Adolescents, especially teens, often get a bad rap: they sleep too late; they’re self-absorbed, dramatic and moody. A breakup or being snubbed by a friend can seem catastrophic.

As a result, adolescents are often characterized as “difficult,” and parents can be unsympathetic.

We often blame the usual suspects: hormones and puberty. Carla Sharp, UH professor of psychology, says adolescent behavior is actually their brains at work. Much like a clinical pathologist searches for the cause of a disease by examining clues in blood or tissue, Sharp studies personality pathology—how our personalities and identities develop and how it can all go wrong, starting at a young age.

Sharp’s work—incorporating what we know about a child’s developmental stage into any diagnosis and treatment—is changing our understanding of mental illness in adolescents and what that developmental stage can mean for relationships with parents and other caregivers, including what happens when those relationships go awry.

The work offers lessons for anyone who deals with children, halfway around the world and here in Houston.

“Forming an identity is the big developmental task of adolescents. It’s what helps us make decisions, like where we’re going to go for college or what we’re going to do for our job. There needs to be some solid sense of self that will guide all of these decisions,” said Sharp.

Brain development goes into hyperdrive during the adolescent years—ages 10 to 18—as kids begin to form an identity. For some people, it’s a difficult time and can strain relationships with family and friends. For others, it can be nothing short of devastating, resulting in personality disorders, emotional detachment, substance abuse, self-harm, anger, impulsivity, even suicidal thoughts and actions.

Adolescents Respond Poorly to Treatment

Sharp’s research has focused on personality pathology for the past 10 years. It is also why she and the Developmental Psychopathology Laboratory, which she directs at the University of Houston, have become international leaders in this area.

“We take the developmental stage of the child into account when we try to figure out what’s going on with their problems,” she said.

Mental disorders like depression, anxiety and substance use in adolescents are well-researched. Mental disorders are the single biggest cause of disabilities in young people, according to the World Health Organization. But there are huge gaps in what we know about treating mental illness in youth. Seventy percent of young people don’t respond to treatment.

“If left untreated, it can impact the overall health of the child and their outcome in life,” Sharp said. “One of the reasons we believe teens don’t respond is because there is a big part of being an adolescent that is being left out of treatment. Specifically, these treatments don’t address the personality, identity and relationship function.”

Keeping the Kids’ Minds in Mind

Sharp’s work includes creating effective, evidence-based therapies, not just for adolescents with personality disorders but for any parent or caregiver who has a strained or difficult relationship with a child. At the core of an intervention framework she’s developed for treating adolescents is what she calls the “literacy of interaction.”

In short, the intervention teaches parents and caregivers to go back to the basics, always “keeping the child’s mind in mind.”

For the past three years, Sharp and her research collaborators at the University of the Free State, South Africa; Bar Ilan University in Israel; Michigan State University; and University College London have been training caregivers at community-based organizations that care for orphans in South Africa, Uganda and Ethiopia in Mediated Intervention for Sensitizing Caregivers, or MISC. As part of clinical trials federally funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, care workers who look after children orphaned by HIV/AIDS are trained to be more sensitive and responsive to the kids in their care.

“Our research indicates that at the core of identity development gone astray is the caregiver’s capacity to mirror and regulate the child’s mental state. Adult-child interactions are of central importance,” said Peter Fonagy, professor and head of the Division of Psychology and Language Sciences at University College London, and a member of the research team.

Children in very stressful, dramatic circumstances tend to shut down—it’s universal, whether the child is an orphan in Africa or an American child whose parent has mental illness or substance abuse issues. Experts say some kids will act out, but most will withdraw. Both scenarios result in poor outcomes educationally, emotionally and generally in life.

“All children can reach their developmental potential if the grownups in their life interact with them in a way that stimulates their learning,” said Sharp, who has seen it first hand while training caregivers in Africa. In Uganda, for example, more than a million children have lost a parent to AIDS.

A Critical Window for Mental Health

But it’s not all bad news. Adolescence offers a critical window in which mental health can be promoted.

The MISC intervention has two parts, addressing the emotional and cognitive components of the adult-child interaction. It centers on establishing a relationship that stimulates learning—not just about math and reading but also about the connection between thoughts and emotions so the child can apply it to future situations.

“It could be highly beneficial for kids with a personality disorder, but this can be done with anybody. The kids we work with in South Africa don’t necessarily have a psychiatric disorder; they are vulnerable because they’re orphans,” said Sharp.

The treatment, which is in clinical trials in Africa and soon in the United States, is ideal for “low-resource settings”—health systems with few resources and where kids are often more vulnerable. There are no required materials or expensive technology. The MISC trainer videotapes interactions between the care worker and the child and discusses the quality of the interaction with the adult, who is taught to build his or her skills over time.

UH will soon take this innovative treatment into the Houston community—partnering with hospitals and schools to deliver MISC training to parents in Houston. With a grant from the UH Division of Research and Technology Transfer, graduate students in the department of psychology have been trained to coach parents using the MISC model.

“This is a low-cost way for a parent to start changing the interpersonal dynamics between them and their kids,” said Francesca Penner, a UH doctoral student in the Developmental Psychopathology Lab who was recently trained to deliver MISC.

Sharp says parents and caregivers can do endless test preparation and tutoring and use the latest, most cutting-edge technology to teach a child, but if it’s not done with the right interactions and a secure relationship, the child simply will not learn.

Her advice is simple: Slow down.

“For me as a parent, this intervention has meant a lot to me personally in helping me slow down my interactions with my children and not be so goal-oriented all the time. The funny thing is, when you do slow down, your goals are met anyway, but it’s done in a calm, joyful way.”