From the Emerging Adulthood SIG

Caregiver Involvement in Emerging Adult Mental Health Treatment: Special Considerations

Caregiver Involvement in Emerging Adult Mental Health Treatment:
Special Considerations

By Arielle Linsky, PhD, Emerging Adulthood SIG Member at Large: Practice
Weill Cornell Medicine

& Joe DeLuca, PhD, Emerging Adulthood SIG Member at Large: Education
Fairfield University & Icahn School of Medicine at Mount Sinai

Emerging Adulthood is a unique developmental stage between adolescence and established adulthood in which individuals shift along the continuum from dependence to autonomy across multiple domains (see Arnett, 2007; Arnett et al., 2014). Emerging adulthood generally refers to the period between the ages of ~18 to 29 in most industrial societies and has become a critical developmental period to understand for researchers and clinicians — especially as adolescence has become more elongated over the past few decades (Cicchetti, 2023; see also our Emerging Adulthood Special Interest Group (EA SIG) Mission Statement). Relatedly, the issue of caregiver involvement in emerging adult mental health treatment has become an important topic of discussion during this transitional stage, particularly as the prevalence rates of mental illness among emerging adults continues to rise (see National Institute of Mental Health, 2021).

Caregivers remain quite involved in emerging adults’ lives in the general population, with many in daily contact and providing regular financial support (Arnett, 2014), as well as reminding their emerging adults of deadlines they need to meet and making appointments for them (Quealy & Miller, 2019). For emerging adults who struggle with psychiatric disorders, the role of the caregiver can be even greater. The literature regarding caregiver participation in child and adolescent mental health treatment is extensive (e.g., Dippel et al., 2022), but guidance on this topic in emerging adulthood care is quite sparse (e.g., Miller et al., 2019). In this brief article, we aim to offer preliminary guidance for clinicians in involving caregivers in emerging adult mental health care and to make the case for ongoing research and professional discussion about this topic.

The role of caregiver over-accommodation and under-support:

Caregivers of emerging adults, particularly those with mental health concerns, can find themselves in an ongoing challenge to determine how much to support and intervene in their emerging adult’s lives. Many mental health problems in emerging adulthood originate in childhood or adolescence (Kim-Cohen et. al., 2003). Thus, patterns of caregiver over-accommodation (e.g., assisting a child’s avoidance of an anxiety-provoking situation) may impact the developmental trajectory of youth, interfering with skill and confidence development and delaying milestone achievement in the emerging adult period (Hoffman et al., 2018; Le Blanc et al., 2020). Further, given the relative modernity of this developmental phase, many caregivers may be confused about the level of support their emerging adult continues to need, contributing to invalidation, under-support, and providing too little scaffolding toward developmental milestones.

Practical strategies for involving caregivers in emerging adult treatment:

Though more research is needed, some evidence-based strategies already exist for involving caregivers in emerging adult treatment for specific clinical populations. For instance, for those with early-stage psychosis this can include manualized programs covering psychoeducation, communication skills, and problem-solving training (Camacho-Gomez & Castellvi, 2020; Herrera et al., 2023). For those with eating disorders, there are programs focused on addressing expressed emotion and family functioning (Dimitropoulos et al., 2019).

Various clinical and administrative tools have also been developed to assist clinicians in working with transitional aged youth more generally. Examples of such tools for youth transitioning to college include a qualitative “Transition Readiness Assessment and Action Plan Checklist” (Martel et al., 2015) focused on addressing gaps in a young person’s health knowledge and skills (e.g., medication use, psychosocial development) and a quantitative “Transition Readiness Assessment Questionnaire” (Wood et al., 2014) focused on health and health-care self-management. Both tools can be completed by emerging adults and their caregivers. Kranzler et al. (2019) have also outlined the importance of individual and group caregiver meetings focused on psychoeducation around the developmental phase of emerging adulthood, the accommodation cycle, core communication skills such as empathy, and scaffolding. This team has published several tools for emerging adult care, including an emerging adult self-assessment, emerging adult transition planning decisions, and developmental considerations for clinicians working with emerging adults.

