The In-Between

From the care of teens to emerging adulthood

Can Emerging Adulthood Be Mistaken for Mental Illness?

Young adulthood behavior changes lead parents to seek psychiatric assessment.

A panicked mom called begging for an urgent psychiatric evaluation for her 19-year-old daughter. Would this be a true mental health crisis or, like so many others, just a bumpy course through the stage of emerging adulthood?

Bree had thrived during her teen years, but near the end of her first year out of the nest, she was flailing. Drinking, staying out all night, neglecting key responsibilities...none of these new behaviors were consistent with Bree’s prior behavior. She had been such a good girl when she lived at home. It was as if she had become a different person. Wasn’t that clear evidence of mental illness?

Not necessarily.

Bree might just be struggling to navigate emerging adulthood. Emerging adulthood is a relatively new term, coined by developmental psychologist Jeffrey Jensen Arnett, Ph.D. in his work on the evolving social roles of young adults (generally ages 18-25, though the emerging adulthood stage is not limited to a specific age range). Adolescence is the stage of attaining physical and sexual maturity, usually completed by age 18. Emerging adulthood is the stage of attaining psychological and emotional maturity, the time when one gradually takes on adult roles and responsibilities.

The study of emerging adulthood began with social roles, but over the past decade there has been a surge in neuroscience research on brain maturity in young adulthood. As it turns out, young brains are different. Brains aren’t “adult” in terms of maturity until at least age 25, around the same time we see a natural acceptance of the responsibilities of full adulthood.

Often, the most appropriate intervention for a family like Bree’s is education about the stage of emerging adulthood, instruction in firm limit setting for the parents, and a heavy dose of reassurance. But when troubling behaviors—like blatant disregard for rules and safety or, on the opposite end of the scale, low motivation and avoidance—become cause for seeking mental health assessment, too many young adults are overdiagnosed and overtreated. Unfortunately, many emerging adults like Bree are inappropriately labeled with mental health disorders by clinicians who fail to grasp the nuances of the emerging adulthood stage.

In the midst of campaigns aimed at reducing the stigma of mental illness and expanding services, we have seen an explosion in the diagnosis of psychiatric disorders in younger populations. Independent adults can choose to seek mental health care based on their own subjective emotional experience, but parents are often the driving force behind mental health evaluation in dependent kids. All manner of behavior problems, stage of life adjustments, and family conflict can get caught up in the net of mental health diagnosis when parents bring kids in for evaluation of problem behavior.

So how can parents protect emerging adult children from inappropriate labels and treatments? Step one is education. Parents who understand that neurological and psychological development are ongoing until age 25 are less likely to panic when a 19-year-old veers off course. Step two: Maybe the doctor isn’t the first person to contact for a behavior crisis. If an emerging adult makes poor choices or fails to function, parents can start by consulting a life coach or a counselor. If the emerging adult’s behaviors exceed the expertise of these first line professionals, only then would a parent seek the opinion of a medical or psychiatric professional.

 

Melissa Deuter, M.D., is a Clinical Assistant Professor of Psychiatry at University of Texas Health Science Center San Antonio.

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