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Weathering the Changes: Discriminating Mental Health Problems and Normal Developmental Struggles in Hard-to-Reach Campers
A camp director is stumped by negative changes observed in a veteran camper. Juan first came to camp as an energetic and enthusiastic eight-year-old. This year, at age fifteen, he walks away from opening campfire, telling his counselors that his mother made him come to camp. He would have preferred hanging out with his friends and wants to go home. Juan is furious when his cell phone is taken away from him according to camp policy. For the next few days he mopes around camp, disengaged and unenthusiastic. He does not want to get out of bed in the morning and doesn't seem to perk up until after lunch. Juan's eating habits have also changed. He refuses certain foods and over eats others (especially treats and desserts). At the end of the first week of camp, it appears that Juan has been stealing from his cabin mates. Is Juan experiencing a mental health problem or just going through a phase?
Katelyn, eleven, has been attending the same overnight camp for the past three years. Until this year, she loved camp and was a model camper. Katelyn is a different child this year. She is clingy to her mother on opening day and cries for several hours when mom leaves. She does not want to swim and purposely took her bathing suit out of her duffel bag. In the cabin, she keeps her head down, clutching her stuffed owl, refusing to look at or talk to people. When asked to do things, she whines and crosses her arms across her chest. Counselors feel like they have to drag her everywhere and cajole her to do things. She behaves this way for most of the first few days of camp, wearing out counselors and frustrating her cabin mates because of all the one-on-one attention she requires. Is Katelyn having a mental health crisis or is she struggling with a developmental transition?
James and Maddy are eight-year-old twins at Camp Sort It Out — their first year at this community day camp. Though they seem like typical eight-year-olds for the first few days, counselors are now concerned about and frustrated by their behavior. James has poor boundaries; he is overactive and gets into people's personal space. He does whatever he can to annoy peers, including pushing them out of the way, saying mean things about them, and constantly complaining that kids are being mean to him. He is loud and disruptive during activities. At the same time, he can be charming and endearing. Maddy gets along better with her peers, but something seems different about her. She seems more mature and sophisticated than the other girls. She is very interested in talking to counselors about their girlfriends or boyfriends. She seeks out the attention of the boy counselors. She talks a lot about her mother's boyfriend and uses adult language to describe their relationship. The twins' mother is always about an hour late for pick up and does not seem to have good control over them. At times, Maddy makes excuses for why her mother is late. Are these normal developmental challenges, or is something more serious going on here?
Distinguishing Between Developmental Transitions and Mental Health Problems
What is behind the significant behavioral and emotional challenges presented by these campers? At what point should a camp director become concerned about the mental health and safety of these campers? What is the most effective way to handle these situations? In this article, we will describe a process that we call "developmental reasoning." This process uses concepts and understandings from the fields of child development and developmental psychopathology to help distinguish existing or potential mental health problems from periods of developmental transition, which are often turbulent. While developmental challenges, transitions, and mental health problems can look the same, the causes are different, thus interpretation and interventions will vary. Having the best understanding of what is going on gives us the opportunity to respond most effectively.
There are many theories that describe how children develop skills, proceed through stages and changes, and move along the normal course of development (Erikson, Piaget, Kohlberg, etc.). Regardless of theory, developmental scientists understand that change is multiply determined, moves in multiple directions, occurs in multiple contexts, and is variable and malleable (Berger 2009). Age is used as a metric for development but is not always the best measure of someone's maturity. Bronfenbrenner's social-ecological theory (Bronfenbrenner 1979) asserts that everything in a child (the child's biology and temperament) and in the child's environment (family, friends, culture, religion, school, community, society, and global events) influence how a child grows and develops as the child interacts with his/her environment. To fully understand a child at any given moment, it is important to consider these multiple influences in addition to their current developmental stage.
For each stage in development, there are struggles and vulnerabilities that are particular to that stage. Kids often make progress for awhile, but they may regress to an earlier stage of development if circumstances create stress for the child. Disabilities that show up at one point in time may not be present later. Similarly, there are some difficulties, disorders, and illnesses, which show up later in development, sometimes abruptly and without warning.
Case Study — Juan
With this knowledge in mind, let's focus again on Juan. The questions in Table A can serve as a guide in our developmental reasoning. Is Juan experiencing a developmental shift? At age fifteen, Juan is right in the middle of substantial pubertal changes. Boys this age are developing significant strength both psychologically and physically. Their increased size and strength provides impetus and readiness for testing boundaries. Is Juan's behavior different from the other kids his age? Some of his behavior is much like other kids his age, many of whom would rather hang out then engage in camp activities, and many of whom are moody and aloof. Further, since very close relationships with a group of peers is so important to kids this age, it is also not surprising that Juan wants his cell phone and would rather be home. Because of rapidly shifting hormones, teens can tire easily and require more rest. They also change eating patterns when they are not under parental control.
Are there cultural or family issues that are affecting Juan's behavior? There is nothing to suggest that Juan's "symptoms" can be explained by culture. So far, Juan's difficulties appear to be mostly development related. Does Juan exhibit any odd or unusual behaviors? The stealing behavior does not necessarily fall within the realm of normal development, although kids this age can be impulsive and have poor judgment. In order to clarify this, staff might want to call the parents for more information. Sometimes significant stress can underlie stealing behavior. Did anything unusual happen with Juan in the past year? If this is a first-time behavior, then we might chalk it up to developmental phase or transition (testing of limits). If it is a repeated pattern and has gotten Juan into trouble before at home, concern goes up a level. Parents may not always disclose important background information, either because they don't understand the importance of camp knowing about it, or they don't want to compromise their child's ability to come to camp. Is Juan engaging in any unsafe behavior or appear to be in unusual emotional distress? Stealing aside, the answer is no on both counts.
