Dr. Laura Offutt on adolescent resilience in face of pandemic

Watch the AMA's daily COVID-19 update, with insights from AMA leaders and experts about the pandemic.

In today’s COVID-19 Update, kicking off International Adolescent Health Week, Laura Offutt, MD, host of “Real Talk with Dr. Offutt,” discusses adolescent health.

Learn more at the AMA COVID-19 resource center.

Speakers

• Laura Offutt, MD, founder, International Adolescent Health Week

Unger: Hello, this is the American Medical Association's COVID-19 Update. Today, we'll be discussing adolescent health during COVID-19 with Dr. Laura Offutt, founder of International Adolescent Health Week and host of “Real Talk with Dr. Offutt,” a digital teen health resource. Dr. Offutt's calling in from Radnor, Pennsylvania. I'm Todd Unger, AMA's chief experience officer in Chicago. Dr. Offutt yesterday kicked off International Adolescent Health Week. Why was there a need to create a week specifically devoted to adolescent health?

Dr. Offutt: Well, Todd, thank you very much for having me here today, and I really appreciate the opportunity to talk about why this week is important at all. I think we all know that adolescence is a specific time in development and a specific age group, but we often forget that adolescents are not just small children and they're not little adults. And it's a very important time, developmentally, socially, emotionally and physically, and oftentimes this awareness gets dropped in terms of meeting the health needs of adolescents.

One thing in particular is when we talk about adolescent health, often as we're trying to educate teens or reach out to them, the messaging is very punitive or negative or all these horrible consequences are going to happen if you make this wrong behavior choice. And so there really is a need to turn this narrative around and celebrate all of the good things that adolescents are doing about their health and dispel a lot of misconceptions. In particular, one misconception around adolescent health or teen health is that teen health only encompasses sexual health. And this is absolutely not true. Just like in every age group, sexual health is a part of health, but there's mental health, physical fitness and nutrition, holistic well-being, preventive health. All of this gets rolled in together. And the focus of the week is to address all of the multifactorial components that go into healthy living for adolescents.

Unger: Well, it seems like every certain generation or demographic is experiencing the pandemic in their own ways. How are you seeing the pandemic affecting adolescents in particular?

Dr. Offutt: Well, one thing that I think is important to think about is what is the work in development that is being done by adolescents at this stage in their life? There's a couple of major tasks that are being accomplished from the ages of 10 to the early 20s. One of these is to learn their independence and to start to separate from their parents. So although that looks like tension and friction in the household sometime, that's a very important piece of work that's being done in adolescents. Another—

Unger: I was going to say, "Uh oh," because that's a big problem right now.

Dr. Offutt: Exactly.

Unger: Even for my 22-year-old who is stationed here at home and working from home with us right now. So that must be a particular challenge. I mean, the way that you put that as there's work to be done in adolescence. How then is that lining up?

Dr. Offutt: Well, so then we're seeing that that coupled with forming identity and sorting out what is your proper peer group, and the increased importance in social and peer connections over family connections, sort of supplement that. All of that is on a head-on collision with the limitations that the COVID pandemic has put into place.

Unger: Do you think that they'll be able to kind of make up for it in rapid progress or is this kind of ... have permanent effects?

Dr. Offutt: It remains to be seen what is going to happen for sure. I think that often we underestimate the resilience of adolescents. And as a nod to that, the theme for Adolescent Health Week this year is adolescent resilience in the face of a global pandemic. Often when we see news stories, we kind of see the different extremes. We see stories of high school students or college students having these huge house parties, or we see a horrible health consequence of COVID, the mental health impacts, or we see the other end of the spectrum with tremendous innovation that young people are doing, like the guest that you had, I think his name was Eli …

Unger: Eli Coustan, yeah.

Dr. Offutt: So we're seeing these extremes of a reflection of how adolescents are experiencing the pandemic. But I think we really need to also think about all of the adolescents that sit kind of in the middle of that. And every day adolescents are demonstrating resilience. They have had to pivot to go to online learning, using multiple different platforms. They have had to find a way to be social in a safe way, even when oftentimes the adults are setting bad examples. They've had to adapt their traditions and milestones in their lives that are very significant into ways that are safe in a COVID setting. And they've had to do all of this while we as adults are struggling too. And oftentimes we're not setting the best example as adults in our community.

Unger: You mentioned the work that adolescents have to do. I imagine that building resilience specifically is one of those things. I mean, there are a lot of challenges that adolescents face throughout their school years. Is this a particular, I guess, I hate to use the word opportunity, or one that maybe while they're experiencing aren't recognizing, but when they come out of this, will in fact have been a building block in resilience?

Dr. Offutt: I think that that is absolutely true. One thing that I do want people to really think about is that resilience is not just an individual activity. So while it's absolutely true that overcoming hardship and coming through traumatic times is something that builds your resiliency bank, resilience is also contributed to by the social supports that are around our adolescents. So things that help to promote financial stability in the family, things that promote access to health care, things that promote connection with the community. So all of those things build into the resiliency bank.

There's some interesting discussion actually that what this generation is going through, actually looks a lot like what is referred to the Greatest Generation, that generation where adolescents and children, through the pandemic of 1918, also at a time of rapid technological advancement, and they were an incredibly socially aware, civil service, forward-thinking for the betterment of the community generation, as we all know. And facing some similar challenges now, there's reason to believe that that may happen again.

Unger: Are there any particular aspects; you kind of outline the broad set of health aspects, including mental health, nd I think that's been a particular issue for adolescents during COVID-19; is that something you're seeing has worsened as an impact of the pandemic and perhaps even as an inability to see health care providers?

