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Book Title: Treating and Preventing Adolescent Mental Health Disorders
> pp. [500]-[504]
UNDEFINED: AUTHORS
Treating and Preventing Adolescent Mental Health Disorders
Print ISBN 9780195173642, 2005
pp. [500]-[504]
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ble features can encourage these positive characteristics and at the same time increase the likelihood of desired outcomes.
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Not only are positive characteristics valuable in their own right, but they may buffer against the development of psychological problems among youth. Attention to positive characteristics may help us promote the full potential of all youth, including those with current or past psychological problems. This contribution therefore addresses positive youth development with respect to mental illness and mental health. We discuss positive characteristics of youth and their settings and how these are related to thriving. We summarize what is known about programs and institutions that promote positive development. In conclusion, we take stock of what we know and what we do not know.
WHAT IS POSITIVE YOUTH DEVELOPMENT?
The field of positive youth development recognizes the good in young people, focusing on each and every child's unique talents, strengths, interests, and future potential (Damon, 2004). As much as we want to raise up children of soundest body and mind, those with straight A grades and perfect school attendance, kids who play in the marching band and star on a high school sports team, the real world is not Lake Woebegone. Real youth, no less than real adults, are a mix of those whose lives are above average and those who are not doing well at all. Some adolescents are anxious and depressed; some develop eating disorders; some use drugs and take other risks; some drop out of school; some become pregnant; and some fail to find praiseworthy pursuits in or out of school. What are we to make of these young people? The positive perspective avoids labeling them as across-the-board failures. Calling someone a schizophrenic, a depressive, a drug user, or a high school dropout overlooks what else may be true about that individual. John Nash, Abraham Lincoln, Edgar Allan Poe, and Peter Jennings could be respectively labeled with these dismis
sive terms, but to do so is to overlook remarkable lives and the people who have lived them. To be sure, the problems for which these labels are shorthand are nothing to ignore and certainly nothing to glorify. We applaud those who attempt to prevent, minimize, or undo such problems, in themselves and in others. But the positive perspective urges that these problems be placed in the context of the whole person. Attention to what is good about a young person provides a foundation on which to base interventions that target what is not so good. In particular, the positive perspective urges us not to give up on children, no matter what problems they may have experienced. These assertions seem obvious, but positive youth development nonetheless stands in contrast with approaches that have focused solely on the problems that some young people encounter while growing up, problems such as learning disabilities; affective disorders; antisocial conduct; low motivation and poor achievement; drinking, smoking, and drug use; psychosocial crises triggered by maturational episodes such as puberty; and risks of neglect, abuse, and economic deprivation that plague certain populations. Models of youth that focus on these problems have long held sway in the child-care professions, the mass media, and much of the public mind. In such models, youth is seen as a period fraught with hazards, and many young people are seen as potential problems that must be straightened out before they can do serious harm to themselves or others. This problem-centered vision of youth has dominated most of the professional fields charged with raising the young. In education and pediatric medicine, for example, a huge share of resources has been directed to remediating the incapacities of young people with syndromes such as attention-deficit/hyperactivity disorder. In child psychology, intense attention has been directed to self-esteem deficits, especially among girls; to damage created by childhood trauma such as poverty, abuse, and early separation; and to destructive patterns such as violence. Descriptions such as the at-risk child, the learning-disabled child, the juvenile delinquent, the bully, and even the super-predator have filled professional journals as well
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as the popular press. The old suspicion that there are “bad seeds,” or, switching metaphors, that there are “rotten apples” that will spoil the barrel if not removed in time has been kept alive in the guise of scientific theories that propose a genetic determinism for youth crime. The job of youth professionals has been to identify the problem early enough to defray and then patch up the damage. This focus on problems and deficits is part of a mental health model left over from the work of child psychoanalysts such as Fritz Redl (Redl & Wineman, 1951). It is also drawn from a criminal justice model that has stressed punishment over prevention and rehabilitation. One of the legacies of this problem-focused tradition has been its influence on the way young people have been portrayed in the mass culture and, as a consequence, in the popular mind. “According to a recent examination of a month of network and local TV news coverage of American youthjust 2% of teenagers were shown at home, while only 1% were portrayed in a work setting. In contrast, the criminal justice system accounted for nearly one out of every five visual backdrops” (Communitarian Network, 2000). A recent survey of adults in the United States found that the majority describe youth in negative terms and believe that young people will leave the world in worse shape than they found it (Public Agenda Online, 1999). But during the past two decades or so, the field of youth development has articulated a more affirmative vision of young people as resources rather than as problems for society. This vision focuses on the manifest potentials rather than on the supposed incapacities of young people—including young people from the most disadvantaged backgrounds and those with the most troubled histories. The positive youth development approach recognizes the existence of adversities and developmental challenges that may affect children in various ways, but it resists conceiving of the developmental process as mainly an effort to overcome deficits and risk. Instead, it begins with a vision of a fully able child eager to explore the world, to gain competence, and to acquire the capacity to contribute importantly to the world. The positive youth development ap
