Disguised Distress in Children and Adolescents 'Flying under the Radar': Why Psychological Problems Are Underestimated and How Schools Must Respond

It is now recognized that there is a very high prevalence of psychological disorders among children and adolescents and relatively few receive psychological treatment. In the current article, we present the argument that levels of distress and dysfunction among young people are substantially underestimated and the prevalence of psychological problems is higher than realized because of a variety of factors. In particular, it is suggested that psychological problems are underestimated due, in part, to the presence of subthreshold conditions that do not meet diagnostic criteria yet involve substantial distress and impairment. In addition, we focus on a subset of children and adolescents who experience profound distress yet keep it hidden or disguised because of a personality style characterized by self-concealment and a tendency to engage in perfectionistic self-presentation. The characteristics of these students who are "flying under the radar" are described with a discussion of associated familial, cultural, and school factors that reduce the likelihood of these students ever seeking help. Given our premise that psychological problems are substantially underestimated, it is apparent that schools have a vitally important role in mental health promotion in terms of the need for proactive system-wide preventive interventions led by school mental health counsellors. Broad programs are needed to bolster levels of resilience and the willingness to seek help among all children and adolescents but especially among those students who would otherwise not be on anyone's radar screen.