social media is a foremost stressor although “not everything about it is bad,” he noted. Its increased usage seems to have risen in tandem with the rise in anxiety. While it’s “nice to connect,” he added, the capacity social media offers to “gang up” on others, or to dilute the strength of relationships, can be stress-inducing.
He also noted pressures driven by a rise in income inequality; there is a growing sense among kids that there is “no room for error,” and with that comes a desperate fear of missing the point of entry into the winning team, the “1%.” For anxious teens, “every step” feels like it counts.
JM: What about the interplay of substance abuse and mental health?
AMA: “Children who have an anxiety disorder before adolescence are eight times more likely to have a substance abuse problem by the end of adolescence,” she said. Social phobias, a primary source of anxiety, can lead to use of marijuana, alcohol and nicotine, to which teens turn in order to help “loosen up” and manage anxiety-producing social interaction.
NR: For teens, self-medicating with substances is often seen as an “easier step” than finding a psychiatrist or therapist. She emphasized that, for many safety reasons, keeping focus on substance abuse is a priority. As more states legalize marijuana, there will be more challenges in controlling use. For example, currently there are no “sobriety tests” for marijuana so driving under the influence goes undetected; as opiate misuse rises it will reach more communities, including our high schools and colleges. And, she warned, opiate misuse with alcohol is a potentially fatal combination.
MacPhee noted research at JED showing millennials (over age 21) and Gen Z (under 21) are more open to talking about emotional issues, and more culturally accepting than previous generations; both factors can be helpful in reducing stigma and encouraging more people to seek treatment. In light of that, he asked the panel:
How can parents best determine if a teen is struggling?
AMA: Adolescence has long been labelled “the storm and stress” age, with moodiness to be expected – yet, “you know your child better than anyone.” Look for danger signs that go beyond ordinary moodiness, she said, such as a sustained low mood, isolation from the family, sleep patterns that veer way off from the usual.
NR: Ask yourselves how long the troubled behavior is sustained; whether it subsides, and if not, pay close attention.
VS: Comparing anxiety distress signals to headaches, he noted “people get them” and that’s not alarming, but if “they worsen, interfere with daily life, and do not get better,” pay attention.
JM: What should a parent do if he or she DOES detect alarming signs?
AMA: LISTEN. Keep conversations going, she advised, but do it on their [the kids’] terms. After they “grunt,” avoiding coherent response, she said, “stick around, be available.” Don’t jump to telling THEM how THEY feel, she urged, but instead ask open-ended questions like, “Tell me more about that,” or, “What you do you think about that?” Then: LISTEN.
NR: Car pools are a “good place to listen in on kids’ chatter.” Say nothing, she advised; instead, LISTEN. She also suggested engaging in activities where conversation can “unfold naturally,” rather than targeted conversations where kids may feel under scrutiny. And, she added, when they do talk, validate. Don’t jump to being judgmental.
VS: If parents were to ask their kids every 15 minutes, “How are you NOW?” it would reveal their own anxiety, and wouldn’t really help the kids. Echoing the other panelists, he advised parents to “be available,” and to “hang around, listen.”
AMA: Parents should “catch the positives;” in other words, don’t overreact to errors while failing to notice and point out positive behaviors. Roy agreed, adding that she recalled suffering over her daughter’s worries but then finding, the next day, that everything was fine. “Keep your reactions in check,” she advised.
JM: If you believe your child does need clinical care, what do you say/do?
VS: Start with your primary care doctor/pediatrician. Ask friends who’ve sought help in similar circumstances. Talk to the school’s guidance staff. He reminded parents to also discuss appointments/treatment with the child before embarking on a plan.
AMA: Parents need to be informed consumers. “Get professionals who understand evidence-based courses of action,” she advised. Studies have shown treatments (cognitive behavioral therapy, medications, or combination of the two) to be effective, she said, and parents need to find clinicians “specifically trained to effectively deliver the treatments that will work,” but not all fit that criterion. Ultimately, she said, the goal is to give your children tools so they can be “out enjoying the world, not just on a therapist’s couch.” Send them back out once they have those tools, she said, but teach them to “touch base and use mental health services from time to time,” if needed.
JM: How does a parent deal with a child who imposes self-pressure?
NR: A recent focus group at a rigorous, prestigious college revealed that students’ peers are the “ones who put the most pressure” on each other. She cited a conversation between two students: Student A: “I studied until 2 a.m.” Student B: “You slept???” Roy emphasized the importance of “keeping a balance.” Encourage kids to “develop passions and strive for balance,” she said, rather than focus solely on academic accomplishments.
VS: The sense that one must be either “a winner” or “in trouble” isn’t helpful. The evidence is clear, he added, that non-academic skills like knowing how to play and to use the imagination help build life skills, inter-personal skills and social skills. Tell kids it’s “okay to do something frivolous,” he said. And, added Roy: “It’s okay to mess up.”
