How Families Can Re-Group After College Withdrawal

20-year-old Penny came home from college during the middle of her fourth semester, defeated after feeling overwhelmed for months. Unable to keep pace with full time college, she failed every class her third semester and withdrew halfway through the fourth. On Tuesday, Penny was sobbing in my office about returning home to her childhood bedroom. She feared she might get stuck back in childhood and never return to her path to adulthood.

On Thursday, Penny’s parents sat in the same spot in the office, without Penny. They were fuming. Their daughter had not held up her end of the bargain at college. Parents paid tuition and rent for two years, and she only produced credits for the first year. They knew their daughter suffered from anxiety and so they had provided her with every available resource to support her in college. They were shocked to learn she had stopped attending classes during two consecutive semesters. After years of saving for college, Penny was throwing away her opportunity. In addition to missing classes, her parents felt she was overspending. They feared she would continue excessive spending and never act like a responsible adult.

Both Penny and her parents shared the same desire: for Penny to regroup, figure out what had gone wrong, learn necessary skills, and return to college as soon as possible. Penny wanted freedom and opportunity; her parents wanted to see responsibility and accountability. The end point would be an independent adult. The problem was, none of them knew how to move out of frustration and defeat and toward a new start.

During the first week home, Penny spent most of her time in her room crying. When she came out, her parents asked her when she planned to get her act together.

The family needed a plan to move forward, so we sat down and wrote a simple list:

Make A Specific Plan/Agreement

            Spell out the details of what you want Penny to do now that she is home.

            Type up the agreement. Give everyone a copy or post it on the wall.

            Keep your rules as simple as possible

Hold Her Accountable

Resist giving advice. If she is required to work, tell her. But don’t tell her where to apply.

            Make her find her own solutions

            Leave her to operate within the rules.

Be Clear About Rules and Consequences

On the written plan, note how you plan to hold her accountable for the rules. Tell her in advance, in writing, what she can expect to happen if she violates part of the agreement.

            Review it together.

Stay Calm and Mindful

No shouting, name-calling, boundary violations. If you’re upset, take a walk. Talk to a friend or counselor.

            Parents vow not to make financial concessions under pressure.

            Parents discuss decisions with the co-parent.

            If you lose your cool, your message may not be heard.

Follow Through

Require a formal meeting with both parents and a formal request in writing to get any extra money.

            Decide in advance what you plan to do if the whole deal fails.

Do everything as you set out in the beginning. If something comes up you had not planned for, make a plan for the new issue and discuss it before handling it.

Dr. Deuter is a psychiatrist who specializes in the care of emerging adults.  

Effectively Parenting Older Teens

Parents of older teens and young adults often ask how they can help kids become responsible and mature. After parents spend years teaching moral values and helping kids practice skills for adult life, the final stages of “parenting” can leave parents feeling daunted. Is there anything more a parent can contribute once a child is grown physically but not yet grown-up behaviorally?

Consider the following two high school seniors:

Hunter was a high school senior in the honor’s program at a local public school. Almost overnight he seemed to lose his energy, interest in school, and sense of responsibility. His parents were worried. Frustrated and anxious, his parents yelled at him and called him lazy. They had heated arguments about his lack of motivation for school and asked him if he was stupid enough to throw away his future. They harassed him to get work done, and when he didn’t, on several occasions his parents completed assignments for him. Doing work for him made them angrier and the situation worsened. His grades were failing. His parents were disappointed. They made him an appointment with me because he seemed depressed and they wondered if there was a medication he could take to improve his mood or his academic performance.

Taylor was also a high school senior. He attended the same school as Hunter and took many of the same honor’s classes. Almost overnight he too seemed to lose his energy, interest in school, and sense of responsibility. His parents were worried. He wasn’t studying for exams, so his grades were poor, and within the first month of the school year he was failing three classes. Taylor’s parents had been through a similar experience with an older daughter and were ready with a plan. Taylor was a debate team champion and a basketball star. His parents responded by cancelling all his extracurriculars until further notice and telling him he had to put his grades first. Taylor was upset, but then got to work. He turned his grades around in about three weeks.

