Youth in High-Achieving Schools: Challenges to Mental Health and Directions for Evidence-Based Interventions

Abstract

In this chapter, we review evidence on a group recently identified as "at-risk", that is, youth growing up in the context of high achieving schools (HAS), predominated by well-educated, white collar professional families. Though these youngsters are thought of as "having it all", they are statistically more likely than normative samples to show serious disturbances across several domains including drug and alcohol use, as well as internalizing and externalizing problems. We review data on these problems with attention to gender-specific patterns, presenting quantitative developmental research findings along with relevant evidence across other disciplines. In considering possible reasons for elevated maladjustment, we appraise multiple pathways including aspects of family dynamics, peer norms, and pressures at schools. All of these pathways are considered within the context of broad, exosystemic mores: the pervasive emphasis, in contemporary American culture, on maximizing personal status, and how this can threaten the well-being of individuals and of communities. The chapter concludes with ideas for future interventions, with discussions on how research-based assessments of schools can best be used to reduce pressures, and to maximize positive adaptation, among youth in highly competitive, pressured school environments.

Full text

1Youth in High-Achieving Schools
Luthar, .S., & Kumar, N.L. (In press). In A. W. Leschied,, D. H. Saklofske, and G. L. Flett, Handbook of
School-Based Mental Health Promotion: An Evidence-Informed Framework. New York: Springer.
Chapter 23 Youth in High-Achieving Schools:
Challenges to Mental Health and Directions for Evidence-Based Interventions
Suniya S. Luthar a PhD [Corresponding Author: Suniya.Luthar@asu.edu]
and
Nina L. Kumar, B.A.
a Department of Psychology, Arizona State University; b IBM, Cambridge, MA
We are deeply grateful to students who have participated in this programmatic research over the
years and to the parents, teachers, and school administrators who, in their respective communities, paved
the way for in-depth assessments and intervention efforts. Our thanks as well to Gordon Flett for his very
helpful comments on a previous version. This work was supported by the National Institutes of Health
(R01DA014385; R13 MH082592) and by the Rodell Foundation.

2Youth in High-Achieving Schools
Youth in High-Achieving Schools:
Challenges to Mental Health and Directions for Evidence-Based Interventions
In this chapter, we review evidence on a group recently identified as “at-risk”, that is, youth
growing up in the context of high achieving schools (HAS), predominated by well-educated, white collar
professional families. Though these youngsters are thought of as “having it all”, they are statistically
more likely than normative samples to show serious disturbances across several domains including drug
and alcohol use, as well as internalizing and externalizing problems. We review data on these problems
with attention to gender-specific patterns, presenting quantitative developmental research findings along
with relevant evidence across other disciplines. In considering possible reasons for elevated
maladjustment, we appraise multiple pathways including aspects of family dynamics, peer norms, and
pressures at schools. All of these pathways are considered within the context of broad, exosystemic
mores: the pervasive emphasis, in contemporary American culture, on maximizing personal status, and
how this can threaten the well-being of individuals and of communities. The chapter concludes with
ideas for future interventions, with discussions on how research-based assessments of schools can best be
used to reduce pressures, and to maximize positive adaptation, among youth in highly competitive,
pressured school environments.
Defining the population
In our early studies of this population, we wrote of these youth as being “affluent” or “privileged”
(for a review, see Luthar, Barkin, & Crossman, 2013), but over time, we have moved toward a different
descriptor, that is, students from High Achieving Schools (HAS). This in fact is the common denominator
across schools sampled; since the late 1990’s, each of our 25-30 school-based assessments have been on
students from schools that have high standardized test scores, rich extracurricular and academic offerings,
and graduates heading for the most selective colleges and universities. Admittedly, such schools
generally serve white collar professional, well-educated families, but some students do come from
families of relatively low socioeconomic status (SES).
A second reason to avoid references to family affluence is because of recent evidence from large
nationally representative samples. Two studies, one in the US and one in Norway, have shown that it is
not family level of affluence, or even neighborhood affluence that connotes elevated risks to adolescents
(Coley, Sims, Dearing, & Spielvoge, 2017; Lund, Dearing & Zachrisson, 2017). Instead, risks are
associated with school level affluence, as described further below; it would appear that having a high
proportion of schoolmates from high income families that connotes high risk, rather than one’s own
family income.
Why are HAS youth “at-risk” – what is the evidence?

3Youth in High-Achieving Schools
In studies of risk and resilience, the concept of risk is defined in terms of statistical probabilities
(Luthar, Cicchetti, & Becker, 2000; Masten, 2001), wherein those exposed to a particular condition (e.g.,
parent alcoholism) are statistically more likely than others to show adjustment problems. This does not
mean that all children in that group are troubled; rather, that overall, their odds of difficulties are higher.
Thus, not all HAS students have adjustment problems, but compared to national norms, a substantially
higher proportion show serious maladjustment.
The problems that this group faces were first identified by chance through data we collected in
the mid-1990’s on youth recruited as a comparison sample for inner-city teens (Luthar & D’Avanzo,
1999). Results showed that the high socioeconomic status students were higher than their low-SES
counterparts in their reported use of cigarettes, alcohol, marijuana, and hard drugs; the lowest levels of
abstinence were found among high-SES girls. While these results were startling to our research group,
they were not at all surprising to the teachers in the affluent, suburban school. A decade later, these
findings were replicated among tenth graders in a different Northeast suburb (Luthar & Goldstein, 2008).
Several other research labs also documented high alcohol use, binge-drinking, and marijuana use in areas
with mostly well-educated, white, high-income, two-parent families (Botticello, 2009; Patrick, Wightman,
Schoeni, & Schulenberg, 2012; Reboussin, Preisser, Song, & Wolfson, 2010; Song et al. 2009).
Analyses of large, national data sets have yielded consistent findings, as noted earlier. In a study
of a US national sample, Coley, Sims, Dearing, and Spielvogel (2017) found that students attending
schools with a high proportion of affluent schoolmates were more likely than others to report intoxication
and use of illicit drugs (marijuana, cocaine, and other illegal drugs). In similar analyses of Norwegian
national data, Lund and colleagues (2017) found links between school-level affluence and drinking to
intoxication.
By all accounts, these trends worsen through college, as indicated by prospective data in the New
England Study of Suburban Youth (NESSY; Luthar, Small, & Ciciolla, 2017). This longitudinal study
entailed surveys of two cohorts assessed as high school seniors and then annually (1) throughout 4 college
years, and (2) across ages 23-27. Across gender and annual assessments, results showed substantial
elevations, relative to norms, for frequency of drunkenness and using marijuana, stimulants, and cocaine.
More importantly, relative to national norms, NESSY-O (the older cohort) women’s and men’s rates of
psychiatric diagnoses of alcohol/drug dependence were three and two times as high, respectively, and
among NESSY-Y (the younger cohort), rates were close to norms among women but were twice as high
among men (Luthar et al., 2017).
Individuals in these HAS samples also report elevated rule-breaking. Although delinquency is
generally thought to be a problem of youth in poverty, we have found that students in affluent schools had