Dr. Offutt: I think you raise a good question. There absolutely is a lot of concern in the adolescent health community about the impact on mental health from the stressors of the pandemic, also overlaid with all of the other tensions and stressors that we have been feeling around us for the last several years. There seems to be some mixed data. It's too soon to know for sure. One thing we are seeing is an increased proportion of ER visits for children and adolescents are for mental health concerns. But we also know that the overall number of ER visits has declined, for instance. Resiliency is a protective factor in terms of protecting your mental health. And so since adolescents haven't had decades of life experience to yet have experienced the common thread of humanity, which is being exposed to suffering and trauma and difficult life circumstances, their bank is not yet as full as an older adult's bank. So then it makes it more difficult to deal with these stressors.

In terms of accessing mental health care, this is another big problem. There already had been a huge shortage of child and adolescent psychiatrists, therapists and mental health professionals in general to serve the needs of the population as a whole. But we are seeing, both with increased awareness of how mental health symptoms can be treated, but also with increased symptomatology in some teens it's difficult to access this care. And then another kind of twist of it is telehealth has definitely helped increase being able to access support and care. But if you think about it, your adolescent is cooped up at home with adults and other family members. So how freely can they talk with a therapist in a telemedicine visit when they don't really have the privacy that they need to be able to be candid about what they are exactly feeling.

Unger: I'm curious too. It's interesting, you mentioned the kind of trauma of this particular adolescent generation compared to earlier generations, the Greatest Generation, for instance. I mean, technology, like you mentioned with telehealth, is certainly playing a big role in our ability to kind of weather this last year. Are you seeing pros and cons in terms of either mental health impacts on adolescents, or not?

Dr. Offutt: Like you said, there are pros and cons, and this is true of technology as it's been over the course of time. Some adolescents are finding a way to find connection through social media, through online social activities. The technology has allowed kids that do not have a positive experience in the school setting to be able to learn without the social distractions. Say they're a subject of bullying or harassment in school in person, they are able more to just concentrate on their education being at home. So there definitely are pros and cons.

On the other hand, one of the tasks of adolescence is to become comfortable in your body. So if social media is being used in a way to portray physical images of yourself, or to look at other physical images of other people like we see on Instagram, for instance, that can actually worsen some of the mental health of adolescents. We are seeing some problems with eating disorders, for instance. Having your routine and your schedule completely disrupted is very difficult for patients that are struggling with eating disorders.

Unger: You mentioned, of course, this is International Adolescent Health Week. Are you seeing any differences, disparities on a global basis in terms of how adolescents are being impacted by the pandemic?

Dr. Offutt: I think that what I am seeing really is what is aligned with wealth gaps. So I work with a group of 27 youth ambassadors from 17 countries, and they have helped to shape this year. We sought adolescent input into the development of the week and then the promotion in different regions. And one of the questions that we have talked a lot about is how the pandemic is affecting them locally. So some of the major themes that had come through with the applicants as a whole, we had almost 200 applicants for the positions, was mental health was definitely a component. It was before COVID, but obviously that continues to be an issue. In terms of access to health care and unequal burden of disease and the impact on family finances and those sorts of stressors, the parallels are very similar with the wealth gaps, where the wealthier are somewhat more insulated from the magnitude of that, and the poorer or the less well-resourced families have more multi-generational living, those sorts of things.

Unger: It's another facet of the inequity in health care or in health that we're seeing among minoritized or marginalized populations. Are you seeing that reflected in adolescent health as well?

Dr. Offutt: Absolutely. Absolutely. And one of the things I was going to just mention before we shift gears is one of my youth ambassadors in Indonesia remarked, we all know educational disruption is a horrible thing just in and of itself, but sometimes we don't think about the direct consequence of that. So in communities where child marriage is still very much a real thing, and we do have communities like that here in the United States, you're seeing a spike in child marriages because of the financial pressures that families are under.

Unger: Well, last question. How can physicians who would like to learn more about or help advocate for adolescents and adolescent health get involved?

Dr. Offutt: Well, I would encourage that anybody that has an adolescent in your life, make note of the week, and wish adolescents a happy Adolescent Health Week. The whole goal of this initiative is really to cross borders, and not just across country borders, but to really get out of our silos. As a primary care physician, I am well-used to thinking about how disease affects multiple organ systems all at the same time. So taking that analogy forward, we can't successfully promote and advocate for adolescent health only thinking in one silo.

So while medical therapeutics and the medical setting is very important, so are health policy that is in place or adequate support for education so our young people can be critical of information that they come across online, the importance to have science and medically accurate health education in schools. All of us need to work together and break down all of our silos as a community at large, as a village, as we started talking, to help advocate for a successful transition into adulthood, which is what adolescence is.

Unger: Well, Dr. Offutt, I want to just thank you for being here today and sharing your perspective and the framing of thinking about adolescence. There's a lot that goes on there and a lot of developmental work that this pandemic has certainly affected. I really appreciate it. And that's it for today's COVID-19 Update. We'll be back tomorrow with another segment. For resources on COVID-19, visit ama-assn.org/covid-19. Thanks for joining us. Please take care.

Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA

With an increased number of people reporting worsening mental health in recent years, it is imperative that people are aware of the 988 Suicide & Crisis Lifeline (formerly known as the National Suicide Prevention Lifeline) telephone program.

People experiencing a suicidal, substance use, and/or mental health crisis, or any other kind of emotional distress can call, chat or text 988, and speak to trained crisis counselors. The national hotline is available 24 hours a day, 7 days a week.

The previous National Suicide Prevention Lifeline phone number (1-800-273-8255) will continue to be operational and route calls to 988 indefinitely.