The key differences in the parents’ approaches:

1.     Stay Calm. The effective parents maintained their composure. The ineffective parents lost their cool. Staying calm when dealing with a teen can be difficult. Research proves that when teens have trouble keeping calm, parents can get triggered. Mastering your calm takes practice.

2.     Be Confident. The effective parents were confident and in-control. The ineffective parents felt powerless, lacked confidence, and used anger to feel stronger. Remember, you’re the parent and you’re in charge! You may feel overwhelmed, but it’s important to appear strong. If you appear uncertain you may get more pushback.

3.     Plan Ahead. The effective parents had a plan for this situation well in advance. The ineffective parents were caught off guard when their son’s enthusiasm for academics plummeted. High school seniors sometimes suffer a drop in enthusiasm (as do teens and young adults at other stages). Expect predictable bumps in the road and be ready with a plan to head them off. Make your plan before you get irritated or angry.

4.     Teach Accountability. The effective parents’ plan made their son accountable for catching up on his work. The ineffective parents took-on accountability for schoolwork to protect their son’s GPA- depriving their son of the opportunity to practice solving his own problem. When your child makes a mistake or has a lapse in his work ethic, it should be his job to clean up the mess with his grades. Make certain your plan has him doing his own work.

5.     Stay Positive. The effective parents stayed positive. The ineffective parents resorted to yelling and name-calling. Studies show that anxiety lowers test scores. It might seem natural to guilt your child for his failures, but it only helps to push your child as far as it takes so he regrets his mistake. Focusing on his duty to rectify the situation is more effective than reiterating his shortcomings.

6.     Teach Valuable Skills. The teen with ineffective parenting ultimately developed mental health symptoms as a direct result of his low motivation and his parents’ response. The teen with effective parents learned a valuable lesson, practiced skills for accountability he will use in adulthood, and felt proud of his achievement. Teaching adult skills is the primary role of the parents during the last few years at home and in the first few years after young adults leave the nest. Fill their toolboxes to ensure they are equipped.

Dr. Deuter is a psychiatrist who specializes in the care of emerging adults. 

5 Shortcomings of Young Adult Psychiatric Care

This week, a long-time patient came to see me for her regularly scheduled appointment. After checking-in on her own (now stable) mental health, she wanted to discuss her niece’s recent evaluation by a psychiatrist in another city.

She said, “My niece is nineteen. She went to see a counselor because she was stressed out about college. At the first session, the counselor thought she needed to be taking an antidepressant, and so she sent my niece to a psychiatrist. Her sister took her to the psychiatrists’ office hoping to go in with her, but was told that even with consent by the patient no family members were allowed in the room while the doctor evaluated a patient. After thirty-five minutes speaking to my niece alone, he prescribed an antidepressant and gave her instructions she didn’t really understand. My niece walked out confused, overwhelmed, and feeling all alone. She didn’t know whether to take the medication. Nothing about the situation seems appropriate to me. Do you think this is good medical care?”

Her story was typical of the standard of psychiatric care for young adults with a crisis brought on by stress. I could see a number of problems:

1.     Brief visits. Thirty-five minutes may be enough time to run through short list of medical questions like, “How much alcohol do you drink?” and, “How many hours do you sleep each night?” but it’s certainly not enough time to get to know a person’s normal baseline or to diagnose disease.

When searching for a psychiatric evaluation, it might be important to ask how long an appointment is expected to last. If the visits are routinely short, consider looking for a doctor who spends more time with patients.

2.     Refusal to receive collateral from family members. Mental health professionals can be sticklers for confidentiality rules. Families often complain that they aren’t allowed to express important observations of a loved one’s behavior, or even serious medication reactions, to psychiatrists, even when the patient offers consent.

Contact with family members is not strictly forbidden by privacy rules, but a signed consent form may be required. Common reasons for refusing to include family members in sessions may include misinterpretation of the rules of privacy, or limited time (see item number 1) since additional parties in the room can extend the time required for an evaluation. If having family members involved to share information is important, ask about a doctor’s policy ahead of time.