4Youth in High-Achieving Schools
similar average scores on self-reported rule-breaking relative to youth in inner city schools. At an item
level, the former endorsed random acts of delinquency, such as stealing from parents or peers, whereas
the inner-city teens displayed behaviors potentially needed for self-defense, such as carrying a weapon.
These findings were later replicated, and results showed that neighborhood affluence was associated with
higher rates of delinquency among boys (Lund & Dearing 2012).
Early studies by our own group were conducted in public schools in the Northeast; subsequently,
there have been multiple studies of HAS students from different parts of the country, including
independent and public schools, day schools and boarding schools (findings on boarding schools are
currently being written up), and in cities and suburbs. Across all of these samples, the evidence has been
unequivocal: as a group, students in these high-achieving schools, reflected a substantially higher
incidence of serious levels of internalizing symptoms such as depression or anxiety; externalizing
problems such as rule-breaking or delinquency; and misuse of drugs and alcohol (see Luthar & Barkin,
2012; Luthar et al., 2013). The particular problem area in which elevations were seen has varied
somewhat by geography. For example, substance abuse has been seen most consistently across all
Northeast schools over the years, and serious depression / anxiety, was markedly elevated in the Pacific
Northwest schools. However, the overall conclusion was clear – as a group, teens from these high
achieving schools are, in fact, an at-risk group.
Understanding mechanisms: “Conduits” of risk, vulnerability, and protection
In resilience research, once a broad risk factor has been identified, the task is to try and
understand “why or how” risk is conferred, and to disentangle processes that might mitigate and
exacerbate this risk (commonly known as protective and vulnerability processes). Accordingly, we now
consider processes occurring in the context of affluence that might confer or exacerbate vulnerability of
youth. As Garcia Coll and colleagues argued in their seminal 1996 paper, in research on little-studied
groups, we must consider not just well-known risks that affect all children – such as alienation from
parents – but also subculture-specific ones, such as discrimination for ethnic minority youth, or
neighborhood blight among low income groups (see Garcia Coll et al., 1996; Luthar, 1999).
Pressures to excel: Multiple sources
Our work over two decades suggests that there is one superordinate or overarching construct that
is implicated in conferring vulnerability in HAS contexts, and that is high and ongoing pressures to
achieve. These pressures come from multiple sources: parents, schools, peers, and values in the larger
subculture in the US. Tacitly or otherwise, adults and students alike endorse the common belief that there
is one path to ultimate happiness – getting into a prestigious college. Young people come to believe that
this is an essential gateway to land high-status jobs in the future, and conversely, that attendance at a

5Youth in High-Achieving Schools
second or third tier college would imply poor life prospects in later life. Thus, students in HAS contexts
begin working on enhancing their “resumes” starting as early as junior high school.
Among HAS students, these pressures become particularly acute, with a sense of urgency to
achieve given a pervasive belief that exceptionally lofty goals (such as achieving admission to the very
best of universities) is actually well within reach (Luthar et al., 2013). Chronic exposure to pressure has
many untoward psychological complications and consequences. The strivings of young people are no
longer striving due to personal wishes and volition; rather, these teens now have internally controlled
forms of motivation that strip away a sense of autonomy, in ways that limit satisfaction with achievements
(see Ryan & Deci, 2017). Flett and associates (2016) have suggested that it is this tendency to be
internally controlled that provides the fuel for the urgent and relentless striving of the child or adolescent
who has developed self-oriented perfectionism. This pressure can become overwhelming when co-
existing with frequent daily stressors, setting the stage for elevated anxiety, depression, acting out
behaviors, as well as substance abuse to provide relief from distress.
The Role of Parents
As has been emphasized before in the literature, affluent parents, as a group, are neither
neglectful nor disparaging (Luthar & Latendresse, 2005; Luthar & Barkin, 2012), and as previously
noted, these youth as a group are not at risk because of their family wealth but rather, because they are in
affluent school contexts (Coley et al., 2017; Lund et al., 2017). Having said this, it bears noting that on
average, affluent youth from mostly two-parent families do not feel closer to their parents as compared to
very low-income youth, mostly from single-mother led families (Luthar & Latendresse, 2005). Across
various dimensions, sixth graders from an affluent suburb rated parent-child relationships no more
positively than did their counterparts living in harsh conditions of poverty. Thus, in the affluent
community just as in the low-income one, some children felt quite distant from their parents, suggesting
pressures faced by some families in both cases.
In HAS communities as in others, there are some critical aspects of parent-child relationships that
are strongly related to the children’s adjustment (Garcia Coll et al., 1996). In terms of discrete parenting
behaviors that are powerful, we find, as resilience research has recurrently shown (Luthar, Crossman, &
Small, 2015), that ‘bad is stronger than good’, wherein harsh, disparaging words can have much stronger
effects than words of affection or praise (Baumeister, Bratslavsky, Findenauer, & Vohs, 2001). Our
research has shown that as compared to feelings of trust or good communication with parents, perceived
parent criticism shows stronger links with diverse adjustment indices (Luthar & Barkin, 2012).
Besides this, generally we have seen stronger associations, with teens’ adjustment outcomes, for

