Helping first-year college students manage expectations and stress

Contemporary PEDS JournalAugust 2022

As the first day of college looms for many students attending for the first time, pediatricians may be confronted with patients experiencing a range of emotions from excitement to stress and uncertainty.

As the first day of college looms for many students attending for the first time, pediatricians may be confronted with patients experiencing a range of emotions from excitement to stress and uncertainty. Most first-year college students report facing emotional challenges, according to an online survey of 1502 college students conducted by the Harris Poll.1 Fifty percent of respondents said they felt stressed most or all of the time.1

Although there is traditionally an emphasis on academic preparedness, emotional preparedness is the most likely factor in students being emotionally and academically successful in college.1,2 Being able to care for oneself, adapt to new environments, control negative emotions, and build positive relationships are factors that determine a student’s success. By providing anticipatory guidance to patients and their families, pediatricians can mitigate the uncertainty that lies before them.

Manage expectations

Even before social media, college was represented as a party-filled atmosphere in movies and television shows. Often described as the “best 4 years of one’s life,” expectations for fun, meaningful relationships, and an enriching academic experience are what most students think they will find awaiting them once they settle into their dorms. The ubiquity of smartphones and social media have now amplified the ideal image of college life. In fact, many college students feel that social media, television, and movies make college seem more fun than it really is, and 49% of the survey respondents said that college was not living up to their expectations.1

When talking with new college students, pediatricians should start with open-ended questions about what patients expect when they get to college. Pediatricians can help manage expectations, noting that college students may find the experience different from how it appears in the media. For example, pediatricians can ask, “Which social media apps do you prefer?” or “What kind of things do you enjoy reading on social media?” and then based on responses, ask about the patient’s perceptions of the content. As a pediatric psychiatrist, I often ask patients what they look at on social media and whether they think it is a true representation or a mirage. Creating a reflective process helps them do so on their own when they are feeling the familiar fear of missing out, better known as FOMO. Helping patients understand that it is normal to feel a range of emotions in the first year will help to normalize the feelings when they inevitably arise.

Paint a picture of real behaviors

One in 5 college students meets criteria for alcohol use disorder.3 Another 50% binge drink during college, and 1 in 5 students report doing so frequently.4 These are concerning statistics that lead to significantly negative consequences. It is important to note that many students do not participate in substance use or binge drinking. Research suggests that social networks are a strong influence in substance use among college students.5 Furthermore, the majority of college students overestimate heavy drinking use of their peers, and this overestimation can lead to more heavy drinking.6 College students drink according to the social norms they perceive.

To buffer students from substance misuse, pediatricians can remind teenagers that many do not engage in alcohol misuse and ask the patients to discuss what types of friends they hope to make in college. In fact, reducing normative misperceptions around drinking has been the most effective brief intervention strategy to reduce heavy drinking.7 Knowing where to get support is an important component of addressing the emotional challenges often underlying substance use at college.

Tour the college counseling center

Many mental health challenges and disorders emerge in students during their college years. Other students will enter college with a diagnosis and in need of ongoing psychiatric or psychological care. Creating a plan with families prior to arriving on campus is an essential task in supporting students’ mental health.

Touring the college counseling center will help foster familiarity with mental health resources on campus. Similarly, pediatricians can start the conversation about where students can go to access additional mental health support. It is also important to engage parents and discuss signs of common mental health disorders such as anxiety, depression, and substance misuse. Once patients turn 18 years old, parents have less access to health care providers, but they can still be an important partner in getting their children the help they need. If an individual entering college is already in treatment, ensuring that the family has a plan to continue treatment is helpful.

For patients who take medications, review with them a plan to get refills before they run out when they are on campus. Families should be informed that their clinicians will need a license in the state where the student lives in order to continue care. Otherwise, parents should find a new therapist or psychiatrist if the student will need ongoing care. The misuse of prescription drugs on college campuses is common, so discuss with patients the important of taking medications as directed and not sharing or selling to other students.

Practice problem-solving before the semester starts

When I talk to parents about managing behavior, I always recommend “striking while the iron is cold.” It is much harder to manage a crisis, or a big tantrum, at peak intensity. Practicing strategies and creating routines around stress management and problem-solving will produce dividends when young adults need to navigate life independently. Build on preexisting strengths. Pediatricians can ask questions such as, “How have you handled stress in the past?” or “Have there been times when you have felt overwhelmed? What helped?” Reinforcing good habits and mentioning new ones in a time of calm will build a foundation for overall well-being.

Mindfulness strategies are easy to learn and beneficial for mental health. In a pilot study using mindfulness training among 109 freshmen, participation was associated with increased life satisfaction and decreased depression and anxiety.8 Introducing simple mindfulness techniques (meditation, progressive muscle relaxation) and practicing them together in the office can create healthy coping strategies.

Living independently requires learning problem-solving skills. Helping families reflect on past transitions can help them cope with the upcoming change. In the years and months leading up to college, parents should allow for more space to let their teenagers experience independence. Reviewing what needs to be completed prior to leaving for college and how the teenager can help is great practice for solving problems once they leave home.

The college years are a time of stress and mental health challenges.9 In the midst of an ongoing pandemic, the baseline of stress among adolescents is even higher and necessitates a response.10 Pediatricians can be a part of crucial conversations that will help set the stage for a successful college transition.

Emily Aron is a psychiatrist affiliated with MedStar Georgetown University Hospital in Washington, DC. She also is a member of the Editorial Advisory Board of Contemporary Pediatrics®.


1. Harris Poll. The first-year college experience: a look into students’ challenges and triumphs during their first term at college. October 8, 2015. Accessed June 28, 2022.

2. Allen J, Robbins SB, Sawyer R. Can measuring psychosocial factors promote college success?. 2009;23(1):1-22. doi:10.1080/08957340903423503

3. Slutske WS. Alcohol use disorders among US college students and their non-college-attending peers. Arch Gen Psychiatry. 2005;62(3):321-327. doi:10.1001/archpsyc.62.3.321

4. Krieger H, Young CM, Anthenien AM, Neighbors C. The epidemiology of binge drinking among college-age individuals in the United States. Alcohol Res. 2018;39(1):23-30.

5. Mason MJ, Zaharakis N, Benotsch EG. Social networks, substance use, and mental health in college students. J Am Coll Health. 2014;62(7):470-477. doi:10.1080/07448481.2014.923428

6. Cox MJ, DiBello AM, Meisel MK, et al. Do misperceptions of peer drinking influence personal drinking behavior? Results from a complete social network of first-year college students. Psychol Addict Behav. 2019;33(3):297-303. doi:10.1037/adb0000455

7. Reid AE, Carey KB. Interventions to reduce college student drinking: state of the evidence for mechanisms of behavior change. Clin Psychol Rev. 2015; 40:213-224.

8. Dvořáková K, Kishida M, Li J, et al. Promoting healthy transition to college through mindfulness training with first-year college students: pilot randomized controlled trial. J Am College Health. 2018;65(4):259-267. doi:10.1080/07448481.2017.1278605

9. Bruffaerts R, Mortier P, Kiekens G, et al. Mental health problems in college freshmen: prevalence and academic functioning. J Affect Disord. 2018;225:97-103. doi:10.1016/j.jad.2017.07.044

10. Wang X, Hegde S, Son C, Keller B, Smith A, Sasangohar F. Investigating mental health of US college students during the COVID-19 pandemic: cross-sectional survey study. J Med Internet Res. Published online September 17, 2020. doi:10.2196/22817

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