Helping Adolescents Feel In Control During Stressful Times: Pediatric Mental Health Minute Series

A sense of control is critical during adolescence. Teens naturally seek to exert control over their lives as they move through social, cognitive, and emotional developmental stages. Experiencing efficacy in this regard is important, particularly during a time when so many parts of life may seem uncontrollable, and potentially fearful. In addition to supporting youth in exerting control in healthy ways, pediatricians can also help them develop skills in coping with the uncontrollable, particularly in times of crisis

Scope in Pediatrics

• Seeking control is a core human instinct that is developmentally prominent during adolescence. A range of factors may complicate a teen’s quest for control – among them, parent/child dynamics, puberty, social flux, and the uncertainties involved in transitioning to adulthood.
• Developing a sense of self-efficacy and control is critical to developing the attitudes and skills that undergird independent adulthood.
• Adolescents often feel vulnerable and seek out ways to cope. Loss of control and ineffective coping can lead to a range of negative health behaviors. In contrast, a sense of control and efficacy can support positive development and healthy decisions. Further, when teens feel a sense of control, they can be focused, goal-directed, and less stressed.

Teaching Points

• There are important differences between being controlling, being in control, and feeling in control. The goal is not necessarily for teens always to be in control or feel in control, but rather to exert control when possible and appropriate, but relinquish control and cope effectively when needed.
• Pediatricians and parents and caregivers should communicate openly with teens, encouraging them to share their feelings and validating their desires for control. At the same time, it is important to reassure them about the uncontrollable and defuse their desires to exert control in unhealthy ways. Helping them carve out spaces in life that they can control effectively is important and can help them develop a sense of value, connectedness, and efficacy.
• Multiple key frameworks and concepts can help guide conversations with youth around control:
  • Positive Youth Development (PYD) undergirds strength-based approaches to care that are essential in helping youth develop a sense of control. In a PYD framework, youth are positive agents of change in their own lives and the lives of others. A strength-based, PYD-consistent approach to care focuses on a young person’s intrinsic assets, their agency in life, their contributions to others, and the enabling environment around them. Through PYD programs and supports, youth develop the capacity to exert control in positive, prosocial ways.
    • Intentional self-regulation is a related concept that explains how youth make choices, plan actions to reach goals, and regulate the execution of their planned actions. This is closely related to a youth’s expectations about their future and how that informs the ways they seek to control their actions.
  • Concepts around different mindsets can also provide a framework for supporting youth in developing a sense of healthy control. Mindsets contribute substantially to how youth drive towards goals and deal with setbacks. A fixed mindset assumes that attributes and abilities are largely unchanging, decreasing the opportunity to modify outcomes. Ironically, youth with fixed mindsets may try even harder to control their experiences in order to prove their worth in the face of limited intrinsic assets and abilities. In this context, failure must be avoided. In contrast, a growth mindset indicates that attributes and abilities can be cultivated and improved. Youth with growth mindsets may cope more effectively with change and other difficulties. A crisis, such as the COVID-19 pandemic, may be less of a threat and more of an opportunity to grow.
  • Acknowledging and addressing loss and grief in the midst of crisis is another important way of helping youth develop a sense of control. Pediatricians and other caring adults can help youth process experiences and find ways to celebrate and remember all that they have lost, including cherished experiences and loved ones.