This blog article is based on the College Talks & More podcast brought to you by Mybookcart.com. Co-hosts Hanna and Cari interviewed two very distinguished authors, Dr. Hibbs and Dr. Rostain who discussed their book “The Stressed Years of Their Lives”. The book helps guide us and show us the life management skills that college students need during their college years, and the struggles they may face. I think this book is more important now than ever because of the COVID-19 pandemic, and the stresses that come along with it. Let me tell you, after reading your book and doing some research, the first review that I read infuriated me. The review said that the title was misleading, because only a very small portion of the book’s advice was geared towards average kids with “normal” ups and downs. It also says the book was written about kids with significant mental health issues. I highly disagree with that statement. I found the book very engaging and eye opening knowing that you can go to school as “normal,” as it was put in the review, and then shit hits the fan. In my opinion this book pertains to children of all ages whether the child does or does not have mental health issues. I am a parent of a 7 and 13 year old and found a lot of your advice very helpful and useful at their current ages and it also gave me lots to think about for their future. Dr. Hibbs and Dr. Rostain started off the interview by giving a brief overview of themselves:
My name is B Hibbs. I’m a family psychologist and my training has been as a clinical psychologist, family psychologist, and also in child development. I have two master’s degrees and a Ph.D, which is more education than anyone would care to have. I’ve practiced in the field of family psychology for the last 30 years and I’ve also taught in graduate school for about 15 years. I’ve written another book that was based more on ethics and family relationships as it pertains to marriages, couples, and also intergenerational family relationships. We’ll probably get into how this book came about but I’ll give away the punchline. My oldest son went to college and I thought he was well prepared but he crashed and burned. In the second semester of his freshman year, after doing very well the first semester, he wound up in therapy. Then, I joined him in his individual therapy with Dr. Rostain and that’s how the book began.
My name is Anthony Rostain. I went to medical school at NYU and came to the Children’s Hospital in Philadelphia to become a pediatrician. In the process of training, I realized that the challenges I saw that needed to be addressed in my kids and families were mental health challenges. I went and did a second set of residencies in adult psychiatry and in child adolescent psychiatry. I have focused my career clinically on kids with neurodevelopmental differences, learning challenges, ADHD, autism spectrum, and kids who, through the normal course of life, find adapting to both school and growing up to be difficult. I also work with families and use a family systems approach. I became involved in medical education and running the training programs for medical students and psychiatry residents at the University of Pennsylvania Perelman School of Medicine. I’ve been there for about 40 years and then I just recently moved over to Cooper University Healthcare, where I’m the chair of Psychiatry and Behavioral Health. One last piece of information is that in the years of 2014 and 2015, I was co-chair of a taskforce at the University of Pennsylvania that was looking into the challenges of mental health and wellness of students at UPenn because there were a number of suicides and the provost and president wanted to understand why was this going on. I got deeply immersed and have been always immersed in both the training of residents and medical students in mental health, my own practice of lifespan psychiatry, focusing on adolescence and transitional age youth, and thinking about the environment that kids are growing up in, for example families, schools, and colleges.
On that note, we know that you’re mental health professionals with years of experience helping families and young adults. We know that you met through Dr. Hibbs’ son but how did your collaboration come together with writing this book and who would you say would benefit the most from reading the book?
I’ll add to what Dr. Hibbs said earlier, which is that Dr. Hibbs approached me to take care of her older son Jensen, who was in his freshman year of college and developed depression to the point where he actually had to leave school. In that time frame, she brought him to see me and I worked with Jensen and his family for a number of years. After he got better and was doing quite well, Dr. Hibbs mentioned to me that she was writing a book about her experiences as the mom of someone who had difficulties in the past and she wanted my input. Initially I said I would help by commenting on the narrative. She was writing the book as a memoir but the person who is advising her about how to get the book out there suggested that we reframe the focus of the book and make it a parents guide. A parent’s guide would make the book much broader than just a specific story of one individual. We thought about all the different kinds of problems that come up as kids get ready to go to school, have trouble leaving home, and how to prepare them for that journey. We know that moving from being at home into the college space is a big challenge to begin with and we realize that parents also feel as unprepared as their kids. We wrote the book to help parents both learn the skills they need to guide their kids through this period of their life and understand this process.
Why is the family tree so important in treating your patients?