JM: What about bullying and exclusion?
AMA: “Look for signs of changes in attitude; attempts to self-isolate; fears about arriving at a social event before the last minute; or shutting down social media contacts.” Parents should get involved, she said, but not judge. Rather, say: “Please tell me what you are feeling,” and try to get them to open up. “Hear the details” without overreaction, then make decisions.
VS: You can try to problem solve with your kids. Help them identify interests that might lead them to join new groups; talk them through strategies.
JM: How can parents help their kids develop protective factors, in advance?
NR: We’re hearing from colleges that students arrive “less resilient than ever before,” lacking basic skills like doing laundry, managing an ATM card, or eating and sleeping well.
Prepare your kids with basic life skills, she advised, so they can manage everyday tasks and can then better focus on their school work. “Give them opportunities to try to navigate for themselves,” she said, especially in conflicts or hard situations. Sometimes, “let them fail.”
Dr. Albano listed factors associated with resilience: 1) Social support – “relationships you can count on,” which can be established and nurtured early through playdates, clubs, interests; 2) Ability to delay gratification – teach them to put off gratification by saying “you cannot have it right now” so they learn to wait, and eventually, to prioritize.
VS: Let them join an orchestra, band, sports team, club or activities-centered group – all “good places to ‘hit wrong notes’ and see it’s not the end of the world.”
JM: Recently, suicide has been presented not only in the media but in the arts, e.g., 13 Reasons Why and Dear Evan Hansen - sometimes done well, sometimes not. How should parents respond to this?
VS: It all depends on the age and maturity of the viewer. For pre-adolescents, he added, 13 Reasons Why wasn’t helpful; although its intent was cautionary, the viewer needed a “sense of irony” to grasp that intent. “Be thoughtful about what your child can handle,” he advised, and be aware that “many may be overwhelmed” by some material. Read about or pre-screen a show first. Or, if like 13 Reasons Why, it’s already streaming on the internet and hard to monitor, sit down and “watch with your child,” he said, so you can “use it as an opportunity for thoughtful conversation.”
JM: How can parents know if a college has strong mental health services available?
NR: Check to see if it is a JED campus (www.jedcampus.org), which means it will have a comprehensive approach to promoting emotional wellbeing and addressing suicide and substance abuse prevention. If your child already has a history, ask about services ahead of time – don't wait until arrival. Check the “campus climate” (fast-paced? compassionate? pressured?). Check opportunities to develop community, e.g., clubs and groups. Loneliness can be a huge problem in the first year, she warned. Consider factors like distance from home and the campus size; help your child find a good fit.
AMA: Parents sometimes mistakenly think “it will all be different at college” with RA’s, new friends, etc., but instead the kids may “flame out.” Anxiety does NOT disappear with the high school diploma, she said. There’s no stigma: if your child is struggling, connect her before she goes with short term college readiness groups, or services she will need.
Q and A: Several questions were taken from the audience. One parent wondered how to spot teen symptoms of depression and withdrawal in an era where there is so much “silence.” With teen lives now lived largely on social media, there’s little for a parent to hear, and very little transparency. Kids may say, “I’m fine,” but really aren’t – so, how does the parent know?
VS: “Find time for meals together and shared activities,” to counter this silence. Look closely at function: are they sleeping/eating okay? Getting their school work done? If not, probe further.
AMA: Make family time a priority, where all the phones go into a basket, such as dinner time. Also, take the phone away at bedtime, not only to help kids have better sleep, but also to teach them how to get themselves up with an alarm clock. Teach them to self-regulate, she urged. Finally, establish a centrally located place out in the open to do homework, like the dining room table, to ensure regular time when parents can see and monitor their children.
The rise in anxiety is real, and parents, in turn, are justifiably anxious about it. But the take-away of the evening was hopeful: there are simple things parents can do, now, without preparation or expertise, to support their kids:
COMMUNICATE – keep conversation alive, without judgmental overreaction. LISTEN – to your child’s responses. WATCH – for signs of changes that don’t seem like the usual adolescent moodiness. TEACH – ordinary life skills, to build confidence and resilience. ACT –if you do suspect deeper problems, and seek expert help.
HELPFUL RESOURCES: Set To Go - JED’s Guide to the Transition from High School to College and Adulthood: https://www.settogo.org
“Fiction is the most powerful way to explore an issue,” Doug Brunt said over lunch recently. It was the second Thursday in November and he was speaking at the NYC-Parents in Action benefit lunch about his third novel, Trophy Son.
“Our youth culture has changed enormously since the time I grew up.” (Brunt was born in 1971.) “I wanted to explore the hyper-scheduling, the intense commitment and the greater parental involvement that we see now.” To do this he chose sports as the vehicle: “Sports is really a bellwether for the youth culture and youth athletics,” and tennis in particular; “the most extreme end of the sports picture. It’s a very narrow, very specialized field of development.”
