College Applications: Stress Management

While autumn means the start of school, cooler nights, and the coming holiday season to most families, for seniors in high school it is crunch time: college application season. This is the last semester when grades "really matter" for their applications, they are preparing for a final set of SATs if needed, and they must write seemingly endless essays on some variation of "why I am special." Then they must organize their various application packages, with supporting materials and recommendations submitted on different schedules.

In addition to meeting with various advisers, everyone is probably asking them where they are applying and why they chose those particular schools – all of this while they are juggling the various extracurricular activities that they hope will help them stand out. In short, it is an exceptionally busy, stressful, and emotional time for any high school student who is hoping to gain admission to a competitive college.

These 17-year-olds have reason to be stressed. With admission rates for the most competitive schools dwindling to the low single digits (6.3% for Harvard and 7.9% for Yale in 2011) and even state schools becoming intensely competitive (University of California, Berkeley, admitted only 21% of applicants in 2011 and their median GPA was 4.19 on a 4.0 scale), students are understandably anxious, especially those students from families and communities that place great value on being accepted to an elite college. Add to that the anxiety about the increasingly burdensome cost of a college education. Then finish this with uncertainty about the job market they will face when they graduate.

For many, where they go to college is a "bottom line," a summary of all they have accomplished, their acknowledged potential, and who they "are." You get the picture.

Pediatricians are in a unique position to offer both seniors and their parents some healthy perspective about this process. While your patients are unlikely to ask you for college advice, you will get to hear about how stressed they are. A simple reminder that 1 year from now, they will be settling into a school that will provide them with an excellent education can sound fresh when coming from someone other than their parents. It also can help to remind them that rather than focusing on the very best school they can gain admission to, they should be looking for the school that will be the very best fit for them.

The application process may seem like a once-in-a-lifetime event, but it is also an opportunity to explore how to work hard in a way that is sustainable, that won’t leave them completely wiped out. Ask them about whether they are finding time for exercise and are eating reasonably well. Has their weight changed? Tell them about the data that suggest that those adolescents who sleep more than 7 hours nightly perform better on cognitive and physical tests. Their concentration will be better; they’ll do better in interviews, and are less likely to get sick. Remind them that finding small ways to relax in the midst of intense work also can be very effective in helping them feel better and perform better. Whether it\'s to exercise or play a little Angry Birds, taking regular breaks is usually well worth the time.

While offering this common sense advice, you also should be on the lookout for warning signs that your patient has moved from stress to distress. Do the patient and family have reasonable expectations? How much is "on the line" for everyone in the family? The more unreasonable their expectations, the more that is on the line, the greater the mental health risks. The pressures and insecurity that can accompany this process can trigger genuine depression or anxiety for vulnerable adolescents, and can exacerbate symptoms in those teenagers who were already managing psychiatric symptoms. These symptoms may have been overlooked by parents and teachers at a time when stress and exhaustion seem routine. Have they withdrawn from friends or previously beloved hobbies? Are they using drugs to try and improve their performance? Are they engaging in self-destructive behavior to manage their stress? Are they cutting? Restricting their food intake or compulsively exercising? Or have their grades started to drop? How have they responded to stress before? While one episode of getting drunk with friends to blow off steam is not alarming, be tuned in for the suggestion of a pattern. If you notice one, have a low threshold for a mental health referral. If they balk, saying that they do not have the time, you can remind them that when untreated, depression and anxiety could derail all their hard work. Making it discussable is the first step to getting them the extra support they may need.

You might hear from parents about their concerns about the stress of the college application process. For those parents who are speaking about "our application to Harvard," you might gently remind them that part of applying to college is about developing the organization and initiative to manage responsibilities independently. Next year, when their children are freshmen somewhere, they won’t have all of this help. This is an opportunity for them to manage an important task independently, asking for help if they need it. Indeed, parents demonstrate confidence in their adolescent’s abilities by stepping back.

It can be very helpful for parents to hear that while their senior might benefit from a (very) occasional reminder about deadlines, parents are exquisitely valuable to their senior in a different way. They are a uniquely qualified resource for an adolescent considering what he or she might want in a college education, with their unrivalled knowledge of the child’s unique interests, strengths, and needs. Parents are the keepers of great wisdom about their children’s gifts, and this perspective can be invaluable as seniors try to think through what they hope to get out of 4 years of hard work and great expense. And this expense matters, too. Parents also should be available to help their children consider what different school packages will cost, and honestly talk through what it will take to pay off these loans. These are difficult matters, but ones they are unlikely to consider deeply with peers or in leafing through the U.S. News college rankings. Yet how much debt they hold when they graduate will have enormous implications for their life’s path.

