Core Influences on Youth Mental Health Haven’t Gone Away

While the rise in youth mental health problems has been widely appreciated, there remains a lot of debate about what specifically is behind it. Many popular articles and books implicate some more modern era suspects, specifically, 1) smartphones, 2) helicopter parenting, and 3) ongoing effects of COVID.

To be sure, there is evidence to suspect these factors in addition to several other 21^st century players such as high potency cannabis, new stressors (such as climate change and school safety), and deepening shortages of good treatment. But in giving these newer causes the consideration they deserve, it is also important not to forget about some of the more traditional influences of mental health, for better or for worse, that continue to exert strong effects on young people today.

Factors like genetics, the prenatal environment, and trauma and neglect, may not grab as many online headlines these days but remain powerful contributors to child and adolescent development, particularly for youth who struggle with clinical levels of emotional behavioral challenges.

Indeed, many of us who tend to work with more acutely impaired youth have begun to notice a split between the factors that are supposed to be driving the current youth mental health crisis and the factors we actually observe in the children and families coming for help for major problems such as suicidal behavior, aggression and dysregulation, and what appear to be psychotic or quasi-psychotic experiences.

Instead of encountering youth with too many online contacts, we often work with youth who have trouble developing social communications of any type. Instead of overly intrusive and involved parents who shower their children with excessive praise and rewards, we continue to see absent or disconnected parents who are often quick to deliver harsh and harmful insults and criticism. Instead of new problems related to the pandemic, we tend to see old problems that have been twisted and inflated.

This combination of 1) an inherited risk for mental health problems, 2) a prenatal environment characterized by substance use or heightened stress, due to things like domestic violence or poverty, and 3) an early childhood containing trauma, neglect, abandonment, socioeconomic challenges, and, at best, suboptimal parenting practices, continues to find its way into an alarming number of histories of youth who present with major mental health problems.

Clinicians may argue about what diagnostic term (complex PTSD, disruptive mood dysregulation disorder, bipolar disorder, oppositional defiant disorder, etc.) should be used to describe youth who have endured these risk factors and now struggle with mood instability, anger, anxiety, and attention problems, but the history and core areas of concern often have a remarkable level of consistency that seems to overshadow the effects of any new technological advance or fashionable parenting trend.

Is it possible that what underlies youth who struggle with high levels of major mental health problems is different from what is driving the depression and anxiety seen with a larger group of stressed out but largely functional adolescents? Good research will need to be performed to explore this hypothesis further, but it wouldn’t be the first time that the genetic and environmental architecture of similar sounding mental health problems are different for different groups.

My objective for this post isn’t to dismiss the real concerns that are being raised about some of the negative effects of excessive screen use, modern parenting trends, or the pandemic, but rather to remind us all that more classic and foundational influences on mental health such as genetics, the prenatal environment, and early trauma and adversity are still very much present and continue to have major impacts, particularly on many of the youth who present with the most acute levels of emotional-behavioral problems. To be effective in addressing the surge of youth mental health problems, we need to stay current in our understanding of the modern pitfalls of 21^st century child development while still keeping our eyes on the ball when it comes to some of the fundamental forces that continue to impact mental health disorders in children and adolescents. ‘

This post is based on my recent article in the Journal of the American Academy of Child & Adolescent Psychiatry Connect.