Brunt is father of an eight, six and four year-old and husband of journalist Megyn Kelly. The inspiration for Trophy Son came when a fellow parent began describing the ordeal of being a chess parent. Both were waiting for their four year-olds to be dismissed from a pre-school chess class when the father began describing the routine of tournament play: waiting for a game to begin, playing the game, waiting for the next game, playing and waiting every day of the week-end, most weeks of the year. Brunt decided this was the stuff of which novels are made and Trophy Son was born - a story about a tennis prodigy and the father who maniacally grooms him to be the best tennis player in the world.
While researching the book, Brunt wondered if this trend towards early involvement in sports was good for the sports business. Speaking to the CEO of the sports equipment company, Rawlings, he found quite the opposite. Kids are no longer multi sport athletes and the purchasing of athletic equipment is no longer seasonal, it’s an “or,” not an “and” game; kids now play one sport only and purchase equipment accordingly- a baseball mitt or basketball, a soccer ball or tennis racquet. And as kids miss out on the benefits of multi sport play, grandparents feel a loss too. At many stops on his book tour grandparents were “lamenting the lack of time they have with their grandkids, (saying) if I want to see my grandkids I have to go to the sidelines of the soccer game.” These exchanges,” he says, were “ touching, endearing and a little sad.”
Dressed in a navy suit, white shirt and brown striped tie, Brunt talked about the “cultural infrastructure” that determines a child’s athletic success and looks something like this: Your eight year-old joins the travel team (which means both weekday and week-end practice) in order to qualify for the nine year-old travel team, so she’ll be able to play well at increasingly competitive levels as she gets older. Brunt feels “it’s a narrower way to grow up and there’s no kids getting bored and figuring out for themselves how to get un-bored.”
The book he, said, is not “a scathing assessment of youth athletics,” but a warning about the pitfalls of obsessively pursuing a single sport from a young age. He believes athletics teaches teamwork, discipline and other life lessons, but he doesn’t want these attributes to be learned at the expense of a broadly focused or varied childhood experience. “I’m very much for passion and concentrated effort. I want to see kids’ eyes light up with enthusiasm for an activity.” What he opposes is the “systematic requirement for early specialization,” that seems to be the standard today.
Brunt sees two categories of problems developing from the current trend in youth athletics. Intensive training at a young age can cause physical problems including an increase in stress fractures and other overall injuries. When these injuries are treated with pain medication, there’s a risk of overprescribing and subsequent addiction that in turn feeds into the nationwide opioid epidemic. But the novel focuses on the mental and developmental problems that result from the all-consuming nature of specialization. “A narrow field of development in those teen years can be dangerous,” Brunt says; young athletes may be left emotionally unprepared to handle new situations and, socially, years behind their peers, particularly if they’ve left the academic mainstream.
There’s a legendary story that a frog is impervious to the danger of water slowly heated to boiling. Brunt uses this as an analogy for how we got to this place of high expectations and early specialization. He says the “slow acting reasons” include the allure of pro sports in terms of money and celebrity; an increase in disposable income that allows parents to support their child’s efforts and/or vicariously live through him or her; today’s heightened level of parental involvement in our “tiger mom” culture; and, lastly, the changing expectations of college admissions boards who now look for students of exceptional achievement in one area, rather than students who are well-rounded. And while parents are usually well- meaning, their efforts may be misguided.
“Drive, drive, drive isn’t better, better, better; at a point it’s actually disruptive,” he warns. Brunt thinks communication and awareness are the keys to change and while it may be slow in coming, change is in the air. The more parents talk to each other and to their children’s teachers and coaches, the easier it will be to change cultural expectations. Finding a passion and excelling at it at the expense of doing something (or nothing) for the fun of it leaves little room for discovery and play. “Of course you have to practice, have to play, have to get good,” said Brunt, but it doesn’t have to be all consuming and kids shouldn't have to miss out on other things. “By the time I’m a granddad, I expect to be spending a lot of time with my grandkids.”
School Relations Luncheon 2017 – Stress, Anxiety & Substance Abuse in Youth: A Primer In Prevention
By Lori Gaon
Anxiety is the most common category of mental health disorders and the most likely to affect children, surpassing even the more widely known ADHD. This was one of the startling facts parents learned at the December 5th NYC-Parents in Action School Relations Luncheon with guest speaker Dr. Marianne Chai, Medical Director of the New York Center for Living.* Dr. Chai provided the rapt audience with eye-opening statistics on anxiety, its prevalence, and its link to depression and addiction. Recent data shows anxiety is the number one issue bringing students to college counseling centers, surpassing depression and relationship problems.