Some parents may be anxious that their son or daughter "just doesn’t care," and they are constantly nagging or simply doing all the preparation themselves, out of concern that otherwise it won’t happen. For these parents, you might gently suggest that when they hold so much anxiety, their child doesn’t have to hold any. While this might make the application process easy, it will leave their child at a disadvantage once they are at college and have to manage their own semester schedule (and laundry) all by themselves. Sometimes asking a school adviser to take a more active role is a better alternative than the parents getting more involved in a process that is designed to help high school seniors individuate and separate from home.

You are in a marvelous position to help your patients remember that this process is about their education and is not a horse race. Indeed, it is one of their last chances to work on a very adult undertaking with concerned adults (parents, teachers) nearby. If their parents can focus on helping their children to manage the stress, keep perspective, develop a nuanced appreciation of their own wishes and abilities, and cultivate both their discipline and flexibility, then the college crucible could instead be a passage that builds maturity and resiliency while parents and children are still enjoying eating dinner around the same table.

Dr. Swick is an attending psychiatrist in the division of child psychiatry at Massachusetts General Hospital, Boston, and director of the Parenting at a Challenging Time (PACT) Program at the Vernon Cancer Center at Newton Wellesley Hospital, also in Boston. Dr. Jellinek is a professor of psychiatry and of pediatrics at Harvard Medical School, Boston. He is also chief of clinical affairs at Partners HealthCare, also in Boston. E-mail Dr. Swick and Dr. Jellinek at pdnews@elsevier.com.

While autumn means the start of school, cooler nights, and the coming holiday season to most families, for seniors in high school it is crunch time: college application season. This is the last semester when grades "really matter" for their applications, they are preparing for a final set of SATs if needed, and they must write seemingly endless essays on some variation of "why I am special." Then they must organize their various application packages, with supporting materials and recommendations submitted on different schedules.

In addition to meeting with various advisers, everyone is probably asking them where they are applying and why they chose those particular schools – all of this while they are juggling the various extracurricular activities that they hope will help them stand out. In short, it is an exceptionally busy, stressful, and emotional time for any high school student who is hoping to gain admission to a competitive college.

These 17-year-olds have reason to be stressed. With admission rates for the most competitive schools dwindling to the low single digits (6.3% for Harvard and 7.9% for Yale in 2011) and even state schools becoming intensely competitive (University of California, Berkeley, admitted only 21% of applicants in 2011 and their median GPA was 4.19 on a 4.0 scale), students are understandably anxious, especially those students from families and communities that place great value on being accepted to an elite college. Add to that the anxiety about the increasingly burdensome cost of a college education. Then finish this with uncertainty about the job market they will face when they graduate.

For many, where they go to college is a "bottom line," a summary of all they have accomplished, their acknowledged potential, and who they "are." You get the picture.

Pediatricians are in a unique position to offer both seniors and their parents some healthy perspective about this process. While your patients are unlikely to ask you for college advice, you will get to hear about how stressed they are. A simple reminder that 1 year from now, they will be settling into a school that will provide them with an excellent education can sound fresh when coming from someone other than their parents. It also can help to remind them that rather than focusing on the very best school they can gain admission to, they should be looking for the school that will be the very best fit for them.

The application process may seem like a once-in-a-lifetime event, but it is also an opportunity to explore how to work hard in a way that is sustainable, that won’t leave them completely wiped out. Ask them about whether they are finding time for exercise and are eating reasonably well. Has their weight changed? Tell them about the data that suggest that those adolescents who sleep more than 7 hours nightly perform better on cognitive and physical tests. Their concentration will be better; they’ll do better in interviews, and are less likely to get sick. Remind them that finding small ways to relax in the midst of intense work also can be very effective in helping them feel better and perform better. Whether it\'s to exercise or play a little Angry Birds, taking regular breaks is usually well worth the time.

While offering this common sense advice, you also should be on the lookout for warning signs that your patient has moved from stress to distress. Do the patient and family have reasonable expectations? How much is "on the line" for everyone in the family? The more unreasonable their expectations, the more that is on the line, the greater the mental health risks. The pressures and insecurity that can accompany this process can trigger genuine depression or anxiety for vulnerable adolescents, and can exacerbate symptoms in those teenagers who were already managing psychiatric symptoms. These symptoms may have been overlooked by parents and teachers at a time when stress and exhaustion seem routine. Have they withdrawn from friends or previously beloved hobbies? Are they using drugs to try and improve their performance? Are they engaging in self-destructive behavior to manage their stress? Are they cutting? Restricting their food intake or compulsively exercising? Or have their grades started to drop? How have they responded to stress before? While one episode of getting drunk with friends to blow off steam is not alarming, be tuned in for the suggestion of a pattern. If you notice one, have a low threshold for a mental health referral. If they balk, saying that they do not have the time, you can remind them that when untreated, depression and anxiety could derail all their hard work. Making it discussable is the first step to getting them the extra support they may need.

