Adolescents at risk conference: Summation

JOURNAL OF ADOLESCENT HEALTH 1991;12:644-647

Adolescents at Risk Conference: Summation DAVID E. ROGERS,

M.D.

These papers, Dr. Ginzberg’s overview and the intense discussions which ran through the 2 days, held one stark central message: The United States is doing poorly by its teenrgers. We are seriously neglecting their :-velfare, their growth, and their development, and we are paying a mounting price for that neglect. How serious is the situation? Very. To recap only part of the litany, almost 7 million of our young people ages 10 to 17 years, almost one in four adolescents, have a low to absent probability of becoming responsible and productive adults. Ms. Dryfoos stated it in compelling terms: This means that 7 million of today’s young people will never enrich our work force, or become competent nurturing parents, or be able to participate in thr political processes by which we shape or govc~~ our society. And each year more will join those blighted ranks. Somewhere in our march toward a prosperous technologically sophisticated society we seem to have left behind some precious parts of the road map which tell youngsters how to become socially responsible, fully formed humans-and it shows. In each of the areas of focus the news was dreary. Adolescent violence is a mounting problem. It in increasingly vicious and destructive. Homicide is now the leading cause of death for young Black males. Handgun use is out of control in our major cities (there are more than 60 million of them in circuliition). The number of abused children is r+Tin’:ing. “Wrong behavior” in the “Saddam Hus,.cms of the sandbox” often results in violent punishment by a parent who is often too young and poorly prepared for the role. Problems of adolescent College, NW York. Address reprint rquests fo: David E. Rogers. M.D., W&h Mchott unimi@! h$2SSOr of Medicine, Cornell University Medical College. 1300 York Ave., New York, NY loo21. Manuscript accepted September 1991.

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drug and alcohol abuse are widespread. Although overall drug consumption is down, at a closer look this appears to be due to a drop in occasional “recreational” use in higher socioeconomic &ircles while it grows worse in poorer urban communities and starts at a younger age. Polydrug use is on the rise, “crack” is a relentlessly advancing scourge, and drug abuse is almost endemic in some of the highrisk adolescent groups discussed at this conference. Sexual experience starts at a progressively earlier age f,:zr American youngsters, and the percentage of teens participating at each age has been increasing rapidly during recent years. Thus, sexual intercourse is the norm, not the exception, for those 18 to 19 years. This has resulted in a shocking rise in the number of cases of sexually transmitted disease, particularly gonorrhea, in teenagers. A surprising number of teenagers have had multiple partners. Experimentation with both same-sex and heterosexual experience is common. And, now interwoven with sex, drugs, and alcohol use are the specter and the reality of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) in this age group. Again, the statistics, though murky, are alarming. As with the other problems examined at this conference, those most disproportionately affected live in poverty, use drugs, and come from minority backgrounds. Because of its long incubation period, we have largely ignored the probability of relentlessly rising rates of HIV positivity in this age group. Because, in Dr. Joseph’s view, AIDS has been too often regarded as a civil rights emergency with public health implications rather than a public health emergency with civil rights implications, we don’t know what the reality is. Consequently, teenage carriers of HIV don’t know that they are infected and neither does anybody else. Although each of these problem behaviors and

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some of their tragic outcomes were reported separately, their inextricable interrelatedness was all too evident. Early on, Dr. Kagan made the point that in the less developed world, birth and infancy are the periods of greatest risk, but present-day American society has turned that around: now, it is the period of adolescence which is the most difficult to negotiate successfully. The data which emerged from the conferees also made it clear that a surprising amount is known about the factors, both global and individual, which warn of potential adolescent failure. Again, they are monotonously famiIiar. At a global level, poverty, absence of a stable family with two parents in it, absence of adult attention or parental caring, lack of implicit or explicit parental expectations for the child to use as guideposts, inferior schooling, lack of help in skill development, lack of employment opportunities-all of these were common antecedents of adolescent failure. Although mo?t +s:uiirtional adolescents are White, the hazard? +~remore common and failure rates greater among those who are Black or Hispanic. Signals which could warn of coming troubles for particular youngsters :vell before they occur were also identified. These children were in trouble early. Early school failure was perhaps the major identifier of future difficulty, but there were other signals as well. Children who would subsequently not make it often demonstrated hurtful behavior toward others, received poor parental support, had parents whose aspirations for them were few, and lacked the capacity to resist peer influence. Thus conferees agreed that a distressing number of our young people were not making it successfully to adulthood. The economic, social-environmental and psychological antecedents which increase the hazards of becoming a loser were quite well known. The signs which could early on warn us that a particular child was heading that way had been identified. All this was true, yet all agreed that we are doing precious little about it. Why is this the case.3 What has led us to this incredible situation? The conference participants brought forth several factors which seemed to have led us down this descending staircase. First, Dr. Ginzberg pinpointed one deep-seated American belief which bears on the problem. Our society is firmly grounded on the premise that the nuclear family is almost solely responsible for all of the inputs into infants and children which guide them through adolescence to adulthood. In days past, when the typical nuclear family consisted of two parents, &

