Over the past seven years as the school psychologist at an ethnically diverse high school, I have observed that it is not uncommon for high school students (aged 14-18) to experience psychological, social, sexual, addictive, adjustment, and disability-based issues of such clinical significance as to warrant independent professional support. The professional psychologist can provide diagnostic clarification, therapeutic intervention, and even subsequent referrals when appropriate. Parents intuitively recognize the significance of timely intervention at this important transitional age and are eager that their child be afforded the best help the community can offer. Many parents express intense devotion to do whatever is needed to get the support their teen needs. Their gratitude and joy is rewarding when suffering, anxiety or discord is assuaged.
Focusing the high school camera’s field of view more tightly, we see that the high school student faces particular types of issues, many of which can be described as adaptive or existential in nature. These include anxiety over grades and friendships, parental pressure and conflict, parental divorce, peer pressure, peer group conflicts, romantic problems, and existential issues regarding identity, sexuality, self worth, personal limitations, and meaning. Beyond the common adjustment challenges and troubling existential ones, there are the “biggies” which could even more likely develop into referrals. I will list the major ones I have observed, in order of frequency of occurrence. Foremost are the Risk-taking Behaviors (elaboration to follow), then Conduct Disorder, Attention Deficit Hyperactivity Disorder (with or without hyperactivity), Oppositional Defiance Disorder, Depression, Bereavement, Autism Spectrum Disorder, Eating Disorders, Self Injury (Self-Mutilation or Cutting), Bipolar Disorder, Post Traumatic Stress Disorder, psychotic disorders (more frequently with premorbid or schizotypal personality features), and Traumatic Brain Disorder. This list is by no means exhaustive, but represents the top baker’s dozen of psychological issues I’ve observed with high school adolescents.
As for the most frequently occurring issue, “Risk-taking Behaviors,” I am referring to behaviors such as tobacco use, alcohol and other drug use, sexual behaviors, dietary and physical health-related behaviors, acts of violence (including gang violence, street “sport” fighting, and sexual assault), and suicide attempts. Though sometimes not included in the national survey reports of adolescent risk taking behaviors, I also include gambling in this category, as it has been seen with increased frequency on our high school campuses and at the online gambling sites accessed by teens. There are excellent statistics available on adolescent risk-taking behaviors in America (1) and in San Diego (2).
Who can help teens work their way out of at-risk behavioral difficulties and other significant problems and disorders? As Obama put it, “Together We Can.” In most cases school teachers and staff turn to appropriate high school and district personnel and programs first. But school psychologists, counselors and nurses are also specifically trained to recognize when to refer out. Special Education IEP Teams are sensitive to this as well. (How referrals happen, and the criteria used for making them is addressed below). Many students find sufficient help from the substantial school and district support services that are available to them, while others require independent psychological or psychiatric expertise or treatment programs as well.
Parents and community members expect their school district to provide front line help for their children, and to refer to community mental health professionals when appropriate. Regarding school-based interventions, the goal is to provide help to the student in the “least restrictive environment” possible, per federal and state...