New Yorkers pride themselves on handling a certain level of anxiety; it goes with the territory in a fast-paced, competitive city. But adding children into the mix changes the equation for parents. We say we want our kids to be happy, so as we see them struggle to navigate social media, academics, personal relationships and more, we may wonder – how much is too much? The more screen time, the higher the incidence of feeling isolated and anxious, and the more stress they experience, the more their troubling feelings are compounded, which can then contribute to various social disorders, depression and addictive behaviors. For our children, if not for ourselves, anxiety can become a threat.
“A certain amount of stress is good,” Dr. Chai began, emphasizing that problems arise when the stress becomes chronic, upsetting emotional balance and leading to substance problems, addiction, or worse. Dr. Chai warned that we have seen an alarming rise in teen suicide, suicidal ideation and self-harm. “This trend is not going away,” she added.
“Stress and anxiety can change your brain,” Dr. Chai said. Stanford researchers found that the larger the amygdala (where the “fight or flight” response and emotional center live), the greater the anxiety level in kids.
Most anxiety is normal, and every child goes through phases where levels rise or fall, normally a temporary and harmless part of development. Dr. Chai explained that anxiety can become “pathologic” when it impairs the ability to function and increases risk for additional health issues, such as substance abuse or addiction. “Pathologic” anxiety is a disorder.
Some eye-opening statistics about anxiety disorder include:
25% of kids in the US will have an anxiety disorder between ages 13 and 18 (vs. 7% in Australia).
1 out of 3 people will have an anxiety disorder during their lifetime
75% with anxiety disorders see signs before age 21
3% will have “severe anxiety disorder”
the disorder may incur up to $42 billion in annual health costs
only 18% of teens with anxiety disorder receive treatment.
Anxiety affects women twice as often as men. It may be “silent,” receiving less attention than ADHD because it’s less noticeable; for instance, a child suffering anxiety may sit quietly in the back of a classroom in contrast to the student with ADHD, who may be disruptive.
Anxiety disorder may be diagnosed when symptoms:
1) are present for at least six months,
2) significantly interfere with a person’s routine,
3) are out of proportion to the actual danger present.
Cultural changes may be implicated in the rise in teen anxiety. Students who have technology at their fingertips with the introduction of smartphones, appear to experience declines in what were, until quite recently, typical aspects of teen life. Notable changes include:
Less time spent hanging out with friends
Fewer teens obtaining drivers licenses
Fewer hours of sleep
Less face to face connectivity with others (thereby increasing feelings of loneliness).
To put things in perspective, Dr. Chai said, kids who spend three hours or more on a device are 35% more likely to have a risk factor for suicide.
Anxiety affects emotional balance and wellbeing. It can trigger feelings of fear, irritability and anger, while impeding happiness and joy. Physical symptoms may include increased heart rate, stomachaches, headaches, dizziness, loss of sleep and loss of bone density, thus impairing overall health over time, according to Dr. Chai.
“Anxiety can be a silent killer,” Chai said, becoming ugly when it affects a person’s thought processes. It can negatively color quality of life through experiences of frightening thoughts and scenarios, fear, and development of “tunnel vision” with respect to every possible negative scenario.
“Seeing the world through the lens of fear is a very sad perspective,” Chai said. Often kids avoid whatever makes them anxious, giving preference to familiarity and repetition, which then gives the fear more power. A familiar example of this is separation anxiety in small children. If diagnosed early and treated, a preschooler who is prone to anxiety “can change their trajectory in life,” with intervention.
Many students self-medicate, thinking that pot is helpful in reducing social stress and anxiety. However, with persistent usage, pot can have the reverse effect. “Teenagers who smoke pot weekly are more than twice as likely as nonusers to have an anxiety disorder in their late 20s, even if they stop using,” Dr. Chai said.
Kids seeking ways to alleviate stress and enhance their ability to study, may turn to the easily accessible drug, Xanax. “It’s being implicated with almost every unintentional overdose in college- and post-college-aged kids we see in the city today. It interplays terribly with alcohol and opiates, causing respiratory failure,” said Dr. Chai.
The good news, Dr. Chai noted, is that anxiety disorders are highly treatable and treatment is effective in 60-90% of cases. Unfortunately, only 18% of those in need of treatment receive it, compared to 79% for ADHD.
Are we, as parents, at the root of this anxiety issue? According to Dr. Chai, many parents try, with good intentions, to ease their children’s suffering, but in doing so, may actually reinforce the anxiety by allowing the child to avoid stressful situations.
Psychoeducation for parents (parent training), is a treatment boasting high success rates by focusing on educating the parents rather than treating the child. The parent is trained to discontinue the negative reinforcement of the anxious behavior, and to refrain from automatically protecting the child from anxiety or fear.