It’s important, as parents, to think of it as a long learning curve of social emotional maturity. It’s a part of the family tree and it speaks to mental health literacy. It’s very important to, in an informal way, discuss what runs in the family. It’s about normalizing conversation related to mental health struggles and in most families, if you look at the family tree, there are many things that our relatives have struggled with in terms of mental health, mental illnesses, and even their recovery. As we think about the family tree, it helps reduce our children’s negative self stigma which can form if they don’t understand this as a fairly common occurrence for people at different points in time. It also assists parents in overcoming the positive bias of “We aren’t going to talk about this because this won’t happen to my kid”. Most importantly, it teaches children that it is good to seek help when needed. Those are the main reasons why we talk about the family tree.
When parents say “How could I have missed this”, what is your response?
First of all, about ¼ of all mental illnesses that could pop up, would typically occur by age 14. The earliest and most prevalent is an anxiety disorder of childhood. However, 75% of all lifetime occurrences of mental illnesses emerge between mid to late adolescence and young adulthood or age 25. Some parents may mistake it as a passing teenage phase or if it becomes substance use, they may think that all the kids are doing it and they will tell their child not to hang out with those kids instead of understanding that it could be a coping strategy for anxiety or depression. Many kids also normalize their distress and don’t report it to parents. They believe that it is just situational or stress so parents may miss the signs and assume it’s developmental moodiness. Another aspect of this is that kids tell their friends first, not their parents. Friends don’t know what to do and they might not direct the child to a trusted adult to get help.
Do friends help or hinder when a student is struggling? How big a role does peer pressure play?
I think friends could be a naturally therapeutic support system. However, it’s important to realize that you need support from friends, family, and sometimes mental health professionals. Most parents and friends aren’t going to be able to differentiate concerns from mental health issues that are more serious or just incipient mood disorders. In the friendship of young men, they sometimes cope by getting a beer, which is not the answer to the problem. It’s important to recognize that there are young support groups for teens. We have an extensive list in our appendix of the different peer support groups that are available to kids as well as professionals. Peer pressure takes the form of looking good, succeeding, or as Dr. Rostain found at UPenn, the “Penn Face”, when you appear fine but mask really serious distress.
Are students more likely to go into college with mental health issues or do they tend to develop while they are there?
The answer is yes to both. We’ve seen over the last several decades, a rise in the rates of anxiety and depression in young people. This is just part of the landscape that we describe in the book. Life has become more stressful because of the uncertainty that people are living in and even more so now since the COVID-19 pandemic has befallen us. Kids growing up nowadays feel more vulnerable, experience higher rates of anxiety and depression, and also we think what adds to that is parents themselves struggling with their own mental disorders. We think of it as a family issue. At the same time, as Dr. Hibbs just mentioned, late teens and early 20’s is when many serious mental disorders really manifest themselves fully. Disorders like bipolar disorder, severe eating disorders, and even psychotic disorders begin to show up. So this is a very important time in people’s lives to look for the signs of a mental disorder. One of the things the book is trying to get across is that parents need to be aware of what these early signs are so that they don’t tribute them as stress or wanting attention. Parents really need to understand that when young people are vulnerable, it’s important to catch what’s going wrong early and get people to help as soon as possible.
There’s been a big push lately to have mental health issues in a more conversational setting. I think people are becoming a lot more comfortable talking about mental health issues like stress and anxiety. Are issues that students struggle with still on the rise and why do you think that is?
They’re definitely still on the rise. Many of the American Collegiate Mental Health Associations do annual surveys of this and a part of what they come up with is that stress, anxiety, and depression are running neck-and-neck with each other in terms of which is the most reported issue that leads kids to seek counseling. Anxiety is also being expressed and reported in younger ages, which is concerning. Part of why anxiety is being found in younger ages is because of a variety of factors but it’s a harsher and more competitive world now. I think the message to kids is often that you can’t miss a beat or step off the very linear and achieving path to a “good life”. This has been a building problem for the past 40 years but just like climate change, it’s a slow, building process. We tend to lose sight of the fact that mental health issues didn’t used to be normal. To piggyback on what Dr. Rostain has said, parents are also reflecting their own anxiety and exerting more control over their kids in order to give them a more competitive advantage. Parents experience it as a sense of danger in terms of “Will my child be okay when they grow up?” This kind of stress on parents is communicated to kids and kids have their own peers who are also reflecting that kind of anxiety or, as we call it in the book, “constantly thriving on behalf of an uncertain future”. COVID-19 has certainly blown up that uncertain future to even greater proportions. Part of what has been paradoxical about this time of growing anxiety is that in prosperous times, parents typically promote autonomy in childhood but that has not been happening for the past 20 to 30 years because parents have been more concerned about what they see as the narrowing path to a “good life”.