6Youth in High-Achieving Schools
quality of relationships with mothers as opposed to fathers (Luthar et al., 2013; Ebbert, Infurna, & Luthar,
2018). This makes sense intuitively. Given that pre-teens and teens, like younger children, generally
have more frequent interactions and more intimate relationships with their mothers than their fathers
(Collins & Russell, 1991), it follows that relationships with mothers should have greater ramifications. In
multivariate analyses of overall attachment -- high trust, good communication, and low alienation -- felt
attachment to mothers explained much more variance across various teen adjustment dimensions as
compared to felt attachment to fathers (Luthar & Barkin, 2012; Luthar & Becker, 2002).
Parenting processes especially salient in the HAS subculture
A major “culturally specific” protective factor or vulnerability that we have discovered is the
notion of parent’s containment for substance use, or students’ perceptions of the seriousness of
repercussions if parents discovered different errant behaviors. Early in our research, several HAS
community members indicated that the signs of high substance use we were seeing were related, in part,
to some parents’ overall laissez faire attitudes towards alcohol use, or the belief that “all kids do this”. To
test this possibility, we created a questionnaire that asked teens, “How serious would the repercussions
from your parents be if they found out that they did the following behaviors?”. Errant behaviors included
substance abuse, delinquency, rudeness to adults, and academic indolence. Results in fact showed that
anticipated repercussions were the lowest for substance abuse across these behaviors (Luthar & Barkin,
2012; Luthar & Goldstein, 2008). Additionally, low levels of perceived containment were related to high
levels of self-reported substance use, consistently across samples studied.
A second culture-specific dimension of parenting that we have measured is perceived parental
over-emphasis on achievement. In this measure, students were told of six values that parents tend to have
for their children, and were asked to rank order the top three that they felt their parents would want for
them. Three of these had to do with achievements, such as getting excellent grades and three had to do
with personal decency, such as being kind and helping others in need. In an early study (Luthar &
Becker, 2002), we found that students who felt their parents disproportionately prioritized the
achievement dimensions were at significantly greater risk than others for various adjustment difficulties.
In more recent work, we asked the same questions on parent values, but separately for mothers and for
fathers (Ciciolla, Curlee, Karageorge, & Luthar, 2017). Findings showed that the highest levels of
adjustment problems among children were those who felt that both their parents were high on
achievement emphasis. By contrast, the lowest levels of adjustment problems, or the healthiest profiles,
were seen among those who reported that both parents had middle to low emphasis on achievements
relative to integrity, kindness, or decency.
It is critical to note that pressures to achieve come not just from parents but as much, if not more

7Youth in High-Achieving Schools
so, from outside the family. Coaches and performing arts teachers, for example, can be highly invested in
the performer’s star status, setting exacting schedules for practice and rehearsals and single-minded
pursuit of distinction at the county and state levels. Furthermore, as we discuss in more detail below,
significant pressures can also derive from the peer group in HAS communities, via their admiration of
dubious behaviors as well as the ongoing competition to keep up with, if not surpass, highly
accomplished peers.
Another potential culture-specific dimension, as suggested by other researchers, is the tendency
of some upper middle class parents to problem-solve excessively for their children, rather than allowing
them acquire and practice everyday life and coping skills (Marano, 2008; Mogel, 2010; Twenge, 2006).
Affluent high school seniors anticipating departing for college reportedly often indicate high levels of
fear, anxiety and uncertainty (Marano, 2008). Worries were less about the academic challenges in college
than about how they would handle the logistics of everyday living, ranging from dealing with a difficult
roommate, trouble with courses, food not to their liking, or a malfunctioning laundry machine (Hofer &
Moore, 2010). Inhibiting the adolescent’s developing autonomy is a parenting dimension that clearly
warrants more systematic attention in quantitative hypotheses testing, in future research on HAS youth.
The Role of Peers
While parents have an important role in culturally specific protective and vulnerability processes,
peers also play a vital role. To begin with, HAS teens constantly rank themselves against each other in
extracurriculars as in academics, with each distinction coveted by all those who are eligible (Chase,
2008). As would be expected, envy is an unfortunate by-product of constant competition to be “the best,”
(Marano, 2008). In comparisons of students from an elite, upper-middle class school versus high
achievers in an inner-city magnet school, we found that the former (especially girls) felt significantly
more envious of peers whom they felt surpassed them across the realms of popularity, attractiveness,
academics and sports (Lyman & Luthar, 2014). More seriously, findings of this study, as well as those
from another study of boys in independent schools (Coren & Luthar, 2014), point to the negative
ramifications of being highly envious. Envy of others, especially with regard to physical appearance, was
clearly linked with several indices of maladjustment, a finding that takes on added importance given the
exceptionally high levels of maladjustment that we have recurrently detected across multiple HAS
samples. These associations between envy and psychological difficulties are likely a reflection, at least in
part, of the propensity to feel “less than” others, as envy derives from unfavorable social comparisons
with others who are (or seem to be) superior to oneself. In HAS contexts, therefore, there is a need for
teens to develop abilities to self-regulate emotions that stem from social comparisons; at the same time,
these results underscore the benefits of limiting the frequency of social comparisons in the first place.