proach aims at understanding, educating, and engaging children in productive activities rather than at correcting, curing, or treating them for maladaptive tendencies or so-called disabilities. As already noted, the change brought about by this shift to a more positive vision of youth potential has taken place on a number of fronts. Positive youth development today is an interdisciplinary field with roots in developmental psychology, developmental epidemiology, and prevention science (Larson, 2000). It embraces an explicit developmental stance: children and adolescents are not miniature adults, and they need to be understood in their own terms. The youth development field emphasizes the multiple contexts in which development occurs. Particularly influential as an organizing framework has been Bronfenbrenner's ( 1977, 1979, 1986) ecological approach, which articulates different contexts in terms of their immediacy to the behaving individual. So, the microsystem refers to ecologies with which the individual directly interacts: family, peers, school, and neighborhood. The mesosystem is Bronfenbrenner's term for relationships between and among various microsystems. The exosystem is made up of larger ecologies that indirectly affect development and behavior, such as the legal system, the social welfare system, and mass media. Finally, the macrosystem consists of broad ideological and institutional patterns that collectively define a culture. There is the risk of losing the individual amid all of these systems, but the developmental perspective reminds us that different children are not interchangeable puppets. Each young person brings his or her own characteristics to the business of life, and these interact with the different ecologies to produce behavior. The youth development field has always had a strong interest in application (Catalano, Berglund, Ryan, Lonczak, & Hawkins, 1999). From their very beginning, national youth groups embraced promotion goals, but throughout the 20th century other applications were increasingly directed at youth problems such as school dropout, juvenile crime, alcohol and drug use, and unwanted pregnancy. These early interventions often targeted young people in crisis—i.e., they helped youth with problems—and the more recent interventions were preventive—i.e.,
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they supported youth before problems developed. The earliest applications were informed more by common sense and intuition than by research. This state of affairs has changed in light of information from longitudinal studies about the predictors of specific problems (e.g., Jessor & Jessor, 1977). This information provides explicit targets for interventions, and theory has begun to guide practice. Another change that occurred as the field of youth development matured is that prevention efforts targeting but a single problem came under criticism. Many problems co-occur and have the same risk factors. Broad-based interventions can therefore have broad effects. Part of the broadening of youth development and its applications was a call for studying and eventually cultivating what has come to be known as positive youth development—desirable outcomes such as school achievement, vocational aspirations, community involvement, good interpersonal relations, and the like. Pittman ( 1991, 2000) has phrased this change, “problem-free is not fully prepared.” Here is where youth development converges with positive psychology and its premise that the best in life is not simply the absence of disorder and dysfunction. As an applied field, youth development marches to the drummer of societal priorities. At least as far as the nation's youth are concerned, the reduction in their problems has been the priority, for good reasons. “Positive” outcomes can be a difficult sell when juxtaposed with tax cuts, pothole repairs, and defense spending. But there is ample reason to believe that attention to positive outcomes has the additional effect of reducing negative outcomes. Researchers at the Search Institute in Minneapolis have studied what they call developmental assets, which include external factors such as family support and adult role models and internal factors such as commitment to learning, positive values, and sense of purpose (Benson, Leffert, Scales, & Blyth, 1998; Leffert et al., 1998; Scales, Benson, Leffert, & Blyth, 2000). Youth with more of these assets not only show fewer problems but also display more thriving (e.g., school suc-cess, leadership, helping others, and physical health). Among the important ideas that frame this
emerging positive vision of youth are the following:
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Children can overcome adversity and thrive. Many by nature are hardy, not delicate. The term resiliency is used to describe the quality that enables young people to thrive even in the face of adversity (Werner, 1982). Associated with resiliency are persistence, hardiness, goal-directedness, an orientation to success, achievement motivation, educational aspirations, a belief in the future, a sense of anticipation, a sense of purpose, and a sense of coherence (Benard, 1991).
