Dear Bob,

As owners and operators of a coed resident camp we have noticed a disturbing trend among both our campers and counselors. We are seeing an increase in the number of young people coming to camp who are suffering from anxiety, depression, ADHD, or some other kind of mental or behavioral disorder. In addition, we have seen more and more first-time campers who have behavioral challenges we just did not know about — everything from bed-wetting to more serious things like bipolar disorder. It seems that some parents want to send their children to camp because they believe we can help them make the friends they've never been able to make at home or achieve a kind of adjustment we just can't believe they have made in school. While this has always been a challenge, it seems to us that the number of children with more severe psychological issues like anxiety or depression is rising.

Without being too confrontational and scaring away what might otherwise be great campers, how do we determine whether a child is truly ready for camp?

Fretting in the Phragmites

Dear Fretting,

You raise several concerns that many camp professionals share with you. Many camps across the United States report a noticeable increase in anxiety and depression in both their campers and staff. In a recent survey directed by Deb Bialeschki at ACA, camp directors were asked about mental-emotional-social health (MESH) concerns in their campers and staff. Over 200 people filled out the survey. The majority of responders reported an increased incidence of MESH issues at camp. The response was also about equal between campers (47 percent) and staff (43 percent).

The top five issues reported for staff, ranked from first to fifth, were:

  1. Anxiety/stress
  2. Depression
  3. Family support
  4. ADHD
  5. Homesickness

The top five issues reported for campers, ranked from first to fifth, were:

  1. ADHD
  2. Anxiety
  3. Homesickness
  4. Family support
  5. Antisocial personality

The camp survey not only corroborates what I have observed in camps across the country, but also what the latest survey on the mental health of young people in the United States from the Centers for Disease Control tells us. The CDC report from 2011, the latest for which we have data, reports that in any given year 13 to 20 percent of all children ages four to 18 in the US will have a diagnosable mental disorder (CDC, 2011). Here is a breakdown of some of their numbers:

There has been more than a 65-percent increase in the number of children in the US diagnosed with ADHD between 2003 and what was estimated to be true for 2015. While many possible explanations exist for such a significant increase — increased pressure from social media, the impact on the brain of early exposure to TV and other technology — the undeniable fact is that, yes, many more children are coming to camp with ADHD.

Here are the numbers for anxiety and depression as of 2011:

  • Major depressive disorder in boys 13-18: 4.6 percent
  • Major depressive disorder in girls 13-18: 5.9 percent
  • Significant symptoms of anxiety in all children 13-18: 25-30 percent

These figures reflect findings in a megastudy of research conducted by Dr. Jean Twenge at San Diego State University. According to Twenge, the level of anxiety and depression in young people has risen five to eight times in just the last 40 years (Twenge et al, 2010).

Some of this has to do with the fact that children do not play and exercise like they did even 30 years ago. This is pertinent because we know that gross motor activities like swimming, biking, and just running around have a substantial, natural antidepressant and anti-anxiety effect in children. There is now considerable evidence that the "slouching posture" associated with the use of such devices as cell phones, iPods, tablets, and other mobile electronic gadgetry, can actually lead to a depressive state of mind (Cuddy, 2015).

What do camp professionals do about this? I am going to confine my remarks to campers and leave the question of anxiety and stress in counselors for another time. Obviously, the first order of business is to get better information about each child before he or she comes to camp. "Great," I can hear you saying, "but what about parents who don't tell you 'the whole truth?'" I agree that many parents do not share important details about their children's histories or lives until you and your staff encounter the effects of those details at camp when it may be too late! On the other hand, I have found that most camp professionals are not asking the right questions — questions that might lead to a more effective pre-camp or pre-enrollment discussion that would better alert you to a child's needs.

I realize that parents can still lie in answer to the questions you pose, but you will never get important information if you don't ask. I also realize there is a balance here. As one camp owner-director said to me last fall, "We need a way to balance the need for camp to sound enticing with the need to get accurate information so each camper is actually successful at our camp."

Before you ask parents anything, you need to talk with them about the demands of camp in general. For example, the reality is that when a child comes to camp he or she instantly inherits a bunch of brothers or sisters with whom he or she shares everything. This may create considerable stress for a child. Second, campers wake up together, eat together, get into trouble together, and get ready for bed together. In short, there is very little down time from other kids at camp. When kids are at home they can often get a reprieve from their classmates or friends when they come home from school. Not so at camp. Helping parents think through the reality of camp life can help them think about whether their child has the capacity to be successful in that environment.