You might hear from parents about their concerns about the stress of the college application process. For those parents who are speaking about "our application to Harvard," you might gently remind them that part of applying to college is about developing the organization and initiative to manage responsibilities independently. Next year, when their children are freshmen somewhere, they won’t have all of this help. This is an opportunity for them to manage an important task independently, asking for help if they need it. Indeed, parents demonstrate confidence in their adolescent’s abilities by stepping back.

It can be very helpful for parents to hear that while their senior might benefit from a (very) occasional reminder about deadlines, parents are exquisitely valuable to their senior in a different way. They are a uniquely qualified resource for an adolescent considering what he or she might want in a college education, with their unrivalled knowledge of the child’s unique interests, strengths, and needs. Parents are the keepers of great wisdom about their children’s gifts, and this perspective can be invaluable as seniors try to think through what they hope to get out of 4 years of hard work and great expense. And this expense matters, too. Parents also should be available to help their children consider what different school packages will cost, and honestly talk through what it will take to pay off these loans. These are difficult matters, but ones they are unlikely to consider deeply with peers or in leafing through the U.S. News college rankings. Yet how much debt they hold when they graduate will have enormous implications for their life’s path.

Some parents may be anxious that their son or daughter "just doesn’t care," and they are constantly nagging or simply doing all the preparation themselves, out of concern that otherwise it won’t happen. For these parents, you might gently suggest that when they hold so much anxiety, their child doesn’t have to hold any. While this might make the application process easy, it will leave their child at a disadvantage once they are at college and have to manage their own semester schedule (and laundry) all by themselves. Sometimes asking a school adviser to take a more active role is a better alternative than the parents getting more involved in a process that is designed to help high school seniors individuate and separate from home.

You are in a marvelous position to help your patients remember that this process is about their education and is not a horse race. Indeed, it is one of their last chances to work on a very adult undertaking with concerned adults (parents, teachers) nearby. If their parents can focus on helping their children to manage the stress, keep perspective, develop a nuanced appreciation of their own wishes and abilities, and cultivate both their discipline and flexibility, then the college crucible could instead be a passage that builds maturity and resiliency while parents and children are still enjoying eating dinner around the same table.

Dr. Swick is an attending psychiatrist in the division of child psychiatry at Massachusetts General Hospital, Boston, and director of the Parenting at a Challenging Time (PACT) Program at the Vernon Cancer Center at Newton Wellesley Hospital, also in Boston. Dr. Jellinek is a professor of psychiatry and of pediatrics at Harvard Medical School, Boston. He is also chief of clinical affairs at Partners HealthCare, also in Boston. E-mail Dr. Swick and Dr. Jellinek at pdnews@elsevier.com.

While autumn means the start of school, cooler nights, and the coming holiday season to most families, for seniors in high school it is crunch time: college application season. This is the last semester when grades "really matter" for their applications, they are preparing for a final set of SATs if needed, and they must write seemingly endless essays on some variation of "why I am special." Then they must organize their various application packages, with supporting materials and recommendations submitted on different schedules.

In addition to meeting with various advisers, everyone is probably asking them where they are applying and why they chose those particular schools – all of this while they are juggling the various extracurricular activities that they hope will help them stand out. In short, it is an exceptionally busy, stressful, and emotional time for any high school student who is hoping to gain admission to a competitive college.

These 17-year-olds have reason to be stressed. With admission rates for the most competitive schools dwindling to the low single digits (6.3% for Harvard and 7.9% for Yale in 2011) and even state schools becoming intensely competitive (University of California, Berkeley, admitted only 21% of applicants in 2011 and their median GPA was 4.19 on a 4.0 scale), students are understandably anxious, especially those students from families and communities that place great value on being accepted to an elite college. Add to that the anxiety about the increasingly burdensome cost of a college education. Then finish this with uncertainty about the job market they will face when they graduate.

For many, where they go to college is a "bottom line," a summary of all they have accomplished, their acknowledged potential, and who they "are." You get the picture.

Pediatricians are in a unique position to offer both seniors and their parents some healthy perspective about this process. While your patients are unlikely to ask you for college advice, you will get to hear about how stressed they are. A simple reminder that 1 year from now, they will be settling into a school that will provide them with an excellent education can sound fresh when coming from someone other than their parents. It also can help to remind them that rather than focusing on the very best school they can gain admission to, they should be looking for the school that will be the very best fit for them.