How to handle these issues? It is important for someone to enter into Juan's confidence by relating to his concerns and trying to come up with compromise solutions for things he doesn't want to do. Because of chemical changes in the brain, teens often have difficulty seeing the short- and long-term consequences of their behavior and may need some re-teaching. If Juan continues to steal and/or becomes highly aggressive with total disregard for the needs and rights of others, he may be in a mental health crisis and in need of professional intervention. In that case, a camp director makes the choice between getting professional consultation and sending Juan home if other interventions attempted at camp do not turn things around.
NOTE: Regardless of the cause for stealing or other antisocial behaviors in adolescents, it is important to set clear boundaries and consequences the first time they appear. In all consequences, communicate care and concern, especially to youth in the midst of a developmental transition.
Case Study — Katelyn
Katelyn is another repeat camper who has shown significant behavior change this summer but for very different reasons than Juan. An abrupt change in a year's time during pre-adolescence is not unusual. Girls this age begin the process of social positioning and can use things like moodiness or sullenness to manipulate peers and adults. There is a big increase in self-consciousness at the onset of puberty, which may help explain Katelyn's reluctance to swim or wear a bathing suit. As puberty approaches, the overwhelming nature of it can cause some regression, as seen by her carrying her stuffed animal around camp. Although separation anxiety may be more common in younger children, it would not be unusual to see it in an eleven-year-old returning camper, especially one like Katelyn who is shifting from childhood to preadolescence.
Although Katelyn is not displaying unsafe behaviors, her withdrawal is so marked and persistent, and she is displaying the unusual behavior of not talking, information from home is needed. Parents may be able to tell us if anything unusual has happened in the past year, or if there are family or cultural factors that should be considered. Regressed behavior can also be a sign of sexual abuse or major change in the home (such as loss or divorce of parents). Finally, there are camp variables that should be considered. Perhaps Katelyn was close to a counselor who is no longer at camp, or maybe her parents have planned a vacation while she's at camp. All of these variables must be sorted out in determining what to do for Katelyn.
Assuming for a minute that Katelyn's difficulties represent a difficult point in her development, we can weather the storm with her and support her in a way that would minimize attention seeking and maximize her appropriate participation in the program. This requires a well-coordinated effort on the part of the staff so that Katelyn gets the reassurance she needs, but also allows her to reach a bit beyond herself to participate more meaningfully in the program. Sometimes planned ignoring (ignoring negative behavior and heavily praising appropriate behavior as soon as it has occurred) is effective with a camper like this. Should these strategies fail and her problems get worse, we might raise our concerns with Katelyn's parents or get some guidance from a local expert.
NOTE: Try not to reward withdrawn campers with increased one-on-one attention. Instead, ignore sullen behavior to the extent that you can, while heavily reinforcing positive behavior. Get help if you are using good behavioral strategies and a camper's mood or behavior still continues to deteriorate.
Case Study — James and Maddy
What's happening with twins James and Maddy? On the surface their behavior could be seen as typical of young children at camp . . . pushing boundaries, being interested in what is happening with staff, jockeying for social position, and being generally overactive, inattentive, and impulsive. Some girls start puberty earlier these days, so Maddy's interest in boys might be age-appropriate for her. There are red flags though — mom is chronically late, and Maddy has some adult-level understanding of her mother's relationship with the boyfriend. It is safe to say that there are things about the home environment that may be contributing. It is also important to keep in mind that this is the age that some psychological disorders such as hyperactivity, inattention, and impulsivity show up for the first time, especially in more loosely structured situations.
A clear set of expectations and a lot of structure will be helpful with Maddy and James, regardless of the cause of the behavior. However, if their problems can be attributed to mental health problems as opposed to developmental shifts (their age does not suggest a developmental shift), typical efforts to provide structure and support will be less effective. In this scenario, they can be successful at camp, but staff may have to be informed of the special things they may need to do, such as increased or one-on-one supervision for James and a special person for Maddy to talk to about the adult issues she raises. Addressing these issues with mom and finding out what exactly is going on at home will also help staff in supporting the children.
Whatever the problem, it is important to remember that challenges, changing emotions, and behavior are a normal part of growing up. While we don't want to "look" for problems, we can be assured that developmental changes and turbulence tend to be temporary. If we can weather through these storms, non-judgmentally and with plenty of good behavior management skills, things may be different next year or later in the summer. Remember that having a mental health diagnosis is a developmental challenge in and of itself. Unfortunately, the incidence of mental health disorders is rising among youth. Kids with challenges can be very successful at camp with some good developmental reasoning, a lot of commitment, a little perspective, and good humor. We all have storms to weather as we grow and change. Camp can be a safe place for children experiencing difficulties, if staff is prepared and willing to go the extra mile during tough times.
Berger, K.S. (2009). The Developing Person: Fifth Edition. New York NY: Worth Publishers.
Bronfenbrenner, U. (1979). The Ecology of Human Development: Experiments by Nature and Design. Cambridge MA: Harvard University Press.
Originally published in the 2010 March/April issue of Camping Magazine.