Suzanne Bender, MD : Olivia buries her head in her hands. We are having a family meeting to discuss her increasing anxiety, dysphoria, and insomnia over the past few months. One clear stressor is her honors physics class taught by Mr. Nash, a notoriously difficult class at her public high school. Olivia has fallen behind on assigned projects, but Mr. Nash has offered her an incomplete with the opportunity to finish work over winter break. Over the holiday, Olivia hasn’t touched her physics book; she is irritable and less interactive, but adamant she wants to stay in this class. I send Olivia out to my waiting room to talk to her parents privately. “Olivia’s mental health and actions are communicating that this class is overwhelming to her. As a teenager, she may have trouble knowing how to respond; she needs parental guidance.” Her parents agree. We call Olivia back in. They are empathic but firm: “With honors physics, your current class schedule has tipped from challenging to overwhelming; we have decided you will drop down to a non-honors physics class in January.” Olivia is angry and resentful, but she doesn’t fight the decision. A few weeks later, her parents overhear Olivia talking to her sister: “I’m so glad mom and dad made me drop Nash’s class; I just tell my friends my parents made me do it and my life is so much better now.” Two take-home messages: An academic schedule that is too intense may cause psychological harm. In addition, never underestimate the need for a teenager to save face. There is no “one size fits all” high school academic schedule. The aim is to find a course load that stimulates but doesn’t overwhelm, and this lineup looks different for each student. The optimal class mix may include intensive STEM courses but unaccelerated humanities classes, or the reverse. Too often, I see issues arise when teens prefer a broad brush stroke approach, i.e. take as many intensive academic classes as possible. Students are understandably proud to report how many honors and Advanced Placement courses they are taking but when the schedule’s intensity becomes too high, it is easy to drown in the onslaught of work. The academic day is long and intense, followed by afternoons pursuing extracurricular activities. To manage the workload, teens may study until the wee hours of the morning, just to wake up and start the whole cycle over again, exhausted. With life on a hamster wheel, students may not have time for recovery or play. When the schedule is too intensive, teens present in my office with an assortment of symptoms during the academic school year. They are overtired, irritable, and dysphoric; they may struggle with debilitating anxiety or panic attacks. Their eating may be disordered; complaints of frequent headaches and stomachaches increase. Sometimes they have passive suicidality: “If I was hit by a bus, I wouldn’t really care.” Over the summer, they are generally much happier as the unrelenting pressure lifts. I float the idea that their current schedule is too intense, but they may resist the recognition that their schedule is actively hurting them. They insist that they love all their classes. Their friends also have this demanding schedule and there may be a communal investment in the misery and lack of sleep. Everyone is pushing themselves to the breaking point. An adolescent “all or nothing” perspective is prominent: These classes protect their future, catapulting them to their dream college and their dream job. Guidance counselors may not feel comfortable setting academic limits for students. The power lies with the parents, but they may need support and guidance to push back against the “pedal to the metal” peer and community pressure. Some worry their talented teen will feel unsupported if they push for a more balanced class load (not all honors, limited AP classes). They are understandably proud of their child who is such a hard worker and involved in so many interesting things. In a family with limited resources, school performance provides a road to secure a profitable future; there is concern that swapping an honors class for a standard version may limit opportunities. The psychological strain feels worth the potential reward. As a child and adolescent psychiatrist, my job is to open a respectful discussion about this issue but I do not take a neutral stance. Post-pandemic, teen mental health is already precarious. Social and emotional development is more important than adding an extra AP course. High school is not the endgame, but just the beginning. Ideally, we want a student to enter college with engine roaring, excited and interested in learning, not exhausted, burnt out from four years that were too intense. It is easier to create a fall class schedule that allows room to breathe than retreating from a class midyear, as Olivia did. For each student the answer is different, but the questions are the same: How full a plate is too full? How can we create a high school experience that allows you to thrive, not just survive?
(Suzanne Bender, MD, is a child adolescent and adult psychiatrist in private practice and on faculty at Massachusetts General Hospital in Boston, Massachusetts).