What Is an ‘At-Risk’ Youth? Part 2

Note: this article is Part II of a series on ‘at-risk youth.’ Read Part I to learn what we mean when we say ‘at-risk youth’ and how to differentiate between risk factors and risk behaviors. Part I also covers the interrelated nature of risks, adverse outcomes associated with increased risk factors and risk behaviors. In this article, we cover the unique vulnerability of youth compared to adults, the risk continuum, and who is most at risk. 

True or False: More than half of female high school students in the U.S. report feeling persistently sad or hopeless. 

True or False: At least half of LGBQ+ students report struggling with mental health. 

True or False: Nearly 1 in 3 teen girls seriously considered attempting suicide in 2021.

True or False: Nearly 20% of teen girls say they have experienced sexual violence.

True or False: 1 out of 10 high school students attempted suicide during the pandemic. 

If you answered True for all of the above statements, you’re spot on. In fact, the CDC Youth Risk Behavior Surveillance System published its most recent set of data just last week, shedding light on the prevalence of youth risk behaviors and risk factors from its 2021 survey. 

Some of the key findings are indicated above. Of particular note are the data that show that poor mental health and suicidal thoughts are increasing for nearly all groups of youth. And female students and LGBQ+ students are experiencing alarming rates of violence, poor mental health, and suicidal behaviors. 

If you’re a pediatrician or family physician, how do you respond? If you work in schools or serve as a college advisor and implement wellness initiatives for incoming freshmen, how do you determine who is at risk, what they are at risk for, and what to do next?  

Part of the answer to these questions involves implementation of universal risk screening to identify struggling youth early enough to intervene effectively. Part of the answer also lies in broad policy initiatives around increased funding for mental health services and regulation of social media use in early adolescents. But another key piece of the puzzle also involves developing our collective understanding and awareness of youth risk. To that end, let’s dive into Part II of our series on at-risk youth. 

Why Are Youth More Vulnerable Compared to Adults?

Adolescence is arguably the most formative period of one’s life. At a minimum, it’s a period of enormous change. Everything about a teen’s life changes during these years: 

  • Physical body 
  • Brain structure
  • Hormones
  • Friends
  • School (middle to high school, high school to post-secondary setting)
  • Place in society (transitioning from being a child in a household with parents/caregivers to a college student or young adult living in a community) 

During this period of significant change, youth are more vulnerable to risks than adults for a number of reasons. 

Brain Development

The adolescent brain is not fully formed. While the brain reaches its final physical size by age 11-14, it does not complete maturity until the mid-late 20s. The prefrontal cortex (the front part of the brain) is one of the last regions to develop and is responsible for skills like planning, prioritizing, and controlling impulses. Since this area is not fully developed during the tween, adolescent, and even young adult years, youth are more likely to engage in risk behaviors without considering the possible adverse consequences. 

Remember the 15-year-old patient who sustained a concussion and broken arm while skateboarding down an icy ramp on a snow day without wearing a helmet? Well, when you want to ask them, “what were you thinking!?,” the honest answer is likely, “I wasn’t.” Having a brain that is not fully developed or fully mature does not excuse risk behaviors like using substances, but it does help explain why youth are more susceptible to them. It’s harder for youth to consider the consequences beyond the immediate moment. Not impossible, but harder. 

Youth are also more vulnerable to stress and require more sleep than adults. Both of these factors contribute to increased vulnerability to risks. 

Emergence of Mental Illness

Another reason why youth are particularly vulnerable is that adolescence is the time in which many mental illnesses, including anxiety, depression, bipolar disorder, eating disorders, and schizophrenia, often emerge. Until these illnesses are properly identified and a comprehensive treatment plan is developed, they may create additional risk. For example, a youth experiencing a manic episode is more prone to impulsive behaviors, such as reckless driving, spending sprees, unprotected sex and/or having multiple sexual partners.

Legal Consequences

Youth are more vulnerable to experiencing adverse outcomes in part because of their age as it relates to the law. For example, consuming alcohol at age 17 is illegal, even in small amounts, compared to consuming alcohol at age 35. A teen who has an encounter with law enforcement during or after drinking alcohol is likely to experience legal ramifications even if their blood alcohol level is below the legal limit for adults and even if no one was harmed. Other examples of this may include: purchasing and/or using nicotine, possessing and/or using marijuana, or engaging in sexual activity with a partner who is older. 


Finally, youth are more vulnerable to risk than adults in part because of their age as it relates to their social, economic, and vocational place in society. In other words, not all risk behaviors for youth are necessarily risk behaviors for adults. For example, an unintended teen pregnancy and a planned pregnancy in stable marriage with adequate resources are two very different experiences of pregnancy. The former is more likely to result in school dropout or lower school achievement, more health problems, financial hardship, and incarceration, compared to the latter.

Youth Risk Continuum

It is important to recognize that youth risks exist along a continuum, and no youth is 100% free of risk. For example, a youth who drives a car or rides in a car as a passenger engages in some degree of risk simply by getting into the car (and the same is true for adults). Risk increases if the youth does not wear a seatbelt. Risk increases further if the youth drives above the speed limit. Risk for serious injury or death increases even more if that same youth drives while texting. Professionals and parents who normalize the idea of youth engaging in some degree of risk will do well to frame the activities and experiences of youth along a continuum, and prioritize risk behaviors and intervention with risk factors that are of moderate to severe risk. 

Here are a few examples of youth risk behaviors and/or youth risk factors that warrant immediate intervention: 

  • Engaging in self-harm or self-injurious behavior 
  • Expressing suicidal thoughts
  • Experiencing persistent feelings of sadness and/or hopelessness
  • Carrying a weapon
  • Experiencing physical, sexual, and/or emotional abuse 
  • Experiencing bullying, including cyber bullying 
  • Witnessing or experiencing domestic violence in the home
  • Engaging in distracted driving, including driving while under the influence

Who Is Most At Risk and Why

Adverse childhood experiences (ACEs) are potentially traumatic events that occur in childhood (from birth through age 17). There are many different ACEs that can negatively impact one’s future, including education, job opportunities, long-term health, and more. Here are a few examples of ACEs: 

  • Experiencing violence, abuse, or neglect in the home
  • Witnessing violence in the community
  • Having a family member attempt or die by suicide
  • Instability due to parental separation or a family member being incarcerated 
  • Substance use by a family member 
  • Mental illness in a family member 

Youth with higher ACE scores are more at risk for experiencing adverse outcomes compared to youth with lower ACE scores. In other words, youth with multiple potentially traumatic experiences, such as being unhoused, having an incarcerated parent, and engaging in unprotected sex, are more likely to experience consequences of their risk factors and risk behaviors than youth with fewer ACEs. 

Mitigating Risk with Universal Screening 

Professionals who work with youth have opportunities every day to be the one trusted, caring adult who makes all the difference. Physicians, social workers, case workers, advisors, nurses, patient care staff, school counselors – all the professionals who have regular touchpoints with youth ranging in age from tween to young adult are in a position to identify and intervene when youth need help. 

“Easier said than done!”, you are rightfully thinking. 

Being understaffed and overworked amidst bureaucratic barriers makes it incredibly difficult to accurately assess and respond to the needs of all youth. That is, unless you have access to comprehensive, standardized, validated screening tools that are easily accessible for both the professional and the youth. The scientifically validated Rapid Adolescent Prevention Screening (RAAPS) and the age-differentiated, risk-prioritized TELL-TALK-VENT screeners provide professionals with the opportunity to screen all youth in their care for high-priority risks, including mental health and suicidality, substance use, sexual health & development, and more.

Interested to learn how to implement universal screening in your organization or practice? Let’s talk.