Adolescents are ready for college: Is your practice?

Dr. Aron’s article, “Helping first-year college students manage expectations and stress,” addresses ways pediatricians can communicate with college students who may be having an array of emotions as entering college and campus life becomes a reality. Dr. Aron discusses ways to ask non-threatening questions of the adolescent/young adult about feelings of anxiety, depression, and alcohol use, especially binge drinking and ways to provide appropriate anticipatory guidance including brief interventions for alcohol avoidance behaviors and mindfulness strategies for stress and anxiety, eg, meditation, progressive muscle relaxation.

Pediatric and family nurse practitioners (PNPs, FNPs) who have practices based on a medical home model are familiar with the emotional needs of the adolescent population and endeavor to build trusting relationships with adolescents during each annual health maintenance encounter. Practices that schedule one-half hour annual appointments with the PNP or FNP best serve the needs of adolescents as more time can be devoted to the emotional assessments and appropriate interventions. In addition, practices that have an “adolescent nurse-champion” meet with the adolescent at the end of each annual appointment to review adolescent age-specific anticipatory guidance and potential harms of high-risk behaviors further help to build trusting relationships. Thus, these adolescent friendly practices are an ideal setting to have a conversation with adolescents who are preparing to attend college for the first time and those returning to college with less pandemic restrictions.

Identifying Potential Problems

Dr. Aron supports discussing drinking behaviors with the adolescent. We are all acutely aware of the problems of fraternity initiations in which excessive drinking has led to the death of a college student. Although these behaviors are prohibited on college campuses, providing insight into potential problems and a brief role-playing session with the adolescent is an important component of anticipatory guidance. As providers, we know that the desire to ‘belong’ should not be overshadowed by potential risky behaviors. This is an opportunity to convey this message to the adolescent with insights into avoidance of potential problems.

The high school experience is completely different from the college experience. College students are expected to be engaged in their own learning, to plan their study time, to meet assignment deadlines, to pass comprehensive high-stake midterm and final exams. Often, these new demands are stressors for adolescents who have had successful high school experiences. Adolescents may miss their home with parents or guardians available to recognize problems and intervene. Although colleges offer student health center services and wellness centers to meet emotional needs, adolescents must seek out these services. Adolescents who have not struggled previously may find themselves facing a dilemma: Do I have a problem? Can I handle it myself? Should I find help? Am I in too deep? The anticipatory guidance here focuses on prevention of harmful behaviors such as suicidal ideation and the awareness of available hot lines. The discussion may begin with a brief scenario in which the adolescent is asked to evaluate an exemplar of a college student who observes a roommate or study friend having overwhelming feelings of doubt, frustration, anxiety, or sadness. The conclusion is to immediately seek help. This is an opportune time to explore with the adolescent the college website for services available at the specific college the adolescent will attend.

OTC, prescribed drugs, and the college student

Another important discussion to include in anticipatory guidance for college age students are over-the-counter (OTC) drugs and prescribed medications. Ask any adolescent: What do you think about OTC drugs? Most often the immediate answer will be “They are safe or they wouldn’t sell them.” This thinking now applies to marijuana including softgels, gummies, other edibles, and topicals as well as cannabidiol oils. It also applies to prescribed medications. Adolescents may ask to take a prescribed drug that a friend has for attention-deficit/hyperactive disorder to stay awake all night to write a paper or cram for an exam. Awareness of these pitfalls through a brief case scenario may provide the adolescent with “emotional protective gear” to avoid unintentional and intentional drug use and misuse.

College students returning with less COVID-19 restrictions

Many college students will be returning to colleges as juniors, and for the first time since entering college, experience less COVID-19 restrictions. The annual office visit is an ideal time to talk about “life with less COVID-19 restrictions” and the importance of avoiding high-risk behaviors that spread CPVID-19 disease. This may be a time when returning students feel liberated with more freedom than they experienced over the past 2 years and will need guidance to focus on their personal health, academics, in combination with enjoying the college experience. Additional discussions with returning college students should focus on the same information as presented to first time college students but the scenarios will be different. The focus may be on such questions as: What experiences have you encountered that have caused you stress, anxiety, feeling sad or bad about yourself? Routine screening for anxiety, depression as well as the CRAFFT tool and other screening tools are very helpful in helping returning college students gain the most from their campus life experiences, as interventions can be in place before they leave for college.