8Youth in High-Achieving Schools
Aside from envy, peers can contribute in the active endorsement or encouragement of some
unhealthy behaviors, notably substance use. Alcohol and drugs play a large role at social gatherings in
HAS. Inebriation is not just standard, but it is often socially desirable, and commonly associated with the
credo, “we work hard, and we play hard” (e.g., Mason & Spoth, 2011). Logistically, it is easy for youth in
HAS to host parties where drugs and alcohol are freely available, as many have the means to purchase
them (Hanson & Chen, 2007).
Our research has shown that among suburban boys, high self-reported substance use has been
significantly linked with high “liked most” nominations by their classmates. These links have recurred in
middle and high school samples and are statistically significant despite controls for possible confounds
(Becker & Luthar, 2007; Luthar & D’Avanzo, 1999). Similar links are seen among girls, but in their case,
substance use is also linked with frequent “liked least” peer nominations, indicating gender-based double
standards in peers’ perceptions of substance use (see also Chase, 2008). Students in HAS also apply a set
of double standards to boys and girls around “hooking up” with different sexual partners; while for boys,
it engenders peer admiration and respect, for girls, it is instead accompanied by disdain (Chase, 2008;
Khan, 2011).
With regard to links particularly pronounced among girls, we have found two other sets of
troubling associations with high peer status, that is, with relational aggression, and physical attractiveness.
Consistent with suggestions that “mean girls” tend to be socially dominant (LaFontana & Cillessen, 2002;
Simmons, 2002), our research has shown that HAS girls who were rated by peers as aggressive towards
others were also rated as highly admired by them (Becker & Luthar, 2007), perpetuating the social
dominance of relationally aggressive girls. Similarly, links between peer-rated attractiveness and peer
admiration were substantially stronger among HAS girls as compared to their male counterparts, and as
compared to inner-city girls and boys, illuminating a major potential reason for why these young women
can become excessively preoccupied with their physical attractiveness.
As Simmons has effectively described in her 2018 book, and we have documented in our research
(Luthar & Goldstein, 2008; Luthar et al., 2013) girls also face high, and often competing, demands from
adults. They are expected to succeed every bit as much as boys in domains that are traditionally male
such as academics and sports, and also in the ‘feminine’ domains of caring and kindness. Simmons
cautions that we are raising a generation of young women who are far too focused on achieving and being
“exceptional”. These girls are prone to presenting an exterior image of self-perfection, particularly on
social media. In everyday life, they tend to shy away from taking chances on critical daily living tasks,
including investment in relationships that are critical for bringing them comfort, support, and affirmation
of their true selves. The result is an underlying sense of anxiety, self-criticism, and conviction that no

9Youth in High-Achieving Schools
matter how hard they try, they will never be successful enough, attractive enough, popular enough, or
admired enough.
There is growing evidence of young people acting as if they are effortlessly perfect (see Flett,
Nepon, Hewitt, Molnar, & Zhao, 2016; Travers, Randall, Bryant, Conley, & Bohnert, 2015), and this
focus on seemingly ‘perfect’ is counterproductive in many ways. Tendencies to project success without
expending effort is potentially destructive both for the self-presenting adolescents, and for their peers.
Some of the difficulties associated with this orientation reflect a tendency to strive for extrinsic, status-
oriented life goals, such as being famous, attractive, and wealthy. Lyman and Luthar (2014) found that an
unwillingness to display or admit to imperfections was associated with having high levels of externally
oriented motives, and with disparities in the pursuit of extrinsic versus intrinsic goals that reflect
investment in close relationships and in promoting the welfare of others. Additionally, recent analyses
suggest that the self-presentation as effortlessly perfect comes with a great potential for hidden distress, as
students hide behind a mask or a front and do not seek the help that they need (see Flett, Hewitt, Nepon,
& Zaki-Azat, this volume). At the same time, projecting an image of being effortlessly perfect represents
an unattainable upward comparison standard. Flett et al. (this volume) describe the high destructiveness
of social comparison when vulnerable adolescents become highly preoccupied with their standing in life
relative to the apparent standing of youth who portray what seems like the ideal life.
More research is needed on areas in which HAS boys could be particularly at risk by virtue of
what it takes to achieve high peer status. During the high school years, their high peer status is linked not
only with good looks, athletic prowess, but also the “cool” factor of frequent substance use noted earlier,
and also being desired as sexual partners by many girls (Becker & Luthar, 2007; Chase, 2008; Khan,
2011). Potential fallouts include low capacity for true intimacy with others (as opposed to frequent
hookups) as well as overly high investment in power and status, or “being a baller” (Luthar et al., 2013).
Working with HAS students, Chase (2008, p. 55) reports that teens agree that in relating to the opposite
sex, girls usually want relationships, but boys generally want sex: “One boy says he will tell a girl, ‘I’ll
still care about you. Nothing will change.’ These are the bullshit lines we use. And they work!” In a
study of boys from two academically elite, independent high schools, one for boys only and the other
coeducational, both samples showed elevations, relative to norms, on exhibitionistic narcissism, as
exemplified by items such as, “I like it when others brag about good things I’ve done” (Coren & Luthar,
2014).
Cohort Differences: Why High SES Might Connote More Risk for Today’s Youth
Students from HAS are more at risk than past generations, in part because of globalization and
the growth of technology. These youngsters, as a group, tend to view their parents as “being well-off

10 Youth in High-Achieving Schools
financially”, and they use their parents’ income and educational levels as standards that they themselves
must attain in the future. However, in today’s competitive, globalized economy, it has become much more
difficult for these youngsters to attain the standards of living that their parents were able to achieve
(Steuerle, McKernan, Ratcliffe & Zhang, 2013).
Additionally, rising rates of stress and anxiety among this group may be linked with technology.
From a young age, sometimes even extending from before birth, this generation have their lives on
display, as parents document their children’s successes on social media. Now, more than ever, children
can easily compare their successes to peers by simply glancing at their cell phones (Simmons, 2018).
Added stress comes from the widespread use of formal college preparation programs such as,
“Naviance”, a subscription service that permits students to input data on their grades, awards,
extracurricular activities, volunteer work and more, to get a sense of the type of college they might get
into (Pappano, 2015). Originally designed for high schools, this program is now reportedly used in over
1,700 middle schools in the U.S., representing nearly 1.1 million youth.
Parents in HAS communities track their children’s prospects via such programs, but technology
now also allows their vigilance of children’s school lives well before high school, and on a much more
frequent basis. Many schools post students’ progress through the semester rather than once per semester,
so that parents could theoretically discuss each suboptimal comment or test grade. Additionally, whereas
just a decade ago, a child caught cutting class might result in a call home, parents can now track their
child’s every move using GPS technology on cellphones and in cars. These increased levels of
surveillance add additional stress to children’s lives.
Increases in technology have also impacted the way that students from HAS view themselves and
interact with one another. New technology has enabled students to interact with each other on a constant
basis, but without forming personal, intimate relationships. As students are now more able to text and
communicate over social media, they are more easily connecting with friends online, but are
disconnecting with friends in real life (Akhtar, 2011; Simmons, 2018).
Relatedly, what used to be leisure activities are no longer done simply for fun. Children in HAS
contexts rarely play impromptu games of kickball or basketball in cul-de-sacs; as early as the second
grade, they are playing in “recreational” games, where they are already competing to secure spots in
travel teams. Poor performances at a given game are watched (and commented on, if covertly) by not
only peers but by a large group of community parents. Reviewing the many benefits of play for
psychological and cognitive development – including beneficial neural effects in the brain’s frontal lobe
(see Panskepp & Biven, 2012) – Marano (2008, p. 29) cautions that, “What play there is has been
corrupted…Kids’ play is professionalized; team sports are fixed on building skills and on winning and