I know personally my husband and I have different parenting styles. How does different parenting styles affect a student’s success in treatment?
There’s no one right or wrong parenting style. It really has to do with Mom and Dad, who don’t have to be exactly alike but they have to support each other and not undermine each other’s authority or ability to work out any differences rather than have the child be in the middle of those conflicts. We believe that there are some positive things parents can do. Positive parenting is an important concept, which is to do as much as possible to focus on things that are going well. Also, positive parenting includes building skills and resilience so that when things don’t go so well, the parents can look at it in an objective way rather than overreact in a negative way. We call it authoritative parenting rather than authoritarian parenting since parents do need to set expectations and clarify that they believe communication and openness are important values and skills. We think that as long as parents are trying their best to understand what their child is going through and really seek to learn rather than to dictate or to demand things go a certain way. Those are not realistic ways of approaching a child who is having difficulties. A less than fair parenting style that lets a kid do whatever they want is not reassuring to kids because they want direction and they want to know that someone can guide them when they need guidance. Neither is the over control micromanaging style of parenting or the overly negative style of parenting. We do discuss, in the book, ways to reduce negative emotions to try to help parents not be dismissive or judgmental, be more tolerant to people who are having trouble, and to understand that getting help is a good thing rather than something to be ashamed of. Last but not least, I’d say being really careful not to overprotect or try to control everything that happens to your child. They’re going to have to figure out how to make the right choices when it comes to treatment. We think parents need to be involved as a sense of support. As we mentioned earlier, our backgrounds are in family systems treatment. We think that parents need to engage when it’s important to figure out if conflicts in the family are obstacles to the young person’s recovery or if the family is unsure and wants understanding about what’s going on. We think everyone’s got a role to play in pushing the forward against the illness that might be interfering with the young person’s success.
Do all students with mental illnesses need to take medication?
Not everyone needs medication. Medication is a tool like other tools in the tool box of mental health providers. Medication can be helpful but it needs to be well monitored and taken as prescribed. It’s important to understand with each medication that is prescribed what the reason is for that medication, how it works, what might be the side effects, what to do if there are side effects, and to make sure that it’s achieving the goal. For those young people who are taking medication, being open about it and seeing it as a part of being healthy is addressing your illness. If you had diabetes, you would need insulin. If you had asthma, you might need to take your inhaler. So if you have something like bipolar disorder, medication can help keep your moods from going way off the deep and getting you into trouble. We think the coping mechanisms of learning to understand what you have, dealing with it, becoming more responsible, having a healthy lifestyle, not staying up all night, and not engaging in too much drinking or other substances can be important. All of these things are coping mechanisms that we spend a lot of time describing in the book.
In your book, you discuss the social and emotional skills that young people need to function independently in college. What are these skills and how can parents help develop them?
- Conscientiousness- the ability to take responsibility for one’s actions. I think parents need to do their best to look at how kids are taking ownership or are shirking responsibility. Also, parents should try to give incentives to young people for taking on and completing tasks or spelling things out. Sometimes even in terms of a contract, taking care of themselves or the chores they have to do is another part of conscientiousness.
- Self-management- the ability to do your day to day activities. We think that trouble with getting up or going to sleep at night is part of self-management. We believe that parents really need to give kids the message that it’s time for them to take charge of these important skills.
- Interpersonal skills- getting along with others, which is probably one of the hardest things for parents to figure out. Making sure you know your kid’s friends and talking with your kids about how they handle difficulties with their peers is important. Also, if they’re having relationships with people that are not healthy for them, trying to talk about what’s going on is essential.
- Self control or will power- being able to say no to things that are not good for you. One of the things we spend a lot of time looking at in the book is computer and smartphone use. We also talk about setting limits on those screens, how to learn to live with the screen and not let it dominate you.
- Grit- the ability to cope with frustration and disappointment in failure. We think that parents should share their own experiences of dealing with disappointment or setbacks and realizing that this is part of life.
- Risk management- understanding that risks are always around us and practicing how to limit one’s exposure to danger. I think this is on everyone’s mind nowadays with COVID-19. Parents need to learn to feel comfortable talking about things like sexuality, substance use, and other risky activities that young people engage in.