Dr. Chai concluded her talk with some professional wisdom for parents: “Research has shown that the most successful people are those who experience failure and develop resilience to keep going. We have to allow our children to fail fast and early, and learn coping skills.”
Although this may be easier said than done, it's advice we should heed, and well worth the effort, to help our children develop strength. We all must learn to cope with the inevitable stressors that provoke anxiety; let’s not forget our children deserve to develop that ability, too, just as we did.
* The New York Center for Living is an outpatient treatment center for adolescents, teens and their families that focus on issues of substance and alcohol abuse. Dr. Marianne Chai is board certified in general, child and adolescent psychiatry, as well as in addiction psychiatry and integrative and holistic medicine. She completed her residency training in general psychiatry at New York University, followed by fellowships in child and adolescent psychiatry at the New York University Child Study Center and in addiction psychiatry at New York University Medical Center Division of Alcoholism and Substance Abuse.
Date: December 5, 2017
Time: 12:00 pm - 2:00 pm
Madison Avenue Presbyterian Church
921 Madison Avenue at 73rd Street New York, NY 10021 Map and Directions
NYC-Parents in Action’s 32nd Annual Teen Scene was held on February 12th, 2018 at the Trinity School, in a packed room of over 400 people, where 16 high schoolers spoke from the heart. They shared only their first names, candidly answering questions from long-time moderator and current PIA Co-President Lucy Martin Gianino, as well as from the audience. A panel of eight girls and eight boys from a sampling of NYC schools (co-ed, single sex, progressive and traditional) discussed a wide range of issues that affect high school life in NYC. There were moments of shared laughter among the panelists and the audience alike, as students offered answers and thoughts that were reassuring yet revealing. One panelist told the parents, “We students are doing a whole lot of good in addition to [doing] the bad.” Despite a changing world, with vast cultural shifts brought about by social media and technology, what hasn't changed much among teens is how decisions are made, why friendships are chosen and how different lifestyles are explored.
The first topic addressed how teens experience pressure, growing up and attending NYC independent high schools. The panelists reminded parents that all high schoolers are dealing with the same issues: finding friends; balancing the demands of school work and extracurricular activities; and peer pressure. Several students emphasized the importance of finding the “right people to hang out with.” Friends, apparently, may be both cause and cure for students’ anxiety (albeit not the same ones!). Panelists agreed that the increased presence of social media encourages a need for “instant gratification,” and prompts a fear of missing out (“FOMO”). Notably, if there were issues at school, students said they often found solace in friends from camp or other extra-curricular programs, such as sports or dance teams. Maintaining good friendships, the panel agreed, is key to surviving high school. Interestingly, there was no mention of turning to teachers as a resource, and “school is never the answer.”
On the topic of smart phones and the control they exert over teenagers, the students did not hide their attachment to their devices. They admitted that while some kids may be “addicted,” there was some policing going on among friends. One student expressed dismay that, on a senior school trip, the students who snuck in phones took away from the other students’ group bonding experience because the phone users were “always looking for Wi-Fi or charging spots.” The widespread perception that technology is out of control and social media is taking over peoples’ lives is real, the panel acknowledged, but also noted that teens realize Facebook and Instagram lives are curated and are not a reflection of real life. Further, the students appeared to understand that even innocuous posts can negatively affect peers, making them feel left out, or worse. As one young man exclaimed “[It] can break your heart!”
When asked how it feels to start high school, the students explained that entering 9th grade was a big leap from middle school: “It is scary, teachers treat you differently, expect more from you.” By junior year, however, the “vibe” is different, as the students, by then, feel like upper-class-men and -women. The biggest laugh of the evening was a senior’s delayed realization that “now everything counts, including 9th grade transcript!” In 12th grade, for all schools, the college process consumes students. One panelist suggested a useful tip for parents regarding college applications: “Don’t keep talking about it, we [students] already know what a big deal it is; [parents need to] just know how much stress your kid is dealing with.”
Sound advice for parents trying to help alleviate stress included making time for dinner every evening as a family. Panelists agreed that despite hectic schedules, dinner together is a good way to relieve pressure, as it allows the students permission to take a 20-minute break.
On the topic of weekend socializing, the panelists confirmed that there are unsupervised house parties. Sometimes good children make bad decisions, they noted, so keeping the lines of communication open is key to managing risky behavior. There seemed to be a casual attitude from the whole group regarding consumption of alcohol. One student explained that at least 90 percent of students in high school have had a drink. Regarding parents offering their teenage children alcoholic beverages, one girl remarked, “Awkward!” but impressively, all the students agreed on the mantra “stall when possible.” Referring to “club kids,” the panelists agreed that despite bouncer bag checks, high schoolers do manage to sneak in clear alcohol in water bottles, for example, or participate in heavy “pre-gaming” before homecoming weekend parties. Despite this level of consumption, there was widespread awareness among the panelists of the dangers of alcohol and drugs to the developing teenage brain, information picked up in school sponsored programs and from outside resources such as Hallways.