11 Youth in High-Achieving Schools
losing, not on having a good time.”
Future Directions: Interventions
In discussing intervention needs and directions, we emphasize first that suggestions we offer
generally involve the use of existing community resources. In US schools broadly speaking, the scant
resource dollars available for children’s mental health services should be reserved for those serving low-
income communities. Within HAS settings specifically, what is needed is heightened awareness of risks
within their communities, and based on research, guidance in the best use of existing resources toward
positive youth development (Doherty, 2000; Luthar, 2003; Weissbourd, 2009). In discussions that follow,
we present possibilities for such interventions.
Research-based interventions: Central considerations
Our approach to intervention is based in long-standing guidelines from research on resilience
(Luthar & Cicchetti, 2000; Luthar & Eisenberg, 2017). Core considerations are that once a particular
group is identified as being “at risk”, what is then needed is a research-based understanding of (a) the
specific types and degree of adjustment difficulties they manifest as a group (b) the major pathways to
these, with an emphasis on subculture-specific influences, (c) careful consideration of the perspectives of
major stakeholders; and (d) the use of research-based findings to guide intervention priorities and
procedures.
Measurement of HAS students’ adjustment
With regard to the first of these issues, since the turn of the century and especially the publication
of the popular press book, “The Price of Privilege” (Levine 2006), there has been a surge of interest in
assessing students in HAS communities across the country. Typically, surveys of students involve self-
report instruments such as the YBSSR (Youth Risk Behavior Surveillance System;
https://www.cdc.gov/healthyyouth/data/yrbs/questionnaires.htm), and the approach is to compare average
scores of students on each of these dimensions, with mean scores of students in similar schools.
Such comparisons of mean scores are useful but they miss an important dimension, that is, the
proportion of students who have symptom scores – in particular domains --in the clinically significant
range, and thus cause for serious concern. We illustrate the importance of this with an example. In a
given school, the average score for students’ symptoms of anxiety may be 50. Theoretically, this average
score might derive from the fact that most students are around the “normal” level with scores of 40 as at
the low end and 60 at the high. Alternatively, an average of 50 could derive from several students scoring
at the extremes of 20-35 on the low end, and 65-80 on the high end. Using just mean scores does not

12 Youth in High-Achieving Schools
illuminate the proportion of students who need clinical attention. Thus, in our own work, we have relied
on the Youth Self-Report (YSR; Achenbach, Rescorla, & Mariuish, 2004) instead. This instrument allows
us to report that whereas 7% of students nationwide have serious anxious-depressed symptoms, rates in
School X, on anxious-depressed or somatic symptoms (e.g., headaches and stomachaches not related to a
physical health problem), are 20%, or three times as many as those in norms. Stated differently, one in
five students in this school have symptoms high enough that parents and school administrators should
treat these issues as cause for concern.
With regard to the YBSSR in particular, there are at least two concerns about using this
instrument as the sole measure of adjustment of students in HAS contexts. The first is that several items
are largely irrelevant for them (such as six items concerning guns, physical fights, and safety in schools).
Externalizing behaviors in HAS contexts are generally not those involving overt aggression, but are those
involving covert rule breaking including stealing, and cheating (Luthar & Ansary, 2005).
Second, there is scant attention in the YBSSR to the problems that do tend to be serious in HAS
contexts: Internalizing problems such as anxiety, depression, and somatization. There is a single question
on depression (aside from those related to suicide) “During the past 12 months, did you ever feel so sad or
hopeless almost every day for two weeks or more in a row that you stopped doing some usual activities?”
and there are no questions on anxiety, which arguably, is among the most serious, widely talked about
problem in HAS contexts (see, for example, Denizet-Lewis, 2017; Merikangas et al., 2010; Rosin, 2015).
The absence of items that assess social anxiety is also a troubling omission, given the importance of
attaining and demonstrating social status and the mounting evidence of both the high prevalence, and the
considerable consequences of, social anxiety among young people (see Knappe, Sasagawa, & Creswell,
2015).
Third, missing in the YBSSR are the real threats to adjustment in this particular context, such as
feelings of perfectionism, competition, and achievement pressures. This goes against what we learned
years ago when research on poverty began to proliferate in developmental science (e.g., Huston,
McCloyd, & Garcia Coll, 1984): it is a mistake to use a “one size fits all” in measuring environmental risk
and protective influences for groups outside of mainstream America.
On the topic of pathways, in our own applied work with HAS communities, we have made
concerted efforts to capture not only “modifiable” dimensions commonly assessed by developmental
psychologists for teens in general – parental warmth and discipline – but also those that are especially
potent in the particular subculture. Examples of these were provided earlier – containment of substance
use and parents’ perceived overemphasis on achievements as opposed to integrity. Similarly, with peers,
it is has not been enough just to examine victimization and support, but also constructs that are especially