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It is important to recognize, however, that resiliency does not operate in a vacuum. Few if any children are impervious to unrelenting adversity. Without appropriate environmental or social support, children will likely succumb to problems. What allows young people to thrive is a combination of individual hardiness and protective factors embedded in socializing institutions (cf. Bonnano, 2004).
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Accordingly, the assets of youth that protect against problems and allow young people to do well include not only individual psychological characteristics such as talents, energies, strengths, and constructive interests but also characteristics of their social settings such as family support, parental involvement in schooling, adult role models outside the family, high expectations within the community, and the availability of creative activities (Benson, 1997). The agenda of positive youth development is to maximize the potential of young people by encouraging both personal and environmental assets. To do so requires a recognition of the reciprocal relation between them (Bronfenbrenner & Ceci, 1994; Riegel, 1973).
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The emerging positive youth development tradition takes a deliberately broad perspective on the qualities of young people that should be promoted. For example, following extensive literature reviews and consensus meetings of experts in the field, Catalano, Berglund, Ryan, Lonczak, and Hawkins ( 2004) identified the following goals of positive youth development.
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Bonding is the emotional attachment and commitment a child makes to social relationships in the family, peer group, school, community, or culture. Child development studies frequently describe bonding and attachment processes as internal working models for means by which a child forms social connections with others (Ainsworth, Blehar, Waters, & Wall, 1978; Bowlby, 1969, 1973, 1980; Mahler, Pine, & Bergman, 1975). The interactions between a child and his or her caregivers build the foundation for bonding that is key to the development of the child's capacity for motivated behavior (Erikson, 1968). Positive bonding with an adult is crucial to the development of a capacity for adaptive responses to change, and growth into a healthy and functional adult. Good bonding establishes the child's trust in self and others. Inadequate bonding establishes patterns of insecurity and self-doubt. Very poor bonding establishes a fundamental mistrust in self and others, creating an emotional emptiness that the child may try to fill in other ways, possibly through drugs, impulsive acts, antisocial peer relations, or other problem behaviors (Braucht, Kirby, & Berry, 1978; Brook, Brook, Gordon, Whiteman, & Cohen, 1990; Kandel, Kessler, & Margulies, 1978). The importance of bonding reaches beyond the family. How a child establishes early bonds to caregivers will directly affect the manner in which the child later bonds to peers, school, the community, and culture(s). The quality of a child's bonds to these other domains are essential aspects of positive development into a healthy adult (Brophy, 1988; Brophy & Good, 1986; Dolan, Kellam, & Brown, 1989; Hawkins, Catalano, & Miller, 1992). Strategies to promote positive bonding combined with the development of skills have proven to be an effective intervention for adolescents at risk for antisocial behavior (Caplan et al., 1992; Dryfoos, 1990).
Resilience refers to any instance of displayed competence despite adversity, whereas resiliency is the individual's capacity to adapt to stressful events in healthy and flexible ways (Luthar, Cicchetti, & Becker, 2000). As already described, resiliency has been identified in research studies as a characteristic of youth who, when exposed to multiple risk factors,
show successful responses to challenge and use this learning to achieve successful outcomes (Hawkins, Catalano, & Miller, 1992; Masten, Best, & Garmezy, 1990; Rutter, 1985; Werner, 1989, 1995).
The construct of competence covers at least five areas of youth functioning—specifically, social, emotional, cognitive, behavioral, and moral abilities. The multidimensionality of competence has been increasingly recognized in the past two decades (Gardner, 1993; Harter, 1985; Zigler & Berman, 1983). More recently, Weissberg and Greenberg ( 1997) urged that competence be viewed and measured in research studies as an important developmental outcome. While the enhancement of competence can help to prevent negative outcomes (Botvin, Baker, Dusenbury, Botvin, & Diaz, 1995), competence can also be specified and measured as an important outcome in its own right, indicative of positive development.
