Middle School Students Are Hurting More Than Ever
By Lucille Carr-Kaffashan, Ph.D.
School districts typically have focused most of their mental health resources on high school students. Teenage angst is a much-discussed phenomenon, but many adults find it hard to believe that younger children can experience severe emotional distress and even consider self-harm and suicide.
Given the dramatic increase in all types of mental health symptoms amongst teens, they continue to require a good deal of our attention. According to a 2021 CDC survey, 44% of American teens reported “persistent feelings of sadness or hopelessness” compared with 26% in 2009. But while it is true that suicidal ideation and behaviors increase with age, the CDC has also reported that since 2020 suicide has become the second leading cause of death for 10 to 14 year-olds, and the 10th leading cause of death for 5 to 9 year-olds. Suicide rates for 5 to 11 year-old children have risen on average 15% a year from 2013 to 2020.
The youth mental health crisis in the United States had been brewing for many years before the COVID-19 pandemic, a life-altering event that exacerbated existing problems and simultaneously shone a spotlight on the cracks in our health and mental health support systems. When we look back on the pandemic in the future, perhaps one silver lining will be that school districts across the country took this opportunity to re-examine school-based mental health services and to increase support for middle and elementary students.
Understanding the Stress of Middle School Students
Middle school is a time of change and transition. Young bodies are changing, and so are the expectations that society has of so-called “tweens” — no longer little kids but still without the privileges and freedoms that teenagers are afforded. Academic expectations are usually higher, and often students must become accustomed to a new school building and more responsibility for navigating from classroom to classroom and teacher to teacher. Middle schoolers want more independence from their parents, yet still require a good deal of help from them.
Perhaps most important of all, tweens start to care a lot more about fitting in with peers and about what others think of them. This is the time when bullying and teasing can start to happen, and when self-consciousness and insecurity can set in. It is also the time when youngsters begin to grapple with identity and try to decode the many cultural messages about gender and what it means to be a boy/man or a girl/woman. It is no wonder that students with mental health problems so frequently point to middle school as the time when their problems began or were exacerbated.
In his April 2022 article in The Atlantic, Why American Teens Are So Sad, Derek Thompson postulates that “four forces are propelling the rising rates of depression among young people”. Although the article’s focus is depression and anxiety in teens, the forces described are highly relevant for middle school students as well and provide a useful way to categorize what contributes to their distress.
The first force discussed by Thompson is the explosion of social media usage. By middle school many students have access to smart phones and are drawn into the world of social media. Psychologist Jean Twenge, author of the book iGen, has noted that teen sadness and anxiety began to steadily rise in the U.S. and other developed countries starting in 2012, precisely the year when the number of Americans owning a smartphone surpassed 50% and social-media use spiked. Thompson noted a new study from Cambridge University “in which researchers looked at 84,000 people of all ages and found that social media was strongly associated with worse mental health during certain sensitive life periods, including for girls ages 11 to 13.” “One explanation is that teenagers (and teenage girls in particular) are uniquely sensitive to the judgment of friends, teachers, and the digital crowd”, and that for some students, social media can exacerbate anxieties about body image, popularity, and fitting in. Of course, it is also important to note that social media per se is not problematic for everyone, and for many young people has facilitated relationship building, social awareness, and learning.
The second force, which is related to the first, is that sociality is down. Dr. Twenge and other authorities have stressed that the biggest problem with social media might not be social media itself, but rather the activities that it replaces. Students are less physically active and are often sleep-deprived because of 24/7 involvement with their phones and other devices. Critically important time with friends has been reduced, decreasing opportunities for practicing social, communication, and self-regulation skills. Many young people are even delaying activities historically related to developing self-confidence and independence, such as getting a driver’s license. Pandemic-related school closures exacerbated tween loneliness and sadness by disrupting the protective effects of close social relationships with friends, teachers, and other mentors.
The third force needs little or no explanation: kids today are growing up in a world that is increasingly stressful. Endless news cycles emphasize the increasing threats of gun violence, climate change, racial hatred and discrimination, political divisiveness, financial hardship, and an unrelenting pandemic. As much as we try to shield them from adult concerns, students are confronted with these stressors every time they participate in active shooter drills, are coached about COVID precautions, or are warned/coached about acts of racial hatred. And, not to beat a dead horse, but social media affords 24/7 access to sites that constantly remind us about the things we could/should be anxious or sad about.
The fourth force cited by Thompson is modern parenting strategies. “In the past 40 years, American parents — especially those with a college degree — have nearly doubled the amount of time they spend coaching, chauffeuring, tutoring, and otherwise helping their teenage children.” Many high-income parents in particular start very early putting pressure on their kids to prepare for college.
