Recently I read a report that struck many interesting notes and has direct ramifications for therapeutic practice. It's a longitudinal study of children growing up in suburban outposts of the culture of affluence.  These kids, or their parents, may be among your clients. The interesting finding is that the kids have a multitude of adjustment problems—often more than age-matched kids growing up in the inner city--and their problems persist despite the mental health services presumably available to them.

SIGNS OF TROUBLE

Beyond a certain point, the researchers found, the pursuit of status and material wealth by high-earning families (say, $120,000 and above) tends to leave skid marks on the kids, but in ways you might not have expected. Affluent suburban high schoolers not only smoke more, drink more and use more hard drugs than typical high schoolers do--they do so more than a comparison group of inner-city kids. In addition, they have much higher rates of anxiety and, in general, higher rates of depression. Among affluent suburban girls, rates of depression skyrocket--they are three times more likely than average teen girls to
report clinically significant levels of depression. And for all problems, the troubles seem to start in the seventh grade. Before then, the affluent kids do well.

A CASE OF SELF-MEDICATION

Interestingly, among the upper-middle-class suburban kids, but not among the inner-city kids, use of alcohol and drugs is linked with depression and anxiety. That raises the possibility that substance use is an attempt to self-medicate. What's more, this so-called negative-affect type of substance use tends to endure over time; it doesn't wane after the teen years. The researchers also found that among the suburban boys, popularity with peers went hand in hand with substance use.

WHAT'S IT ALL ABOUT?

In part, the affluent kids are responding to achievement pressures.  Rates of depression, anxiety and substance use were high among those whose families overemphasized their accomplishments and who saw achievement failures as personal failures. Isolation--emotional as well as literal--from adults also played a big role. Where the demands of the parents' own professional careers eroded relaxed family time, and the kids shuttled between various after-school activities, distress and substance use among the young were high.

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ACCESSIBILITY COUNTS

"A common assumption is that parents are more accessible to high- than
to low-income youth, but our data showed otherwise," the researchers
report in the February issue of Current Directions in Psychological
Science. Wealthier kids didn't feel closer to parents or spend more
time with them at the dinner table, for example. Eating dinner with at least
one parent on most nights turned out to be a big deal. It predicted
both adjustment and school performance--at both economic extremes.


SINKING IN A SEA OF HELP?

Why do affluent kids have so many problems if their families can easily
afford to get professional help for them? Maybe, the investigators
suggest on the basis of other research, they aren't eager to delve into
problems that are not conspicuous--"unless symptoms include those that
inconvenience adults, such as disobedience." Too, both privacy concerns
and embarrassment may keep them from attending to invisible problems.
They may need to maintain a veneer of well-being. Then there are all
the inconveniences of daily life that impede them--the demands of their
very high-powered careers that provide so well for their families. "Few
families would blithely repudiate such rewards," the researchers
concede.
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HERE'S THE KICKER

Even if the kids of the affluent got all the mental health care they
need, something irreplaceably protective would still be missing from
their lives: strong attachments with parents. Research shows that you
can't relieve "crystallized maladjustment" as long as kids' everyday
lives still present major challenges to adjustment.


SO WHAT CAN YOU DO?

First and foremost, say the researchers, raise awareness of the costs
of overscheduled and competitive lifestyles. Second, you can sensitize
parents to the risks affluence poses to healthy adjustment of their
children. And a third measure seems self-evident: Prescribe dinner.