Social competence encompasses the range of interpersonal skills that help youth integrate feelings, thinking, and actions to achieve specific social and interpersonal goals (Caplan et al., 1992; Weissberg, Caplan, & Sivo, 1989). These skills include encoding relevant social cues, accurately interpreting those social cues, generating effective solutions to interpersonal problems, realistically anticipating consequences and potential obstacles to one's actions, and translating social decisions into effective behavior. In a review of 650 articles on biopsychosocial risk factors and preventive interventions, Kornberg and Caplan ( 1980) concluded that competence training to promote adaptive behavior and mental health is one of the most significant developments in recent primary prevention research. In general, social competence promotion programs have been designed to enhance personal and interpersonal effectiveness and to prevent the development of maladaptive behavior through (a) teaching students developmentally appropriate skills and information, (b) fostering prosocial and health-enhancing values and beliefs, and (c) creating environmental supports to reinforce the real-life application of skills (Weissberg et al., 1989). To produce meaningful effects on specific target behaviors, it also appears necessary to include opportunities for students to
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practice and apply learned skills to specific, relevant social tasks (Hawkins & Weis, 1985).
Emotional competence is the ability to identify and respond to feelings and emotional reactions in oneself and others. Salovey and Mayer ( 1989) identified five elements of emotional competence, including knowing one's emotions, managing emotions, motivating oneself, recognizing emotions in others, and handling relationships. The W. T. Grant Consortium on the School-Based Promotion of Social Competence ( 1992, p. 136) provided a similar list of emotional skills that are ingredients of many prevention programs: “identifying and labeling feelings, expressing feelings, assessing the intensity of feelings, managing feelings, delaying gratification, controlling impulses, and reducing stress.”
Cognitive competence includes two overlapping constructs. The W. T. Grant Consortium on the School-Based Promotion of Social Competence ( 1992, p. 136) defined the first form of cognitive competence as the “ability to develop and apply the cognitive skills of self-talk, the reading and interpretation of social cues, using steps for problem-solving and decision-making, understanding the perspective of others, understanding behavioral norms, a positive attitude toward life, and self awareness.” The second aspect of cognitive competence is related to academic and intellectual achievement. The emphasis here is on the development of core capacities, including the ability to use logic, analytic thinking, and abstract reasoning.
Behavioral competence encompasses the skills required for effective action. The W. T. Grant Consortium on the School-Based Promotion of Social Competence ( 1992, p. 136) identified three dimensions of behavioral competence: “nonverbal communication (through facial expressions, tone of voice, style of dress, gesture or eye contact), verbal communication (making clear requests, responding effectively to criticism, expressing feelings clearly), and taking action (helping others, walking away from negative situations, participating in positive activities).”
Moral competence is a youth's ability to assess and respond to the ethical, affective, or social justice dimensions of a situation. Piaget ( 1952, 1965) described moral maturity as both a respect
for rules and a sense of social justice. Kohlberg ( 1963, 1969, 1981) defined moral development as a multistage process through which children acquire society's standards of right and wrong, focusing on choices made in facing moral dilemmas. Gilligan ( 1982) countered that morality is as much about relationships and interdependence as it is about societal rules, and Hoffman ( 1981) proposed that the roots of morality are in empathy, or empathic arousal, which has a neurological basis and can be either fostered or suppressed by environmental influences. He also asserted that empathic arousal eventually becomes an important mediator of altruism, a quality that many youth interventions try to promote in young people.
Encouraging self-determination.
Self-determin-ation is the ability to think for oneself and to take action consistent with those thoughts. Fetterman, Kaftarian, and Wandersman ( 1996) defined self-determination as the ability to chart one's own course. Much of the literature on self-determination has emerged from work with disabled youth (Brotherson, Cook, Lahr, & Wehmeyer, 1995; Field, 1996; Sands & Doll, 1996; Wehmeyer, 1996) and from cultural identity work with ethnic and minority populations (Snyder & Zoann, 1994; Swisher, 1996). Although some writers have expressed concern that self-determination may emphasize individual development at the expense of group-oriented values (Ewalt & Mokuau, 1995), others link self-determination to innate psychological needs for competence, autonomy, and relatedness (Deci & Ryan, 1994).
Spirituality has been associated in some research with the development of a youth's moral reasoning, moral commitment, or a belief in the moral order (Hirschi, 1969; Stark & Bainbridge, 1997). Recent reviews of the relationship between religiosity and adolescent well-being have found that religiosity is positively associated with prosocial values and behavior, and negatively related to suicide ideation and attempts, substance abuse, premature sexual involvement, and delinquency (Johnson, Tierney, & Siegel, 2003).
Developing self-efficacy.
Self-efficacy is the perception that one can achieve desired goals through one's own action. Bandura ( 1989,
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doi:10.1093/9780195173642.003.0027
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