1 Why Are Our Kids "At Risk"? Life Inside the Pressure Cooker Amanda should have felt elated: She was a varsity athlete, the president of the debate club, and about to graduate from her competitive high school with top grades. She had just received an early acceptance letter to her college of choice, an elite university with an admissions rate of a mere 10 percent. It had taken six full years of sacrifice and singular focus to finally reach this moment. Now she could do anything. She''d made it. But instead of overwhelming pride, what she remembers is shock and anxiety. The Saturday after receiving her college acceptance, she brought a bottle of Smirnoff vodka to a friend''s house and partied all night-not to celebrate, but to numb a quiet desperation she couldn''t quite name. Amanda grew up on the West Coast in a small, relatively affluent town reminiscent of so many of the communities around the country I visited while researching this book: a beautiful downtown kept up by high taxes, parents who work long hours in white-collar professions, kids who work just as hard on their homework and devote their weekends to traveling club sports.

As a child, Amanda loved school. She was "great at being a student," she told me, and she enjoyed learning-until seventh grade arrived. "Then people started telling me that I had to do this activity or take that class for my college application, and life became about setting yourself up early to get into the best college you could," she said. For four long years of high school, Amanda maintained an intense schedule filled with year-round sports, after-school clubs that focused on serving the underprivileged in her community, and a maxed-out course load of honors and AP classes. Her parents had instilled a strong work ethic in her and her siblings. Her dad worked twelve-hour days as a lawyer at a tech company, while her mother volunteered in various leadership positions for the PTA. Their house was always impeccably maintained. Amanda remembers the frenzy that would take place whenever guests were coming over, even just to drop something off-everything had to be exactly right.

Holidays were particularly serious affairs, prompting her mother to spend weeks decorating, striving to create storybook memories for her kids. Even family vacations were planned with the same methodical precision-nothing left to chance. "Achievement in all areas of our lives was what mattered most to my parents," she said. When it came to Amanda''s school performance, her parents were careful not to make the conversation directly about grades. Instead, Amanda said, "it was more subtle, under the guise of ''You''re not fulfilling your potential.''" Bringing home a C or even a B on an assignment would be met with a quiet, buttoned-up coldness. Their message was clear, she said, even without being explicit: We know you can do better. Many of her friends felt the same way.

"We live in a community where your grades, how you look, your weight, where you travel, what your house looks like-everything has to be the best, to be perfect, and to look effortless," said Amanda. Classes at the high school were competitive and demanding, she recalled. Teachers expected a high level of performance from their students, as did coaches during after-school practice. Most days, it looked like Amanda could juggle it all-until suddenly she couldn''t. By the end of junior year of high school, with college applications looming and the pressure mounting, Amanda would stay up late working, then lie awake, gnawed by anxiety. The next day, utterly exhausted, she''d skip classes and head over to the music room to play Bach or Chopin on the piano and temporarily escape. Amanda was depressed, even if she didn''t recognize it at the time. Her life had become rigid, with little time for simple pleasures or even rest.

The unrelenting pressure led to the development of an eating disorder that toggled between anorexia and bulimia. Every time she ate a "forbidden" food-secretly bingeing on cookies or ice cream in her room to numb the pain-her lack of self-control only reminded her that, yet again, she''d failed to measure up. Her self-worth would go up or down depending on the number on the scale or the score on a test. "I always felt like I had to maintain this perfect image at home, at school, and online, so I wasn''t genuinely connecting with most people, especially my parents," she said. "It was a very lonely time." Amanda''s mental health issues flew under the radar because, despite everything she was going through, she still managed to bring home straight As. Weekends brought fleeting relief. "My friends and I worked so hard all week that we felt like we deserved to let go," she said.

They''d binge drink, sometimes to the point of blacking out. Amanda said there was a tacit agreement in town between some parents and their teens that you could do whatever you wanted on the weekends as long as you were performing during the week. Some parents, she told me, would supply the booze and even join them in the drinking. Amanda''s parents had a different perspective: "They thought hanging out with my friends was a waste of time, so I''d have to fight with them to be able to go out. Being productive and successful was the number-one priority and anything else, even friendship, was secondary." By the time Amanda left for college, she''d embraced a "work hard, play hard" mindset. On campus, she found an environment even more competitive than in high school. She struggled to maintain straight As.

Her eating disorder worsened, her drinking picked up, and she dabbled with drugs to escape her shame at never quite measuring up. The pressure from her parents migrated from grades to summer internships. After graduation, Amanda landed a dream job in advertising and moved into a beautiful apartment in San Francisco. She was thrilled. But that familiar drive-to achieve more, to reach higher, to be the best among her peers-followed her. "I was working all the time, getting promoted, but had no sense of balance in my life or healthy ways to cope with all the stress," Amanda said. She turned to old, unhealthy habits instead. One night, after binge drinking and snorting cocaine with friends, she sat on the curb outside her apartment building and considered suicide.

"I had this desperate feeling like I just couldn''t take it anymore," she recalled. "I was completely exhausted and just wanted to end it." Amanda''s depression deepened, and she soon started drinking during the workday. While driving home one night, she was pulled over by the police and charged with a DUI. After nearly a decade of excessive drinking and drug use, her arrest forced her to deal with her problem, and also forced her parents to accept the reality that their daughter, who seemed to have it all, felt utterly vacant inside. Amanda went into rehab. Now she''s been sober for two years. She''s seeing a therapist and slowly unpacking the heavy weight of two decades'' worth of expectations.

"All of my life, I have felt like I had to be perfect, or people wouldn''t love me," Amanda said. It''s a mindset that is so ingrained in her that she doubts it will ever entirely leave: "I still want to perform, I still want to achieve, but now I''m trying not to punish myself quite so much when I don''t." An "At-Risk" Group? When Suniya Luthar first began studying the lives of American teenagers, her work focused on the challenges of living in the inner city. As a researcher at Yale in the 1990s, Luthar put together a study that followed a group of teens whose lives were impacted by poverty, crime, and substance abuse. In need of a control group with whom to compare her findings, she sought out teenage subjects in a nearby affluent community, tracking the same variables: rates of depression, rule-breaking behavior, and the use of drugs and alcohol. Much to her surprise, she found that the upper-middle-class suburban youth were doing worse on many of the study''s measures: they were significantly more likely to use alcohol, marijuana, and hard drugs than the average teen and relative to inner-city kids; suburban girls, in particular, were suffering from much higher levels of clinical depression, and both genders showed slight elevations of clinically significant anxiety relative to norms. To Luthar, the results of the study seemed counterintuitive. To others, they seemed simply wrong.

"Initially, there was resistance to the idea that these kids who have it all, who are given every opportunity, could possibly be doing worse than the average American kid, not to mention kids living in poverty," Luthar told me. People couldn''t wrap their heads around the study''s findings. Americans assume that wealth equals well-being, Luthar said, or at the very least that it protects kids against these kinds of hardships. In the years since this groundbreaking study, Luthar and other scientists have discovered that what places a child "at risk" for clinically high levels of anxiety, depression, and substance abuse is not growing up in an upper-middle-class family, but rather growing up in an environment of unrelenting pressure. A 2018 report by the influential public health and policy experts at the Robert Wood Johnson Foundation (RWJF) named the top environmental conditions negatively impacting adolescent wellness. Among them were poverty, trauma, discrimination, and "excessive pressure to excel." According to the RWJF report, a "family and/or school environment characterized by extreme pressure to succeed or to outdo everyone else-often, but not exclusively, occurring in especially affluent communities-can affect youth in significantly deleterious ways, including causing high levels o.