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.
Dr. Michael S. Jellinek
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.
Dr. Susan D. Swick
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.