13 Youth in High-Achieving Schools
prominent in these settings, such as envy of peers and competition among them (and associated effects on
well-being). It is powerful when parent and faculty groups see a Power Point slide clearly showing that
envy of friends is significantly higher across domains among affluent youth than their inner-city
counterparts.
To our knowledge, there are two groups that have burgeoned in conducting assessments of HAS
in particular, and one is the Challenge Success group based in California
(http://www.challengesuccess.org/about/). This group is founded and led by educators and clinicians,
who have written widely read books for the lay public including Levine (2006) and Pope (2001). This
consulting group provides a survey that measures “middle and high school students’ perspectives on
homework, extracurricular activities, sleep, physical health, stress, parent expectations, academic
engagement, academic integrity, and teacher support”. With dozens of schools assessed thus far,
ostensibly, schools are given reports on mean students’ scores on each of these dimensions, with reports
across schools.
What would be invaluable from Challenge Success would be more research evidence to back up
their methods. To our knowledge, there are no peer-reviewed quantitative studies in developmental,
school, or educational psychology journals providing reliability and validity of measures, and stringent
statistical analyses testing postulated links between risk/ protective factors and outcomes particularly
problematic in HAS contexts. With regard to the latter, from the website description, it is not clear how
this group captures different types of internalizing or externalizing symptoms. The same concern applies
to interventions offered; it is not clear if there have been any randomized trials, or even pre- and post-
intervention comparisons of students’ adjustment or feelings about school climate. Per their site, this
group offers leadership seminars for administrators and leaders: “Through interactive presentations,
workshops, and dialogue with peers, you will learn new strategies to improve student well-being and
promote academic engagement in your school community” but there is no accompanying evidence
supporting prior use of these strategies (see http://www.challengesuccess.org/schools/school-
program/new-school-information/).
A second group that uses similar approaches is the Independent School Health Check, by a group
based in Connecticut. Again, this group offers a 45 minute survey covering the following topics:
“Academic achievement and motivation; Attitudes about school, teachers, parents; Parental oversight and
support; Academic pressure; Academic honesty; Use of out-of-school time; Internet use and misuse;
Alcohol and substance use; Social life; Nutrition; Sleep; Sexual activity; Bullying; Fitness; Ethnicity;
Gender Identity; Sexual Orientation; Help Seeking Behaviors; And many other topics relevant to
independent schools” (https://independentschoolhealth.com/about/). With so many domains assessed in

14 Youth in High-Achieving Schools
45 minutes, it is likely that several of them are measured by one or two items, which clearly limits
reliability of measurement (as compared to multiple item scales that generally higher reliability and thus
validity). Although there is a page on “Research”, once again, it is not clear if the measures, methods
used, and analyses are those that would pass the scrutiny of peer review in scientific publications.
The critical importance of attention to these issues is evident from prior attempts in psychology
and education to intervene with children at risk where approaches have not been scientifically tested. At
best, such interventions can lead to the use of resources with students’ high distress continuing unabated;
at worst, this distress can be exacerbated. A good example of this is therapeutic programs involving
groups of disruptive adolescents, where the teens can end up reinforcing poor behavior in each other
through negative “peer contagion” (Dishion & Tipsford, 2011; see also Yaeger, Dahl, & Dweck, 2018).
As noted earlier, for the aforementioned consultant groups committed to working with HAS
communities, it would be extremely helpful to provide science-based data, and a useful model for this lies
in a different group that more generally targets social-emotional learning, the Collaborative for Academic,
Social, and Emotional Learning (CASEL; https://casel.org/2017-meta-analysis/). This is a group where
assessments as well as interventions in the schools are grounded in decades of rigorous science in peer-
reviewed journals. Unfortunately, it is unlikely that CASEL’s highly effective initiatives have reached
adolescents particularly in HAS contexts. As indicated in a recent meta-analysis, most successful social-
emotional programs have been with younger students; Domitrovich et al. (2017) have underscored that
we need more research-based programs in schools that are developed and tested at the high school level.
In addition, there are some unique social-emotional skills that would likely need attention in HAS
context. To illustrate, under the category of “self-awareness”, there would be special need for students’
awareness of tendencies toward perfectionism, high anxiety, and even envy (see Flett et al., this volume).
Among “relationship skills”, there could be value in promoting an understanding the negative
implications of unhealthy competition among peers, or excessive reliance on social media or hooking up
as a means to connect with others.
Two other intervention approaches that have gained popularity in recent years have been to foster
growth mindsets and grit. Each of these is very helpful in many respects, but there is scant evidence on
the benefits of applying interventions based specifically on these approaches in HAS contexts. With
growth-mindsets for example, Yeager et al. (2018) reported that interventions using “wise feedback” to
students, wherein teachers indicated respect for their competence and capacity to improve, have had
significant benefits for African American 7th graders but small and nonsignificant effects for White
students.

15 Youth in High-Achieving Schools
Similarly, in a recent meta-analysis of 88 independent samples, Credé, Tynan and Harms (2017)
indicated that grit was only moderately correlated with performance and retention. “In aggregate our
results suggest that interventions designed to enhance grit may only have weak effects on performance
and success, that the construct validity of grit is in question, and that the primary utility of the grit
construct may lie in the perseverance facet” (Credé, Tynan, & Harms, 2017; p. 492)
More seriously, efforts to promote grit could have inadvertent negative fallout in HAS contexts
(as did previously noted well-intentioned programs that elicited negative peer contagion). This has been
effectively described by Rachel Simmons (2018) in her book, Enough as she is: how to help girls move
beyond impossible standards of success and live healthy, happy and fulfilling lives. “For too many girls
today, the drive to achieve is fueled by brutal self-criticism and anxiety that they will fail. We are raising a
generation of girls who may look exceptional on paper, but are often anxious and overwhelmed in life....
No matter how many achievements they accrue, they feel that they are not enough as they are.”
Qualitative accounts support suggestions that the significant stress of adolescent girls reflect pervasive
performance pressures, narrow definitions of success, and discrepancies in personal versus parental
expectations (Spencer, Walsh, Liang, Mousseau, & Lund, 2018).
Undoubtedly, many of the same concerns apply to boys in HAS contexts; thus, the major concern
in these schools is that for most students, it is not a lack of motivation and perseverance that is the big
problem. Instead, it is unhealthy perfectionism, and difficulty quitting when they should quit, when the
high octane drive for achievements is over the top (see also https://www.greatschools.org/gk/articles/can-
you-have-too-much-grit/.) Among highly ambitious, achieving youth, each new accomplishment tends to
set the stage for pursuing another. Skilled athletes tend to enlist in competitive teams year-round – soccer
followed by basketball and then lacrosse -- as the talented musician plays not just for the jazz band but
also for orchestra and the pep band (with all the required practices and rehearsals). Academically, these
students take every Advanced Placement course they possibly can, even when they are ill-equipped to
handle the stringent curricula (Tierney, 2012). The exhaustion and depletion that can accrue are
poignantly described in journalists’ essays profiling the lives of individual children (Denizet-Lewis, 2017;
Rosin, 2015).
The description of the pressures facing these youth is very much in keeping with the concept of
socially prescribed perfectionism that was introduced in the seminal work of Hewitt and Flett (1991).
This highly destructive type of perfectionism is based on the perception that others expect perfection, and
it only results in expectations being escalated higher and higher. Given the unrelenting nature of this
pressure, Flett and Hewitt (2014) have advocated for a focus on multi-faceted school-based programs
focused on the prevention of perfectionism and the maladaptive reactions that typically emerge when

