A Developmental Psycho-neurobiological Approach to Assessment of Emerging Adults
Emerging adults with psychiatric problems, and their families, have many unanswered questions and missing pieces in their understanding of what is wrong and what would truly help. Their problems and concerns at this age are extremely complex and occur across many or most areas of their lives. The developmental agenda for all emerging adults is to define themselves, and their life’s greater purpose, in relation to the larger community and world. They must do this as they redefine themselves within their family as increasingly independent while still emotionally connected. There is no greater developmental challenge in all of adult life. Research shows that emergent adulthood is the single most formative time of adult life (Arnett and Tanner, 2006). The young person is making life-long decisions about everything from choice of education and career to marital partner to peer group to lifestyle and value systems.
Neurobiologists teach us that the emerging adult brain mirrors these formative changes. The brain at this time of life is the most neuro-plastic that it will ever be during adulthood. It is evolving evermore expansive and complex systems of neural networks, particularly in the higher brain centers for executive functions and behavioral and emotional self-regulatory functions (cf., Giedd, 2008). Emerging adulthood is also the time of greatest exploration and risk-taking in everything from alcohol and drugs to frequency of sexual partners to pushing the limits of their bodies and society’s rules and norms. Developmental scholars understand these processes of experimentation and risk taking to occur across species and to reflect the brain’s normal maturation and preparation for separation from the original family unit in order to launch the new adult and family within the community (Giedd, 2008). Considering all these developmental demands and complex changes occurring at once, it is no wonder that emerging adulthood is such a time of upheaval and turmoil for the emerging adult and the entire family. This is precisely why we emphasize a developmental focus, not a symptom-focus, the way most other treatment facilities do.
Not surprisingly, emerging adulthood is also the age period when prevalence of psychiatric disorders is highest, onset of serious psychiatric disorders is most common and the risk of suicide is also greatest (see Viner, Emerging Adult Psychiatric Disorder, this issue). The co-occurrence of serious psychiatric disorder and/or substance abuse, on top of the enormous challenges of this developmental stage, make it virtually inevitable that the emerging adult’s life will come to a profound halt. When we see emerging adults and their families for their initial assessment, many are utterly overwhelmed, confused, frightened and demoralized. They do not know what is really wrong or what will help. That is precisely why, at Yellowbrick, we place such an emphasis on a thorough assessment of the developmental, psychological, psychiatric, life skill, and neurobiological functioning of the emergent adult, including both strengths and weaknesses. We devote three full days, and our three most senior staff, in order to formulate a thorough and multi-layered understanding of the interplay of the young person’s functioning, dysfunction and potentials across all of these areas of their lives. We have learned that it is never simple or straightforward. We hear time and again from families how grateful they are that at last someone can explain to them how it all fits together that their brilliant son had to drop out of college and won’t leave his room or their multi-talented daughter, who seemed to have everything going for her, tried to kill herself. Yellowbrick also helps to frame the questions and the path for further discovery when issues are not yet clear.
The Emerging Adult Assessment Center utilizes a developmental, psycho-neurobiological model of understanding the young adult, just as Yellowbrick utilizes this model in the approach to treatment. Psycho-neurobiology integrates the role of brain development during this critical period for formation of self-identity, self-regulation of behavior and emotion, attachment relationships, and separation and individuation from the family, as the young person emerges into the larger community and world. The assessment process incorporates different methodologies to analyze the emerging adult’s functioning across all of these central domains, and their neural substrate, as well as the primary areas of personal, occupational, and self-care functioning necessary for adult life. Each domain of the assessment process will be described, in turn, to give you a more in-depth understanding of what we assess and why it is important.