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working father and a mother at home who cared for an average of two children, this model may have served us adequately. But this “family” is a vanishing commodity in America, and we have failed to acknowle-lge or-come to grips with this reality or to establish staff or institutions or support structures to compensate for its loss. Second, Dr. Kagan made the point that our wide acceptance of “social darwinism” and the belief that it is as applicable to human species as to nonhuman was serving us poorly. He believes that acceptance of the premise that society is a jungle and that survival of the fittest is the way of the human world permits us too readily to look the other way or be indifferent to the plight of others or agree on simple standards for what is right and Mrong. Third, and perhaps most tragic, it was generally agreed that mid d!+class Americans have become increasingly imlifferent to the miseries of the poor and that they care little about the increasing gap-economic, social, educational, cultural-between the haves and the have-nots in this country. That this has serious consequences was made repetitively apparent. The risks of becoming a “problem adolescent” are overwhelmingly greater for those at the bottom. Given this situation-or something approaching it---is there hope? Of course. And here I can report some of the more cheerful and encouraging data offered by the conferees. One thread which ran c-ontinuously throughout the conference was articulated by many speakers. Most, indeed the majority of adolescents, are wonderfully resilient. They can take a remarkable amount ot battering, adversity, disappointment, and deprivation and come citrt as adequately functioning adults. Each of the participants was careful to point out that any or all of the factors described as predictors of failure are not inevitable determimwts of poor outcomes. Dr. Jessor made a compelling case for the interrelatedness of biological, social, and psychs4ogical factors, both hazardous and protective, in shaping adolescent behavior and life-style. His complex but carefully crafted diagram gave conferees a broader conceptual framework in which to view risk behavior, and it deserves another careful look by the reader. This and other data made it evident that all “risk behavior” is not bad. some risk-taking has positive outcomes and fulfills important developmental needs. Clearly, coping with manageable adversity is important to growth, and there is evidence that successful coping with tough problems increases the chances of SUCcess in adulthood. All societies give their children

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tasks to accomplish. But it was the wisdom of the past to give each child tasks that he or she could do, and thus feel good about himself or herself. We are losing sight of this bit of common sense. Perhaps most hopeful was the abundant evidence that not only could those at risk be identified but that there were interventions which . ;orked. These had certain common ingredients: They were initiated early and dealt with antecedents, not results, of failure. They were programs’ which gave one-on-one attention to children. One adult caring for and paying attentiun to one child became a marching banner for the conferees. They supplied, fostered, and encouraged development of tile basic skills of reading and writing, skilis critical for success in our society. Socialization skills were also important. Many successful programs were located in schools, but often were not of them. They were generally run by outside groups or agencies. Successful programs involved pa>:ents as well as children and made both groups fu13participants in the process. They had a real and obvious connection with the world of work. They had exciting leaders who related well to tidolescents and vice versa. The information gathered by Dryfoos showed clearly that there were no magic bullets. Programs which were successful in putting their charges on the achievement track were multifaceted. Singularly unsuccessful were efforts at “scaring straight,” moralizing, media or poster campaigns, or one-shot programs. How did the conference end? With this massive evidence of serious and mounting adolescent troubles, with evidertce that we know many of the factors which promote loss of teenagers from responsible society, evidence that the specific children who will fail can be identified, and evidence suggesting that the kinds of programs which can prevent this are known. What did conferees feel at closure? As I have reviewed the discussion, I think ambivalence would best df,scribe the collective mood: ambivalence tending tornrard optimism in some, toward anger in some, and toward despair in others. The reasons for this were straightforward. There was, on the one hand, an overwhelming consensus that genuinely to turn around what was happening to our young

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would require profound and fundamental changes Large-scale in America’s social infrastructure. changes in education, in housing, in income support, in child care, in opportunity structure, in the way we deal with poverty were required. On the other hand, there was also a consensus (though not unanimous) that this was simply not going to happen soon and that the political will or interest or leadership to carry out such revolutionary reform was singularly lacking at all levels of society and government today. Those tending more toward despair further felt that without such changes most of the other efforts would be piecemeal, after the fact, and only marginally effective. But not all were willing to settle for this stalemate. A “children’s crusade” with a bread agenda, a coupling of health professionals and those in the social welfare field to put the facts more squarely betore Congress and the public, was advocated by some who believe that such an effort could make a difference. SO at the risk of going beyond where conferees came out at conference end, but to lift our collective spirits, I will ciose with a set of highminded recommendations which attempt to capture the hopes of the group while ignoring some of the realities of the currelIt national climate: 1. Put together a simple, broad, unequivocal national agenda for action which spells out the sweeping changes in social infrastructure needed to give every child an opportunity to make it in America, Pound home the fact that our society is failing to meet the objectives it has set for itself and emphasize the obvious: that this nation cannot long prosper if one fourth of its youth become crippled dysfunctional adults. While w0rking toward this end, initiate the following interim efforts to improve the situation: 2. jupport any and all programs which can bolster families: undertake welfare reform to ensure decent minimal subsistence levels of income for all families with children. Where family structure is fragile, failing, or destroyed, establish a Jyskm of surrogate parents, a minimum of one caring aduh for e& child in Amerrira. 3. Help schools to rethink their mission. l.et them recognize that they are part of the probiem. Convince them that it is their responsibility to see that every child succeed at something and feel good about himse!f or herself. 4. Create early wamng systems to signal which children are at hazard of falling off the train. Put that information in the hands of responsible

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adults with the authority to act on it. School failure or falling behind may be the most important indicator, but others, such as violence toward others, depression, drug use, or venereal disease, should trigger the system. 5. Marry communities and their schools. Make those institutions the site of 7-day-a-week, 24hour-a-day activities which are exciting, educational, and fulfilling. These programs should encourage skill building, nurture feelings of selfworth, and involve parents, children, and adults of all ages. Let outside agencies and organizations which care about children take major responsibility for program development. Connect these

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programs with the world of work and involve business, labor, community leaders, police, artists, dancers, sports enthusiasts, and the like. Make programs like Headstart, Vista, the Peace Corps, and the Job Corps better known and more visible to both adults and young people. Clearly in the absence of a more generous national commitment to children and a willingness to direct major efforts and resources toward them, steps 2-5 will not suffice. But they would be a start, and could perhaps hold the line until that day when the nation recognizes, as it most surely wi!l, that this waste of our most precious resource-our youth-must stop.