The application process may seem like a once-in-a-lifetime event, but it is also an opportunity to explore how to work hard in a way that is sustainable, that won’t leave them completely wiped out. Ask them about whether they are finding time for exercise and are eating reasonably well. Has their weight changed? Tell them about the data that suggest that those adolescents who sleep more than 7 hours nightly perform better on cognitive and physical tests. Their concentration will be better; they’ll do better in interviews, and are less likely to get sick. Remind them that finding small ways to relax in the midst of intense work also can be very effective in helping them feel better and perform better. Whether it\'s to exercise or play a little Angry Birds, taking regular breaks is usually well worth the time.

While offering this common sense advice, you also should be on the lookout for warning signs that your patient has moved from stress to distress. Do the patient and family have reasonable expectations? How much is "on the line" for everyone in the family? The more unreasonable their expectations, the more that is on the line, the greater the mental health risks. The pressures and insecurity that can accompany this process can trigger genuine depression or anxiety for vulnerable adolescents, and can exacerbate symptoms in those teenagers who were already managing psychiatric symptoms. These symptoms may have been overlooked by parents and teachers at a time when stress and exhaustion seem routine. Have they withdrawn from friends or previously beloved hobbies? Are they using drugs to try and improve their performance? Are they engaging in self-destructive behavior to manage their stress? Are they cutting? Restricting their food intake or compulsively exercising? Or have their grades started to drop? How have they responded to stress before? While one episode of getting drunk with friends to blow off steam is not alarming, be tuned in for the suggestion of a pattern. If you notice one, have a low threshold for a mental health referral. If they balk, saying that they do not have the time, you can remind them that when untreated, depression and anxiety could derail all their hard work. Making it discussable is the first step to getting them the extra support they may need.

You might hear from parents about their concerns about the stress of the college application process. For those parents who are speaking about "our application to Harvard," you might gently remind them that part of applying to college is about developing the organization and initiative to manage responsibilities independently. Next year, when their children are freshmen somewhere, they won’t have all of this help. This is an opportunity for them to manage an important task independently, asking for help if they need it. Indeed, parents demonstrate confidence in their adolescent’s abilities by stepping back.

It can be very helpful for parents to hear that while their senior might benefit from a (very) occasional reminder about deadlines, parents are exquisitely valuable to their senior in a different way. They are a uniquely qualified resource for an adolescent considering what he or she might want in a college education, with their unrivalled knowledge of the child’s unique interests, strengths, and needs. Parents are the keepers of great wisdom about their children’s gifts, and this perspective can be invaluable as seniors try to think through what they hope to get out of 4 years of hard work and great expense. And this expense matters, too. Parents also should be available to help their children consider what different school packages will cost, and honestly talk through what it will take to pay off these loans. These are difficult matters, but ones they are unlikely to consider deeply with peers or in leafing through the U.S. News college rankings. Yet how much debt they hold when they graduate will have enormous implications for their life’s path.

Some parents may be anxious that their son or daughter "just doesn’t care," and they are constantly nagging or simply doing all the preparation themselves, out of concern that otherwise it won’t happen. For these parents, you might gently suggest that when they hold so much anxiety, their child doesn’t have to hold any. While this might make the application process easy, it will leave their child at a disadvantage once they are at college and have to manage their own semester schedule (and laundry) all by themselves. Sometimes asking a school adviser to take a more active role is a better alternative than the parents getting more involved in a process that is designed to help high school seniors individuate and separate from home.

You are in a marvelous position to help your patients remember that this process is about their education and is not a horse race. Indeed, it is one of their last chances to work on a very adult undertaking with concerned adults (parents, teachers) nearby. If their parents can focus on helping their children to manage the stress, keep perspective, develop a nuanced appreciation of their own wishes and abilities, and cultivate both their discipline and flexibility, then the college crucible could instead be a passage that builds maturity and resiliency while parents and children are still enjoying eating dinner around the same table.

Dr. Swick is an attending psychiatrist in the division of child psychiatry at Massachusetts General Hospital, Boston, and director of the Parenting at a Challenging Time (PACT) Program at the Vernon Cancer Center at Newton Wellesley Hospital, also in Boston. Dr. Jellinek is a professor of psychiatry and of pediatrics at Harvard Medical School, Boston. He is also chief of clinical affairs at Partners HealthCare, also in Boston. E-mail Dr. Swick and Dr. Jellinek at pdnews@elsevier.com.