16 Youth in High-Achieving Schools
perfection is not attained.
In a related vein, it is critical that we ensure greater care in the use of words such as “character”;
outside of academia and science, it appears that character is often conflated with grit. In a recent
commentary on the topic, Anderson (2016) indicated that “the debate is no longer about whether character
matters, but which traits—grit, open mindedness, optimism—matter the most and how to effectively teach
those.” In future research and interventions with HAS groups, we would do well to think in more fine-
grained ways about dimensions of character that most urgently warrant attention in HAS settings. While
considering positive, non-academic aspects of students’ development that warrant attention, arguably, it
behooves us to focus on constructs such as altruism, prosocial behavior, integrity, and compassion
(Luthar, 2017): Knowing as we do that HAS teens are at high risk for rule-breaking and cheating, it is
important to ascertain not just what promotes high striving but also rule-abiding behaviors, and going step
further, to illuminate what promotes strong principles, integrity, and doing for the greater good.
Applied developmental science: Collaborative, quantitative research to inform interventions
Our own programmatic work with HAS groups has involved a limited number of schools at a
given time, as it entails time- and labor-intensive collaborations with major stakeholders. This
collaboration starts at the point of planning assessment. Typically, interested schools review our standard
battery of measures, all with documented good psychometric properties. Invariably, individual schools
request some changes, and we work with school administrators and parent representatives to ensure that
we capture issues that they are particularly concerned about. As examples, one school recently assessed
requested measurement of the use of pornography among students and its ramifications, as another school
asked for specific questions on the use of “Juull” – a particular type of e-cigarette rampant in their
community.
Second, when results of school-based surveys are collated, the first author personally presents the
results to parents and faculty, bringing them together in collaborative efforts to address the areas of
identified need. In any community that has faced high incidence of student self-harm or addiction (low or
high income), it is natural that adults are anxious, which sometimes manifests in tendencies of parents and
school personnel to feel that the other party should do more to prevent these problems. In our own
presentations to schools, the data are presented not just in terms of the backdrop of programmatic research
on resilience, but also include personal insights from an educator and mother who has first-hand
experience of raising children in a HAS community. As in work with children in poverty, it is important
if scientists from outside the community can convey, with some empathy, that they are not the only town
or school facing these problems (that hyper-competitiveness is endemic to high achieving schools across
the country), nor are the “parents to blame” (or the schools). This mutual give and take is critical to get

17 Youth in High-Achieving Schools
the buy-in of diverse stakeholders, and to maximize the enthusiasm with which they come together with
support to address salient intervention initiatives.
Third, we go beyond offering simple descriptive findings in reports to pursue in-depth analyses of
data. Resilience researchers have long been criticized for producing lists of risk and protective factors
ranging from personal attributes to aspects of brain functioning, as these are not helpful for community
stakeholders looking for specific directions of how best to change (Luthar & Eisenberg, 2017). What they
request is guidance on the top two or three initiatives they should most, and this means identifying in
multivariate analyses which particular variables are the most strongly linked with outcomes, having
considered others that are conceptually related. Again, consider an example: parents’ containment of
substance use is correlated with students’ self-reported substance use at say .30. At the same time, more
conventional measures of monitoring and discipline are each also related to substance use at .30.
Multivariate regression analyses allow us to ascertain that containment is most strongly related to
substance use even after considering general monitoring and supervision. The message for parents and
schools is important, that is, in order to minimize your child’s substance abuse in a context where it is
rampant, it is not enough just to keep track of your adolescent’s whereabouts or to know who her friends
are. It is specifically important that children believe that the repercussions from you, the parent, will be
non-trivial if they discover that use of drugs and alcohol.
Parenthetically, this type of perceived parental engagement also conveys to children and
adolescents that they matter to their mothers and fathers. In large samples of adolescents, Rosenberg and
McCullough (1981) documented that mattering to parents is associated uniquely with reduced depression
and anxiety, and fewer antisocial tendencies, and these associations were found after taking related
individual differences in self-esteem into account. Research on mattering is not extensive but continues
to show consistently that young people are less at risk when they have a clear sense that they matter to
parents (see Flett, this volume).
There are several other examples of how such multivariate analyses have pinpointed what is
particularly important. These analyses have shown, for example, that more than the number of hours in
extracurricular activities, it is the relationship with parents that is important for children’s adjustment;
more than low affection, high perceived criticism from parents has strong effects; even after considering
aspects of parent-child attachment, perceived emphasis on achievements is significantly related to
children’s distress. Such prioritizing of ‘what’s the most important’ can be invaluable for parents who
themselves are bewildered by messages that 18 of 25 “risk and protective factors” are correlated with
children’s adjustment, giving them some sense of exactly where and what they should start to address.