Conclusions

Clearly, more research and professional discussion are needed around this topic. As we note in our EA SIG Mission Statement, cultural considerations are also essential in this work (e.g., Swanson, 2016; Syed & Mitchell, 2013), as the phase of emerging adulthood and caregiving practices can differ cross-culturally and within cultures. We particularly look forward to more discussion and work in this area.

Overall, the EA SIG is very interested in starting a dialogue about potential answers to this broad topic, so please feel free to join our email list here. We are also interested in hosting and co-hosting practical webinars on this topic, as well as presenting at conferences and writing commentary and empirical pieces.

References

Arnett, J. J. (2014). Presidential address: The emergence of Emerging Adulthood: A personal history. Emerging Adulthood, 2(3), 155-162.

Camacho-Gomez, M., & Castellvi, P. (2020). Effectiveness of family intervention for preventing relapse in first-episode psychosis until 24 months of follow-up: a systematic review with meta-analysis of randomized controlled trials. Schizophrenia Bulletin, 46(1), 98-109.

Dimitropoulos, G., Landers, A. L., Freeman, V., Novick, J., Cullen, O., & Le Grange, D. (2019). Family-based treatment for transition age youth: The role of expressed emotion and general family functioning. Eating Disorders, 27(5), 419-435.

Dippel, N., Szota, K., Cuijpers, P., Christiansen, H., & Brakemeier, E. L. (2022). Family involvement in psychotherapy for depression in children and adolescents: Systematic review and meta‐analysis. Psychology and Psychotherapy: Theory, Research and Practice, 95(3), 656-679.

Herrera, S. N., Sarac, C., Phili, A., Gorman, J., Martin, L., Lyallpuri, R., … & Corcoran, C. M. (2023). Psychoeducation for individuals at clinical high risk for psychosis: a scoping review. Schizophrenia research, 252, 148-158.

Hoffman, L. J., Guerry, J. D., & Albano, A. M. (2018). Launching anxious young adults: A specialized cognitive-behavioral intervention for transitional aged youth. Current psychiatry reports, 20, 1-8.

Kim-Cohen, J., Caspi, A., Moffitt, T. E., Harrington, H., Milne, B. J., & Poulton, R. (2003). Prior juvenile diagnoses in adults with mental disorder: developmental follow-back of a prospective-longitudinal cohort. Archives of General Psychiatry, 709–717. https://doi.org/10.1001/archpsyc.60.7.709.

Kranzler, A., Pimentel, S. S., & Zayde, A. (2019). Scaffolding and Support Beams: Clinical and Administrative Tools for Emerging Adult Programs. Evidence-Based Practice in Child and Adolescent Mental Health, 4(2), 122-140.

LeBlanc, N. J., Brown, M., & Henin, A. (2020). Anxiety disorders in EA. Clinical handbook of anxiety disorders: From theory to practice, 157-173.

Miller, K., Sukhera, J., Lynch, J., & Wardrop, N. (2017). Voices unheard: Exploring the caregiver experience for caregivers of emerging adults with mental illness. Families in Society, 98(4), 310-318. 

National Institute of Mental Health. (2021). Prevalence of Any Mental Illness. U.S. Department of Health and Human Services, National Institutes of Health. Retrieved April 30, 2024, from https://www.nimh.nih.gov/health/statistics/mental-illness

Quealy, K., & Miller, C. C. (2019, March 13). Young adulthood in America: children are grown, but parenting doesn’t stop. The New York Times. https://www.nytimes.com/2019/03/13/upshot/parenting-new-norms-grown-children-extremes.html

Swanson, J. A. (2016). Trends in literature about emerging adulthood: Review of empirical studies. Emerging Adulthood, 4(6), 391-402.

Syed, M., & Mitchell, L. L. (2013). Race, ethnicity, and emerging adulthood: Retrospect and prospects. Emerging Adulthood, 1(2), 83-95.

Wood, D. L., Sawicki, G. S., Miller, M. D., Smotherman, C., Lukens-Bull, K., Livingood, W. C., … & Kraemer, D. F. (2014). The Transition Readiness Assessment Questionnaire (TRAQ): its factor structure, reliability, and validity. Academic pediatrics, 14(4), 415-422.