Similarly, perhaps because of their own anxieties and/or the perception that the world is a more dangerous place, many parents try to insulate their children from risk and danger, and in doing so are inadvertently contributing to children’s heightened anxiety and lower self-confidence. Thompson notes that “children are growing up slower than they used to … are less likely to drive, get a summer job, or be asked to do chores.” The greater the protection, the more children are deprived from learning problem solving skills, from developing a sense of competence, and from learning to tolerate uncomfortable emotions.
Risk Factors and Stress Indicators for Younger Students
Younger children generally do not have the language skills to express a full range of emotions, so habit changes (e.g., less interest in favorite activities, difficulty getting ready for sleep), physical symptoms, emotional meltdowns, and acting out (including aggressive outbursts) are common ways that they will signal their distress. Children’s artwork, stories, or play can indicate an obsession/fascination with death or violence, and they might say they “don’t want to be around anymore” or that no one wants them or would miss them if they went away. Children as young as 5 or 6 can understand that killing oneself leads to death, but not understand the permanence of death. Younger children in general have less well-developed impulse control, and students with ADHD or other neuro-cognitive differences might be more impulsive and thus more at risk.
Data from the National Institute of Mental Health (NIMH) indicate that less than a third of children who die by suicide had a previously diagnosed mental illness. Forty percent, however, had experienced family instability such as divorce, parental depression, parental substance abuse, or a school disruption — problems exacerbated, of course, by the pandemic. As parents’ lives were disrupted, so too were the lives of younger children. It has been estimated that 37,300 children in the U.S. lost a parent due to COVID. Poorer communities and communities of color were disproportionally harmed by the pandemic in multiple ways, and suicides among children of color have also been rising disproportionately both before and during the pandemic. Compared to teenagers, preteens and younger children who die by suicide are more likely to be Black and male.
Middle school students, while better able to express their emotions verbally, may hide their suffering for fear of being labeled crazy or different at a time of life when fitting in and being accepted is paramount. In the absence of direct verbal expressions of distress by the tween, caring adults should take note of increased anger/irritability/aggression, somatic symptoms (including weight loss or changes in eating habits, reports of pain/illness, sleep problems etc.), habits changes, changes in academic performance, social difficulties, and/or the possibility of bullying. Monitoring the safety of internet and social media usage (e.g., types of sites visited) and awareness about possible self-harm are also important.
How Can Schools Help?
As districts close out yet another school year impacted by the COVID-19 pandemic and plan for 2022–23, they might consider the staff and parent training and the mental health services that are needed to adequately support middle school students.
- Tier 1 universal screening tools and administration timeframes, with accompanying protocols, should be adopted across all grade levels.
- Districts that offer Tier 2 and Tier 3 services onsite might consider expanding these services to the middle school level if not already offered.
- ALL personnel who have student contact should be included in training about suicide prevention. This includes bus drivers, cafeteria workers, custodians, etc., since students may not necessarily approach a teacher about their distress but may confide in another trusted adult.
- Parent training sessions can be offered to raise mental health and suicide prevention awareness.
- All staff and parent training sessions must emphasize the need to be clear and direct with students and not shy away from hard questions. There is no evidence to support the myth that asking direct questions about suicide or self-harm will put the idea in a child’s head. Experts agree that it is important to be open and direct about these difficult issues while avoiding blame and expressing compassion. Students are often desperate to be heard and yet can find it hard to open such a difficult conversation with a parent or other adult.
- Staff trauma and burnout must be recognized and addressed. Staff members’ stress can impair their ability to stay vigilant about student distress and to maintain a trauma-attuned stance.
- Explore the availability of “teen tip lines” in your community that allow other students to report concerns about a peer.
- Install and utilize software to analyze student internet searches to detect worrisome patterns.
A Shifting Landscape
As reported in a recent New York Times article, “Health risks in adolescence are undergoing a major shift. Three decades ago, the biggest health threats to teenagers were binge drinking, drunken driving, teenage pregnancy, cigarettes, and illicit drugs. Today, they are anxiety, depression, suicide, self-harm, and other serious mental health disorders.” Sadly, the above statement is readily applicable to middle school youngsters as well.
Most school budgets have always been, and will always be, stretched beyond reasonable limits. Educators have always been, and likely will always be, expected to do way more than impart academic knowledge. Perhaps the Surgeon General’s urgent call to action last year about the youth mental health crisis will ensure desperately needed funding for school-based mental health services. With or without additional resources, however, district leaders, school boards, and parents must broaden their perspective about younger students’ need for mental health services.
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