18 Youth in High-Achieving Schools
A fourth characteristic of our collaborative approach is working with the schools as a system. In
a recent study, we established that HAS students’ feelings of emotional engagement with the school were
significantly linked with students’ adjustment even after considering multiple aspects of their
relationships with mothers and with fathers (Zillmer, Phillipson, & Luthar, 2018). These findings led us
to ask, what is it about a school that helps children to feel emotionally engaged with it? Collaboratively
working with school personnel, we are now examining diverse aspects of school climate, testing the
relative strength of their links with children’s outcomes. Over a dozen indices are being examined,
ranging from the number of Advanced Placement, college level courses and hours of sleep, to the school’s
perceived tolerance of bullying and respect for diversity. What is particularly appealing about this
approach, from a school’s perspective, is not just that these are dimensions shown statistically to be
important, but critically, they are dimensions readily changeable by administrators and faculty. For
instance, the benefits of exposure to caring adults are well-documented (e.g., Luthar et al., 2015; Werner
& Smith, 1982) and this can take the form of being able to interact caring teachers and other staff
members, who instill a strong sense of mattering at school in children as well as adolescents. To reiterate,
students’ having a clear feeling of mattering is an essential element of the psychologically healthy school
(see Flett, this volume).
In addition to documenting links of these various dimensions with adjustment outcomes, we also
now provide, for individual schools, information on where their own students stand on those dimensions
that appear to be the most influential. Examples are shown in Figure 1. In this particular school, there
were four dimensions of school climate that were most consistently linked with well-being of both boys
and girls: feeling like there (a) were adults at school who cared about them, (b) was low tolerance for
bullying, (c) was fairness in enforcing rules (and low favoritism), and (d) were few adults who were
critical of them or from whom they felt alienated. As shown in Figure 1, this particular school fared very
well on three of these four indices; most students had a mean score of between 3 and 5 (neutral to
extremely positive) on the scales involved. On the scale involving criticism and alienation, however, it
was of concern that as many as 20-25% of students fell in the mean range of 3-5. These results led to
focus groups between trusted adults at the school and students, to try and understand how best to
minimize such feelings of alienation.

19 Youth in High-Achieving Schools
Figure 1. Sample slide from a presentation to School X showing distribution of students’ ratings on four
critical aspects of school climate, indicating one that needed to be addressed.
Although we have not yet performed statistical comparisons of school climate or students’
adjustment before and after presentation of our survey findings to stakeholders, preliminary descriptive
data provide room for cautious optimism. In Figure 2, for example, we show the proportion of youth
falling above clinical cutoffs for scores on the Youth Self-Report in one school assessed during 2016
(second column), along with rates in other similar schools and in national norms (7%). These findings
were part of the overall presentations that the first author delivered to faculty as well as parent groups.
Following both sets of presentations, Luthar met with senior administrators, advisors, and students, and
all collaboratively pinpointed specific aspects of school climate that most urgently warranted change. The
following year -- as administrators reported that many of these changes had been put in place -- we were
invited back to re-assess the same school, and as shown in Figure 2, 2017 rates of clinically significant
problems in the school (shown in the first set of columns) were uniformly lower.

20 Youth in High-Achieving Schools
Figure 2. Rates of clinically significant symptoms in one school (BR) in two consecutive years, and
comparative rates with similar schools and national norms.
Another important direction, also consistent with central guidelines from resilience research, is
that we are focusing on tending the adults who are responsible for taking care of these highly stressed
children. In a Special Section of the journal Child Development spanning 11 sets of authors studying
different types of adversities, the single strongest common message, in terms of what should be top
priorities in interventions, was to ensure the well-being of adults in significant caregiving roles (Luthar &
Eisenberg, 2017). Thus, in our own research, we have tested a three month support-based intervention,
called Authentic Connections Groups, with white collar professional mothers who served significant
additional caregiving roles in their professional lives, i.e., health care providers (physicians, nurse
practitioners, and physicians assistants) at the Mayo Clinic in Arizona. Results showed significant
improvements across multiple aspects of psychological functioning as well as cortisol, with effect sizes in
the moderate range, and gains still stronger three months after the intervention (Luthar, Curlee, et al.,
2017).
In addition to working with mothers in HAS communities, the next logical group for us to work
with was K-12 teachers, counselors and administrators. These adults, like physicians, are at very high
risk for burnout; thus, we recently brought the groups to an elite boarding school in the Northeast. The
first round of groups were, again, very successful; as in the Mayo health-care providers’ groups, average

21 Youth in High-Achieving Schools
ratings on the question, “Would you recommend these groups to others like you?” received a rating of 9.8
of 10, and not a single participants elected to drop out of the program prior to completion. Aside from the
quantitative data, qualitative data highlight the critical need for such support for these overextended “first-
responders” to the distress of many (see
http://www.authenticconnectionsgroups.org/pages/testimonials.html). At the time of writing this chapter, a
second round of groups is scheduled to start at the same school.
Closing comments: Why Enhanced Attention to HAS Youth?
In closing our discussions on future directions, we address the question of why researchers,
educators, or policy makers should devote attention to the problems of youth in HAS contexts -- who
after all are mostly from well-educated, white collar professional families, and thus ostensibly have
access to mental health care. To put it plainly first and in self-referential terms, we reiterate that these are
our children about whom we are speaking. Second and more importantly, it is unconscionable for us to
deliberately disregard any group of children that is known to be statistically at-risk, notwithstanding all
the resources to which they are assumed to have easy access. Given the evidence that has been
accumulated over two decades and the seriousness of problems reported, it is incumbent to understand
what makes for this risk, to whom it generalizes and who is relatively untouched, and what tends to both
exacerbate and alleviate this risk. Third, we must not lose sight of the fact that those HAS youth who are
able to achieve positive states of development may be in a position to make important societal
contributions dedicated to the well-being of others. Aside from previously described interventions via
parents, peers, and schools, positive youth development experiences (e.g., mentoring) can provide youth a
sense of purpose, focused on promoting the welfare and well-being of others and making contributions to
society (see Liang et al., in press).
Finally, from a practical standpoint it is clear that these youth will disproportionately hold
positions of power in the next generation, and their trajectories of adjustment and value systems will
shape future norms and mores in education, politics, and business (Luthar et al., 2013; Luthar, 2017).
Early trajectories of “gaming the system” can pave the way to serious white-collar crimes. Unhappiness
and loneliness, as well as high envy of others, can accentuate personal acquisitiveness as opposed to
philanthropy and doing for the greater good. At an individual level, serious depressive episodes during
adolescence connote elevated risk for recurrent episodes later in life. Prolonged feelings of stress can
affect not just psychological well-being but also physical health and, naturally, productivity at work
(Monroe, 2008). Frequent substance use starting in middle school is linked with high risk for addiction in
adulthood. For all of these reasons, we would do well to take very seriously the costs, short-term and
long-term, for individuals and for society, of the rampant “I can, therefore I must” way of life that

22 Youth in High-Achieving Schools
pervades the milieu of HAS communities across the country.

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