Marijuana’s recent legalization in some states has made high schoolers more willing to try it, despite associated risks. Some have even seen fellow students smoking in class with a very cavalier attitude. The prevalence of vaping (using both flavors or scented oils and more addictive substances, such as pot) was of great concern among parents. Students reported significant vaping use among their peers at all high school grade levels, either to relax or to get high without getting caught. Parents learned that vape shops (without checking customers’ ID) routinely sell the popular Juul, a small, vapor-delivery device made to resemble an ordinary pen.
Addressing sex and relationships, the panelists reported significant knowledge about health and sexual activity safety. There was strong concern about, and well-informed interest in, the #MeToo movement. Further, conversations on gender equity, in settings both formal and informal, are occurring regularly among teens.
After this in-depth discussion of teenage life in New York City, the students closed with some heartwarming thoughts, when asked by a parent what “makes them hopeful.” They said they were “hopeful about the future,” and listed as reasons: their friends; the ability to do so many different things; the desire to help others, to bring about change, to educate; and to share opportunities. This positive, cheerful vision further lifted the spirits of an already enthralled audience. While teenage years are considered the age of rebellion, it was comforting to parents to know the kids value what is “right” despite what we hear may be “wrong.”
Vaping: Essential Information and Strategies for Protecting Youth
(Presented in partnership with the Hallways Program of Freedom Institute)
By Melanie Wells
The explosive rise of vaping and JUULing is a deceptively normalized phenomenon, with research now revealing that these activities are far less benign than users initially assumed. And yet, according to Hallways, parents should not despair, but should remember this hopeful message:
“YOU are still the most important influence in your child’s life. TALK to your kids, early and regularly.”
In perfect alignment with PIA’s long-time support for effective communication, Freedom Institute’s Rachel Russell (Chief Clinical Officer, Freedom Institute) and Katherine Prudente (Hallways Program Manager) enlightened the audience at the Collegiate School on Wednesday, April 11 with a reassuring message: you have a key role to play in protecting your child’s well-being, and there are strategies you can employ to effectively do so. That was the good news.
The more sobering news, delivered first, was a dense tutorial on the ominous explosion of the use of JUULing/vaping by teens, and the clinical facts surrounding it. The audience was urged to take note: “We are at a critical turning point,” said Russell, likening it to a similar flash point that emerged around cigarette smoking decades ago, when a long-ignored health threat demanded action and intervention.
Before launching into the details, Russell asked the audience, “Are you curious? Nervous?” Both feelings were acknowledged. Russell assured the crowd that they’d learn “essential info” to better understand vaping/JUULing and to counter myths; and they’d also learn practical tips to use at home.
First, Russell offered some background on teen development, pointing out that parents need to know what will NOT work with this age group. “Scare tactics,” she emphasized, “DO NOT work.” (Think “just say no” and “here is your brain on drugs” – tactics from the crack cocaine years.) Further, she added, facts alone (even medical lectures) don’t work either. Kids, typically, do not ingest these facts and then avoid substances; rather, the research shows, they listen, become more curious, and then go experiment. What does work, said Russell, are holistic preventive efforts that promote social-emotional wellness, whereby kids develop important life skills. An effective prevention approach is:
1) Data-driven (evidence-based facts stand up best to scrutiny);
2) Community-based (looking at all elements – family, school, cohort, teams, other activities);
3) Ongoing and strategic (informed by science);
4) Person centered (keyed to the ages and culture of the kids involved).
Social-emotional wellness, firmly established, is key, but, Russell noted, it is “hard to gauge.” Social-emotional wellness comprises the “softer skills” (good decision making, impulse control, emotional regulation, ability to weigh consequences, i.e., the “frontal lobe” stuff). Effective prevention programs use skills-based learning to encourage and promote healthy development. However, working counter to the steady, successful development of social-emotional wellness, are a few risk factors. A big one is the adolescent brain itself, which, Russell explained, not only doesn’t fully develop until age 25-26, but more critically, develops “back to front,” allowing the primitive systems (think, “old brain”) to mature first, and the all-important executive function system (frontal lobe) to develop last.
This late development of executive function explains those puzzling times when parents, seeing a bad decision their child has made, may ask incredulously, “WHAT were you thinking??” The answer is, they weren’t. The ability to think ahead, weigh consequences and synthesize data to make good decisions is still a work in progress in the teen years. Similarly, when a parent asks a teen or tween to describe her feelings, the blank stare the parent gets in response is not always surliness, it is often simply evidence of a brain not yet able to find the abstract words to describe the feelings.