- Self-acceptance or self-compassion- We think this begins at home because you can’t really teach this like a skill. You have to model self-acceptance to the extent that you as a parent can openly talk about ways that you learned how to deal with your own shortcomings and not be afraid of those.
- Open mindset or knowing when things aren’t going well- We think parents need to model this and be able to get help for themselves if they need it and not to look at that as something to be ashamed of.
We hear about the dangers on campus, such as binge drinking, sexual assault, and mental health issues. What should parents be most concerned about and when should they intervene?
I think parents should always be concerned about all of these things because they are the risky behaviors that are going on in schools. Talking with your kids about binge drinking, sexuality, how to avoid sexual assault, or what to do if you’re in trouble are things that need to be discussed long before kids go off to college. We’re seeing that some of these issues are happening to children in high school and even in middle school. So parents who are listening, if you have a kid in middle school, that’s when you should start to talk with them about risks in the world, how to face them, and how to be open if something happens to you that you don’t like. For the children, talk to your parents. They won’t get angry at you and they don’t want you to hide these things. By the time kids leave for school, you should be able to talk with them about their own strategies and how to limit exposure to things like excessive alcohol, substance abuse, or situations in which you might be put into a compromise relationship with someone that you don’t want to be in. Colleges are also spending time now teaching about these risks and there are lots of resources on the internet about how to talk with your kid. Also, there are resources that can help your kid really understand the choices they can make and the ways they can politely decline risky behavior without looking like a nerd.
With that said, how can a parent help in the aftermath of a setback or mental health problem that occurs in college or before college?
We’re having a COVID-19 setback right now that affects kids in pre-K to young adults in their 20’s. The setback from COVID-19 and loss of a social life and academic in-person experience is really testing parents and kids today in terms of understanding and seeing what the stressors on kids are. One of the things that parents can do now while their kids are doing school at home is recognize the losses the kids have experienced and not say that “We will be back to normal soon,” because time does not go backwards. We have to be flexible and parents have to be in a leadership position in terms of helping their kids with risk management and safety assessment. We need to figure out how we can conform to things that make us a weak community, which means we’re going to have to make sacrifices at a family, local, community, and national level. This is a time of great maturity building with kids back home because parents have a new chance, especially if their kids have been away at college, for assessing how they are coping, how they are doing, and how we can help them cope. Some things that can help kids cope are routines, exercise, and mindfulness meditation. These are some ways to keep ourselves resilient in a time of great uncertainty. We’ve all lost our old routines and kids don’t have as many years of coping with uncertainty as adults do and they need to lean on us in that way. This is also a great opportunity to relearn the lesson that life is not linear and even the path that parents think of as the “launch” to college is not a straight path. Mental health problems can happen in college so I’d tell parents to throw out their misconceptions that it will be a totally linear path. It takes longer for kids to grow up now. The role of full adulthood really doesn’t happen until late 20’s or early 30’s. If you have a mental health problem on top of it, just consider it a developmental delay. Also, learn that you as a family are incredibly helpful and supportive as advocates for your children’s treatment and getting adequate treatment for their mental health issues. So think of yourself as parents and partners to your kids, to their school, their professors, or their colleges. Part of what we want to avoid is negative parenting, which can sometimes be an easy thing to fall into. Some examples of negative parenting are bright-siding things, which is called positive bias, avoiding over-involvement, or blaming the student. These things require the support from parents. Parents are crucial and it’s clear from research that parents who practice positive parenting and are part of the treatment team have kids who recover from mental health issues faster. It’s mutually beneficial for parents to be part of the solution.
Let’s get personal. I want to thank you for sharing about your son Jensen’s story in your book. We really want to know, how is Jensen doing now?
I always say to people who thank me that the “thanks” goes to Jensen. He, very generously, gave permission to have his story shared in a very public way. His only real question about sharing it was, “Will it help people?”. I said it would help people, so he let us share his story. He had a good response to the medication during his treatment, although there were many medication trials that were not successful prior to meeting Dr. Rostain. We didn’t give up and just kept going until we got a better answer. Jensen decided to discontinue his creative writing liberal arts education and he got an associate’s degree as a biomedical technician because he wanted a job with healthcare benefits. Since that time, he has been steadily employed and I’m very proud of him. He traveled on three forms of transportation to get to his hospital on Staten Island and this entire spring, New York was at the center of the COVID-19 pandemic and miraculously he did not get sick. Recently, he was happily married right before COVID-19 shut down wedding receptions. He’s in a good place now, thank you for asking.