3.     Refusal to discuss the treatment plan with family members, even when the patient has requested to have someone present.

Whatever the specialty of the doctor, having a family member sit in to the educational portion of the session reduces forgetting and errors. Inquire about the doctor’s policies in advance.

4.     Rush to DSM 5 diagnosis without considering the long-term ramifications. When a young adult receives a new mental illness diagnosis, she may absorb the illness into her sense of self- see it as who she is. But not all young adults with an episode of depression will go on to experience another one.

Patients and families should ask specifically to discuss the doctor’s opinion about the long-term prognosis. After a single episode, even if treatment is required, there is usually no clear indication a person will suffer from lifelong depression.

5.     Rush to prescribing medication. The use of medications for depression is based on research in a broad range of adults, not a group of nineteen year olds. Since young brains are different than mature brains, the effects of medications in young people might be different from the effects in mature research subjects.

Because young brains are different than the average adults who volunteer for research studies, prescription medication should be considered for young adults only after non-medication alternatives have been exhausted. It is unclear why the nineteen year old described above was referred to a psychiatrist so early in her course.

Dr. Deuter is a psychiatrist who specializes in the care of emerging adults. 

5 Things To Discuss Before Your Teen Heads Off To College

Communication between college students and parents is key. Here are five important things to talk about before your teen leaves home:

The Budget

One of the biggest potential sources of family conflict is the college student budget. Whether you are funding your child’s education, or expecting him to come up with the money himself, your child will need to be on the same page. If your financial assistance will be limited, it’s importance to explain what help you can provide and how it will be distributed. Plan to deposit five hundred dollars a month to help out? Say so. Don’t expect your child to intuit your financial plan.

Parents often promise to pay for college in full, but may not define their expectations clearly. Maybe you have been saving since your child was a toddler, but how to you plan to disperse the funds? What if the savings won’t be enough to cover living expenses all four years? Paying for college extends well beyond tuition.

Points to consider:

·      Who will pay living expenses? Will those be paid directly by parents, or will money be deposited in an account for the student to use to pay bills him/herself?

·      How will food, transportation, and clothing be paid for?

·      What about the cell phone?

·      Will parents pay for health care?

·      Who will pay for extras?

The Timeline

College isn’t always four years of coursework. Some students extend time in college because their programs last five or more years. Some change majors. Others take it slowly for the first couple of years.

If your plan is to fund college for your child, does your strategy take these things in to account? Is there a time limit to your financial support? How about your patience? Are you prepared to pull the plug if your child is on the seven-year plan? If so, maybe she needs to hear your thoughts ahead of time, so she can find a part time job or pick up the pace.

Crisis Situations

Medical or mental health crisis: Record numbers of college students are seeking mental health support according to recently published studies. Common mental health related causes for leaving college include: depression, anxiety, panic attacks, excessive drinking, and drug use. Are there medical or psychiatric issues that might prevent your college student from completing school uninterrupted? If so, under what circumstances might you need to bring him home? Does he know when to ask for your help?

Academic Crisis: Do you have a plan for failing college grades? Most paying parents won’t want to continue writing checks unless kids are producing passing grades. Have you discussed your views with your soon to be college student?

Breaks From School

Some parents express frustration when kids arrive back home during college breaks, dump their laundry next to the washing machine, and flop down into bed for the duration of the school break. If your son or daughter is home on break, do you expect him or her to help around the house? Work a summer job? Be up and at ‘em by nine every morning and in bed before midnight? Whatever your expectations, be certain to spell them out before the first academic break begins.

Plan B

Recent statistics estimate that almost half of college enrollees drop out before completing a degree. No parent sends a kid to college hoping she’ll drop out, but with estimated dropout rates so high, all parents and new college students should discuss alternative strategies in case college doesn’t work out. 

Dr. Deuter is a psychiatrist who specializes in the care of emerging adults.