Still, social-emotional wellness skills are crucial to avoiding addiction (which is, by the way, an adolescent onset illness – with 90% of cases beginning in the teen years) and therefore must be taught if we are to help protect teens. Adolescents who rate high on stress (and many in our community do) are three times more likely to experiment with marijuana and two times more likely to do so with alcohol.
Further, and with relevance to our community, research has revealed a surprisingly big risk factor: affluent culture. This doesn’t mean an individual family of means is necessarily at huge risk, but it does mean the CULTURE of affluence surrounding our teens increases addiction risks. Per the research of Suniya Luthar, negatives associated with affluent culture include:
1) higher rate of substance abuse than the national norm
2) higher rate of depression/anxiety
3) immense pressure for achievement
5) focus on external markers of success
6) priority on extrinsic, as opposed to intrinsic, value
7) easy access and exposure to substances (with money for purchase power).
Kids internalize messages about success, noting the high value affluent culture places on external markers, vs. acknowledgment of the child’s own inherent worth. A sense of one’s inherent worth increases confidence; a lack of it has the opposite effect.
With this background in mind, what are the nuts and bolts of vaping and JUULing?
Facts: e-cigarettes (ENDS, or “electronic nicotine delivery systems”) come in many forms, from pipes to plug-ins, and deliver differently according to their mechanisms. (Kids know the terrain well. They’ve even learned to take ENDS apart and tweak the mechanics in order to deliver drugs other than nicotine, or to increase nicotine’s effect.)
Nicotine is delivered via vaporized liquids, which come in over 7,000 flavors, often cannily named and packaged to suggest a fantasy candy-land, with the young user in mind. (No self-respecting adult is likely to be seduced by “Cake Berry Blaster,” “Tutti Frutti,” “Cotton Candy” or “Avalanche Apple Slam.”) These “vape sauce” flavors represent an obviously cynical marketing approach on the part of companies who clearly target young people, while adhering to the fiction that the product is meant only for the legal user (age 18 and over). Virtually all marketers know that the best time to grab new customers is in the teen (or even tween) years, said Russell. And this is a $3.7 billion market, she added, projected to rise to $5.1 billion by end of 2018, with three major tobacco companies involved. Teens are blissfully ignorant of risk, and believe “vape sauce” is harmless, said Russell, and though some products are labelled “nicotine-free,” the industry is not well regulated. The flavoring agents, notably, are unregulated, and though their ingredients may have been approved for ingesting, they haven’t been approved for inhalation into the lungs. Some trace compounds in the flavored “vape sauce” are carcinogenic, if inhaled.
Regulation holds no appeal for companies seeing profits from three million middle- and high-school students who use their products annually, and some recent research on vaping is funded by the very companies who profit from it. However, counter to early claims, there is data to show that vaping has NOT proven an easy path to quitting traditional cigarettes; rather, vaping may prompt teens to START smoking traditional cigarettes, within 6 months of e-cigarette use. Further, the kids who vape and JUUL are not seduced solely by nicotine producers. Vaping has a huge presence on social media, with YouTube videos demonstrating “vape tricks” under titles like “simple vape tricks everyone should know.” Hiding a JUUL in the string of a hoodie (readily accessible to pop in the mouth for a quick hit) or creating weird vapor “trails” are shown as easy, fun ways to rebel. Ducking under a desk for a quick hit in class, when the teacher turns to the board, works too.
JUUL, with its small size and resemblance to a pen or USB stick is the most popular delivery system with many kids. It is easy to hide (adults don’t recognize it) and is convenient – it comes with pre-filled pods, carrying a liquid nicotine of choice. It’s easily found at any bodega or online. Kids “hack” the system by taking it apart to access the heating coil and pour liquid on it directly to intensify the hit (“dripping”), or to swap out nicotine for THC, in the pod. It’s ubiquitous – and its popularity is going nowhere but up.
So, is this really safe? Russell noted side effects: impulsivity, attention deficits, gum disease, lung cell damage, bronchitis, wheezing, elevated blood pressure and “popcorn lung” (scarring). It’s time to “amass forces,” said Russell, which will take “all of us, working together” to intervene – parents, schools, community. Early prevention works best, she said; Hallways currently goes into the schools to do its preventive work. Ask your kids what’s happening in their schools around this subject, she advised.
Russell stressed again that the heart of successful intervention is overall social-emotional wellness, combined with strong family relationships, with a focus on coping, decision making, stress management, building interpersonal skills and empathy. What should parents know about what THEY can do to help?
1) STRONG ADULT RELATIONSHIPS are key. Do your part in strengthening yours with your child.
2) SKILL REINFORCEMENT is crucial. It must come from home, school, community. Russell likened it to teaching a toddler to walk – parents patiently assist them over and over until they can manage alone. Social-emotional skills, too, need to be WALKED THROUGH and PRACTICED, over and over.
