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Students heading back to college face a return to COVID-19 risk factors. Here's what to do.

To understand college students' behavior, we need to understand some basics of neurobiology and psychology.
Image: University of North Carolina
Freshman Sarah Anne Cook packs to leave campus following a cluster of COVID-19 cases at the University of North Carolina in Chapel Hill on Monday.Gerry Broome / AP
By Suzan Song

With no national consensus on how to approach teaching classes at colleges and universities, some schools started remotely as early as last week, while others sent tens of thousands of students back to in-person classes. What immediately followed were images of students across the country filling house parties, clubs, bars and sidewalks without social distancing or masking.

We all know that students — like the rest of us — want to return to life as normal, which means seeing their friends and having full freedom of movement. In a College Reaction/Axios poll last month, 76 percent of college students said they would return to campus if given the option. The majority said they would still abide by public health measures, though, by not attending parties (79 percent) or sporting events (71 percent), and 95 percent said they would wear masks when they couldn't socially distance.

Still, even before the school year started, more than 6,600 coronavirus cases had been linked to U.S. colleges. And within a week of reopening, East Carolina University reported more than three times the number of COVID-19-positive students versus the week prior and the University of Washington had more than 200 positive cases, while in Mississippi, nearly half of reopened schools have cases of COVID-19 (in 39 counties). The University of North Carolina-Chapel Hill shifted back to online classes because of four COVID-19 case clusters just one week after reopening. The University of Notre Dame did the same after 80 of 419 students tested positive; the majority of the cases were reported to have been linked to off-campus parties.

Meanwhile, students are continuing to return to other college and university campuses all over the country.

So how do we talk to our students — our children — to help prevent them from getting or spreading COVID-19 after they head back to campus?

To understand college students' behavior, we need to understand some basics of neurobiology. Young people (defined as those 15 to 24 years old) are going through a huge period of physical, cognitive, social and emotional development. The brain isn't fully developed until about age 25 — particularly the prefrontal cortex, which is responsible for organizing, setting priorities, strategizing and controlling impulses.

But a still-developing prefrontal cortex isn't the only factor influencing young people's behavior. Many are aware while acting that they are engaging in risky behavior, because, in emotional situations, their more mature limbic system — the emotional center of the brain — may win over the knowledge demonstrated by the prefrontal cortex.

Teens can show adult intellectual capacity earlier than adult impulse control, meaning that, in the heat of the moment, they are aware of their poor decisions but that the influence of their emotions will bias their behavior. There's an increase in novelty and sensation-seeking (influenced by the limbic system) but a lag in self-regulation skills (controlled by the prefrontal cortex).

In addition to these neurobiological changes' giving more power to the prefrontal cortex, young people are also going through a process of social and emotional development. They are often questioning: "Who am I? Where do I belong? How do I relate to others?" These years are a time when they are becoming independent through their relationships and learning how to communicate, interact, assess situations, control and cope with emotions as adults.

They're also developing "meta-cognition," or the ability to think about thinking, which includes thinking about how they feel and how they are perceived by others and taking another's perspective. It's why many young people feel they don't belong anywhere or that no one understands them — and also why they can become "cause"- and "justice"-oriented, leading to social uprisings.

The question, then, is, knowing all of this, how we can we speak with young people at their developmental level to influence their behavior in the midst of this pandemic in a positive way?

Parents should try to understand their teen and young adult children's perspective by first remembering their own adolescences. Most people have times in their past when they did things they aren't proud of or took risks they never would now. Taking some risks as an adolescent, however, can be normal and healthy: It shows exploration, creativity and identity-building and helps young people learn decision-making skills.

Once we as adults have reminded ourselves of our own youth, we can, from a place of empathy, listen to the young people in our lives to understand, not to judge, them. When young people talk about the party they went to where they didn't wear a mask, listen to understand that it's likely that there were emotions motivating their decision — feeling left out, embarrassed or frustrated that they would have to take precautions. Validate those emotions, because they will be stronger drivers of behavior than the cognitive logic.

Once we understand the emotions driving young people's actions, we can then help strengthen their prefrontal cortex skills by engaging in more realistic discussions. "Yes, you really want to party with your friends. You will see many who won't wear masks, leaving you feeling like an outcast or questioning yourself. It doesn't feel fair. What can you do?" You can also build young people's meta-cognitive skills by asking them to reflect on their decisions or potential decisions: "Tell me why you think that?" Help them think through solutions to uncomfortable situations or the consequences of behaving impulsively. Play out emotional scenarios, instead of having them simply reassure you they they'll wear masks and socially distance, only to later be placed in difficult situations and rely on their emotions to guide them.

Many parents, administrators and other adults are justifiably disappointed and upset with the young people who aren't adhering to public health guidelines on and around college campuses, placing others in danger. We should hold people accountable for their actions and teach them to be responsible members of society — but we need to do so without shaming, which leads to low self-esteem. Limits and consequences are necessary for public safety.

But this pandemic won't be the last time these young people face the challenges of how to do what they know is right (for example, with drugs, alcohol and sex), despite the emotional pressures around them. Parents and other adults already know we can't make these kinds of decisions for them without facing their resistance; we have to help them learn how to make these decisions for themselves without lecturing them.

Suzan Song

Dr. Suzan Song is a Harvard- and Stanford-trained psychiatrist who serves as the director of the division of child, adolescent and family psychiatry at the George Washington University Medical Center. She is also an adviser with Save the Children Denmark.