Helping freshmen manage expectations and stress

As the first day of college approaches for many first-time students, pediatricians may encounter patients experiencing a range of emotions from excitement to stress and uncertainty. Most freshmen report facing emotional challenges, according to an online survey of 1,502 students by Harris Poll.1 Fifty percent of respondents said they felt stressed most or all of the time.1

Although the emphasis has traditionally been on academic readiness, emotional readiness is the most likely factor in students’ emotional and academic success in college.1.2 Being able to take care of oneself, adapt to new environments, control negative emotions and establish positive relationships are factors that determine a student’s success. By providing preventative guidance to patients and their families, pediatricians can alleviate the uncertainty that awaits them.

Manage expectations

Even before social media, college was portrayed as a party atmosphere in movies and TV shows. Often described as the “best 4 years of his life,” the expectation of fun, meaningful relationships and a rewarding academic experience is what most students think they’ll find once settled into their dorms. The ubiquity of smartphones and social media has now amplified the ideal image of college life. In fact, many students feel that social media, TV, and movies make college more fun than it actually is, and 49% of survey respondents said college doesn’t meet their expectations.1

When talking to new students, pediatricians should start with open-ended questions about what patients expect when they come to college. Pediatricians can help manage expectations, noting that students may find the experience different from how it appears in the media. For example, pediatricians may ask, “Which social media apps do you prefer?” or “What kind of things do you like to read on social media?” then, based on the responses, ask about the patient’s perceptions of the content. As a child psychiatrist, I often ask patients what they look at on social media and if they think it’s a real representation or a mirage. Creating a thought process helps them do this on their own when they experience the familiar fear of missing out, better known as FOMO. Helping patients understand that it is normal to feel a range of emotions during the first year will help normalize feelings when they inevitably arise.

Draw a picture of actual behaviors

One in five students meet the criteria for an alcohol use disorder.3 Still 50% binge drinking in college, and 1 in 5 students report doing so frequently.4 These are worrying statistics that lead to significantly negative consequences. It is important to note that many students do not participate in substance use or excessive alcohol consumption. Research suggests that social media has a strong influence on substance use among college students.5 Additionally, the majority of students overestimate the heavy drinking of their peers, and this overestimation can lead to more alcohol consumption.6 College students drink according to the social norms they perceive.

To protect students from substance abuse, pediatricians can remind teens that many do not abuse alcohol and ask patients to discuss the types of friends they hope to make at school. university. In fact, reducing normative misperceptions around alcohol consumption has been the most effective brief intervention strategy for reducing binge Knowing where to get help is an important part of addressing the emotional challenges that often underlie substance use in college.

Visit the college counseling center

Many mental health issues and disorders emerge among students during their college years. Other students will enter college with a diagnosis and will need ongoing psychiatric or psychological care. Creating a plan with families before arriving on campus is an essential task in supporting student mental health.

Visiting the college counseling center will help familiarize you with mental health resources on campus. Likewise, pediatricians can start the conversation about where students can go to access additional mental health support. It’s also important to engage parents and discuss signs of common mental health conditions such as anxiety, depression, and substance abuse. Once patients turn 18, parents have less access to healthcare providers, but they can still be an important partner in getting their children the help they need. If a person entering college is already in treatment, it is helpful to ensure that the family has a plan for continuing treatment.

For patients on medication, review with them a plan to get refills before they run out while on campus. Families should be informed that their clinicians will need a license in the state where the student lives in order to continue care. Otherwise, parents should find a new therapist or psychiatrist if the student needs ongoing care. Prescription drug abuse on college campuses is common, so discuss with patients the importance of taking medications as directed and not sharing or selling them to other students.

Practice problem solving before the semester begins

When talking to parents about behavior management, I always recommend “hitting while the iron is cold.” It is much more difficult to manage a tantrum, or a big tantrum, at its maximum intensity. Practicing strategies and creating routines around stress management and problem solving will pay dividends when young adults need to navigate life independently. Build on pre-existing strengths. Pediatricians may ask questions such as “How have you dealt with stress in the past?” or “Were there times when you felt overwhelmed?” What helped? Reinforcing good habits and mentioning new ones in times of calm will lay the foundation for overall well-being.

Mindfulness strategies are easy to learn and beneficial for mental health. In a pilot study using mindfulness training with 109 freshmen, participation was associated with increased life satisfaction and decreased depression and anxiety.8 Introducing simple mindfulness techniques (meditation, progressive muscle relaxation) and practicing them together in the office can create healthy coping strategies.

Living independently requires learning problem-solving skills. Helping families reflect on past transitions can help them cope with the change to come. In the years and months leading up to college, parents should plan more space for their teens to experience independence. Reviewing what needs to be done before leaving for college and how the teen can help is great practice for resolving issues once they leave home.

The college years are a time of stress and mental health issues.9 In the midst of an ongoing pandemic, baseline stress levels among teens are even higher and require a response.ten Pediatricians can participate in crucial conversations that will help set the stage for a successful transition to college.

Emily Aron is a psychiatrist affiliated with MedStar Georgetown University Hospital in Washington, DC. She is also a member of the Editorial Advisory Board of Contemporary Pediatrics®.


1. Harris Poll. The freshman college experience: A look at students’ challenges and successes during their first term in college. October 8, 2015. Accessed June 28, 2022. pdf

2. Allen J, Robbins SB, Sawyer R. Can measuring psychosocial factors promote academic success?. 2009;23(1):1-22. do I:10.1080/08957340903423503

3. Slutske WS. Alcohol use disorders among American college students and their non-college peers. Arch Gen Psychiatry. 2005;62(3):321-327. doi:10.1001/archpsyc.62.3.321

4. Krieger H, Young CM, Anthenien AM, Neighbors C. The epidemiology of heavy drinking among college-aged people in the United States. Alcohol Res. 2018;39(1):23-30.

5. Mason MJ, Zaharakis N, Benotsch EG. Social networks, substance use and mental health among students. J Am Coll Health. 2014;62(7):470-477. doi:10.1080/07448481.2014.923428

6. Cox MJ, DiBello AM, Meisel MK, et al. Do misperceptions of peer drinking influence personal drinking behavior? Results of a comprehensive social network of freshmen. Psychol Addict Behavior. 2019;33(3):297-303. doi:10.1037/adb0000455

7. Reid AE, Carey KB. Interventions to reduce alcohol consumption among college students: state of the evidence of behavior change mechanisms. Clin Psychol Rev. 2015 ; 40:213-224.

8. Dvořáková K, Kishida M, Li J, et al. Promoting a healthy transition to college through mindfulness training with freshmen: a randomized controlled pilot trial. J Am College Health. 2018;65(4):259-267. do I:10.1080/07448481.2017.1278605

9. Bruffaerts R, Mortier P, Kiekens G, et al. Mental health problems in first-year students: prevalence and school functioning. J affect disorder. 2018;225:97-103. doi:10.1016/j.jad.2017.07.044

10. Wang X, Hegde S, Son C, Keller B, Smith A, Sasangohar F. Survey of American student mental health during the COVID-19 pandemic: a cross-sectional survey study. J Med Internet Res. Published online September 17, 2020. doi:10.2196/22817

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