3) REPETITION is key. You don’t tell your child once in his life to pick up his clothes and make his bed; you remind him, again and again. Social-emotional skills, too, take reminding over time to become habit. Tell your children over and over that you want them make good choices.
4) BE PROACTIVE: talk to your child EARLY, OFTEN and CONSISTENTLY. Russell noted that kids “value their relationships with their parents and want to know they can talk to you, even if they seemingly resist.”
5) USE TEACHABLE MOMENTS. Become adept at the “one-minute conversation,” described by Russell as quick, frequent, in-the-moment observations you can make to your teen. And for longer conversations, carve out the time needed to extend those teachable moments into a full discussion.
6) EMPATHIZE. It’s hard to be a teen! Remember? Recognize their lives are tough, often with social hurt.
7) DON’T CRITICIZE TEEN FRIENDS. Instead of saying “I don’t like so and so – she’s trouble,” say that you’re worried about her well-being. Express concern for the friend. If you convey concern, your child will know that if he screws up, you’ll worry about him rather than reject him.
8) SET BOUNDARIES. Be clear with your expectations. Say plainly, “I don’t want you vaping, I don’t want you smoking pot - I want you to be healthy and safe.”
9) MODEL what you want to see. If you come home and say, “What an awful day – I need a drink!” what are you telling your child? That if things are tough, go find a chemical? Wrong message!
10) ANTICIPATE SITUATIONS, TALK THROUGH THEM, AND ROLE PLAY. If you want your child to avoid risky situations, play through them and help her brainstorm ways to handle them safely, or extricate herself.
11) ENFORCE CONSEQUENCES for risky behaviors. Russell acknowledge this is a hard one, always. Yet, she said, kids who have no consequences are pitied by other kids. Kids with them, feel cared for.
Russell also noted warning signs for parents to heed. For nicotine use: evidence of pods or packaging in bedrooms or backpacks; little thumb-drive-looking things; unusual changes in online purchases; hiding/secrecy (sneaking out to vape/JUUL); anxiety, or restlessness. For THC: red eyes; dilated or constricted pupils; changes in sleep/eating/activity patterns; changes in dress or grooming; declining grades or decline in extracurricular participation.
Katherine Prudente, Hallways Program Manager, noted that a substance abuse problem develops over time, and she outlined the stages:
1) This is fun, and it feels good. (Your child still has some control).
2) I want to do it again. (Still more a “want” than a “need.”)
3) I had a terrible day and I need to get high. (Now it’s a need).
4) I feel bad if I don't use. (Now it’s a requirement to avoid withdrawal; fully developed dependence).
It is important, said Prudente, to intervene before there is a fully developed pattern of dependence. The Hallways intervention system (Hallways Indicated Prevention Program, or HIPP) follows a protocol of assessment (teasing out symptoms vs. normal teen behavior, identifying other factors that may be at play, such as depression or anxiety and determining what intervention is needed); short-term counseling (including learning healthy skills and practicing); and referrals (if indicated).
Prudente also provided a short list of intervention strategies that parents may use:
1) If you see something, say something.
2) Parents/caregivers must all be on the same page and the same team.
3) Trust the strength of your relationship.
4) Always lead with concern.
5) Use dialog, not reprimands.
6) Discuss family history – if there is addiction, share that information with your child.
7) Seek support.
Finally, she advised, find your OWN words for talking points. Express yourself as yourself, in ways that will help your child hear you. Be clear. Most important, say where you stand, without ambiguity.
The speakers then took a few audience questions:
Q: What is the nicotine high? A: The “hit” may make users a little dizzy, but they don’t know they’re hooked until they cannot get more of it. It is subtle.
Q: Does vapor trigger smoke alarms? A: No
Q: Are e-cigs as toxic as traditional ones? A: No, but they aren’t safe. It’s like the difference between 60 mph with no seatbelt or 90 mph with no seatbelt. Neither is safe, but it’s a matter of degree.
Q: Where do kids get THC? A: Online, in the form of oil or “dabs.”
All parents want the same things – to see their children grow up healthy, and to keep them safe. But no parent, alone, can face a crisis of the expanding magnitude of the JUUL/vape crisis. Take heart, take heed of Hallways’ valuable tips, and take comfort in numbers – we are a community. Stay involved, informed and connected, and together our community will find the strength to support our children - through love, attention and ALWAYS, through consistent communication.
FREEDOM INSTITUTE, a non-profit organization, was founded in 1976 as one of the country’s first intervention programs. For more information about Freedom Institute, its services and the Hallways Program in New York City middle and upper schools, go to www.freedominstitute.org or www.hallways.org.
Date: April 11, 2018
Time: 7:00 pm - 8:30 pm
Collegiate School Auditorium
301 Freedom Place South New York, NY Map and Directions