What chapter do you find is most beneficial to parents and students?
It’s a tough question to answer but I will give you two chapters because the book is written in two parts. The first half discusses prevention and preparing your child for the “launch”. I think of those chapters, my favorite is the chapter on social emotional stress, which identifies the skills that young people need and how to help them develop those skills. Oftentimes, the preparation is usually emphasizing either your academics or your extracurricular. Parents do a really good job at getting kids to do well in school and making sure they have the right kind of extracurriculars. We thought that social emotional skills and readiness to launch are really something that parents should know about and I think that’s a great chapter. Then in the second half, which really has to do with when things are serious and evolving, I think that chapter 8, which is called “Crisis Care,” really describes Jensen’s story in a powerful way and really talks a lot about what parents need to think about if their young person is in a crisis.
Out of curiosity, are you still treating any of the patients that you mentioned in your book?
Dr. Rostain and I have what we call an “open door policy,” so any patients that need to get back in touch with us are welcome to come back in. Right now, I’m not treating any of the people that are mentioned in the book, however I’m in touch with them and a couple of them have volunteered for a documentary that we’re part of and also for a podcast that we’ve shared with educators. We have a wonderful group of folks that we’re in touch with in terms of asking them if they would be interested in helping other kids or educators understand what could go better for them.
Are there any changes that you would recommend to colleges that would help support students who are having a difficult time?
I think the most important change is a change in culture regarding families and making sure that parents are involved right from the beginning and understanding the adjustment issues that may be going on. Too often parents are kept in the dark and they’re told it’s no longer their business because their kid is on their own. I think the culture is changing and schools are growing more friendly towards parents because they understand that young people are arriving not fully formed or independent and that parents still offer important support and knowledge about the young person that might be really key to the success of that person’s adaptation to college. I think the biggest change that is coming about is that as schools start to think about the social safety nets they need to be developing on campus, that safety net also includes reaching out to families and making sure that families feel supported when they’re feeling scared, concerned, or upset about what’s happening with their young person. With that kind of partnership, we think that anyone who has a mental health challenge or any other kind of challenge in school will have a better recovery. Including family is an important, positive change that we see going on and we’d like to see more of.
How does a parent know that their child’s therapy is working when the child is away at college and the parent has limited involvement in treatment?
We highly recommend that before your child leaves for college to talk to your child about signing a HIPAA and FERPA. These are legal documents that should be signed because at age 18, your child’s privacy is protected unless they give consent to allow a parent to speak to a counselor or, under FERPA, allow counselors, staff, and faculty to talk to each other about the student to make sure the student is doing well. Parents can always call the counseling center and ask if their kids would sign a HIPAA form so that the parent can talk with the counselor and get reassurance that their child is okay. Also, you should talk to your child about the benefits of having a HIPAA or FERPA form signed so parents can function in an appropriately helpful way. These forms don’t allow the parent to be intrusive, it’s just to know how the child is doing and what the parent can do to better support their journey.
Looking back, is there anything you would add to the book that wasn’t included?
When St. Martin’s Press was coming out with the paperback, we actually got a chance to write an appendix. We’re really happy with the appendix because it’s all about continuing the conversation between parents and kids. This is additional material in the paperback that allows the conversation, that we were beginning to talk about, to go into more depth. It’s about how to talk to your young person about either risk-taking or what to do if school isn’t going the way they want. That’s one thing that is now included that wasn’t. The only other thing that I would want to add in the book is something directed at free college advising. I would add a section on talking with college counselors, preparing kids for college, and something aimed at helping college counselors play a bigger role. We think that schools have a role to play, not just in preparing the students academically, but in developing social and emotional skills. This added section would reach out to the educators a little more. Dr. Hibbs and I have been going around the country talking with educators and we learned a lot from them. That might be a subject for further writings or webinars aimed at helping the high school teachers and advisors.
We’re all very curious, are you two planning on writing another book together?
I think that would be lots of fun. Writing this book with Dr. Rostain was a labor of love and it was also deeply engaging and a gratifying experience with each other and as we talked to audiences around the country. We’re always interested in hearing ideas from our listeners and your listeners today about any topics of interest that they would like to see addressed. We don’t have any firm plans but we love to talk about any topics. We’re also in the process of filming a documentary about these issues so out of that may come another idea for a second book.
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