Speaking of success, what parent doesn't want his or her child to be successful? This is why I recommend that you have a short statement that helps you establish common ground with all prospective camper parents. To me, the most powerful place to come from with parents is asserting your hope that their child's experience at your camp is going to be a happy, healthy, and successful one. I define that success in part as being able to make and keep friends; meet the responsibilities of living in a cabin, bunk, or tent; respect the authority of the counselors; freely take advantage of camp activities; and work out the conflicts that come when a bunch of boys or girls share common space.

A child who comes to camp who is not socially or emotionally ready risks not only being turned off to camp in the future, but also suffering from the embarrassment and humiliation of the failure. Everyone wants what's best for children, and camp certainly can widen a child's horizons and add tremendously to his or her self-confidence and ability to cope in the world. If a child is not ready for that experience, however, he or she may end up miserable and feeling worse off for it. The partnership with parents begins in looking together at what information might help decide whether a child who has never been to camp before is ready. And if the child is not ready this year, maybe he or she will be next year. 

This takes us right back to the questions mentioned earlier that I believe camp directors should be asking parents. Each of these questions is designed to lead naturally to a more complete discussion with parents depending on how they answer them. For example, the first question has to do with medication. "Is your child on any medication, whether for mood, allergies, behavior, learning in school, or any other reason?" If a parent tells you that a child takes medication "only for school," you can surmise that the meds have to do with attention and focus. Follow up by asking, "Specifically for what in school? What about hyperactivity or impulsivity? How long has the child needed the medication? Are you planning any changes in the medication before camp? What is the impact on his or her behavior if the child does not take the medication one day?" The ultimate follow-up question regarding medication is whether the camp can have permission to speak with the prescribing physician, because many doctors do not understand how important medication can be for kids at camp, either to control their impulsivity, to pay attention at activities, or to help them socially by being able to follow the banter and give-and-take of social conversations.

Ask if the child is on an individualized educational plan (IEP). While the main focus of an IEP may be to help the child academically, and the fact that a child may be on an IEP doesn't itself indicate any social or emotional challenges, many IEPs do have sections on social or emotional support. Ask!

The third question is whether their child has received professional help for issues either at school or at home. Again, this may be followed with a variety of questions, the ultimate one being whether the camp can have permission to speak with the professional providing that service.

I have found from years of practice that these three questions offer a good chance of surfacing an issue that might be germane to a child's success at camp. Other questions can also be helpful, such as whether the child has had any prior experience at another camp, whether he or she has been successful in having a sleepover at another child's house (not a relative), or how the child does with transitions, especially getting out of the house in the morning or getting ready for bed at night.

In some ways camp professionals are victims of their own marketing. We believe so strongly that camp can be beneficial for youngsters that we may have inadvertently attracted parents whose children are desperate to have friends or be accepted, or who simply want to be in an emotionally safe environment. As a result, you may be enrolling campers whose needs are beyond the scope of your staff and program. Some parents simply want to believe that camp can somehow magically help their children do at camp what they have never been able to do in their school or community. Couple this with the belief most camp professionals have about being able to deliver life-changing experiences, and you have a prescription for possible disaster. Being optimistic about helping children is a great outlook to have unless we adhere to it indiscriminately.

Deb Bialeschki, D. & Gaslin, T. (2015). ACA survey of camp directors on MESH concerns at camp, Healthy Camps Committee.
Centers for Disease Control (2011). Centers for Disease Control: Report on health care provider diagnosis and medication for ADHD.
Cuddy, A. (2015, December 13). How iPhones ruin your posture and your mood. The New York Times Sunday Review.
Ditter, B. (2011). Appendix A: Ready, set, go! Five areas of readiness for camp. Summer Camp Rules, Healthy Learning Publishers.
Twenge, J., et al. (2010). Birth cohort increases in psychopathology among young Americans. Clinical Psychology Review, 30, 145-154.

Bob Ditter is a licensed clinical social worker specializing in child, adolescent, and family therapy. "In the Trenches" is sponsored by American Income Life Insurance.