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Excessive pressures to excel, generally in affluent contexts, are now listed among the top 4 "high risk" factors for adolescents' mental health, along with exposure to poverty, trauma, and discrimination. Multiple studies of high-achieving school (HAS) cohorts have shown elevated rates of serious symptoms relative to norms, with corroborating evidence from other research using diverse designs. Grounded in theories on resilience and ecological influences in development, a conceptual model is presented here on major risk and protective processes implicated in unrelenting achievement pressures facing HAS youth. These include forces at the macrolevel, including economic and technological changes that have led to the "middle class squeeze," and proximal influences involving the family, peers, schools, and communities. Also considered are potential directions for future interventions, with precautions about some practices that are currently widespread in HAS contexts. In the years ahead, any meaningful reductions in the high distress of HAS youth will require collaborations among all stakeholders, with parents and educators targeting the specific areas that must be prioritized in their own communities. Leaders in higher education and social policy could also help in beginning to curtail this problem, which is truly becoming an epidemic among today's youth. Public Significance StatementMajor policy reports have now declared youth in high-achieving schools to be an at-risk group. Following a summary of findings documenting elevated problems, this article describes the complex, multilevel factors that eventuate in high levels of pressure. Also reviewed are interventions that might reduce stress levels and promote positive well-being.

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Previous studies have suggested that Asian parents' high academic expectations can lead to negative mental health outcomes among Asian American youth. We explore this hypothesis by analyzing data collected in an affluent, suburban high school with a large Asian American population. We examine the relationships between parent expectations, students' relationships with their parents, and mental health outcomes among Asian American (predominantly Indian American and Chinese American) and white youth. We find that the quality of parent-child relationships is associated with mental health outcomes and that the association between parent expectations and mental health outcomes is insignificant after controlling for these relationships. We discuss significant differences by race and gender. The findings presented expand our understanding of the influence of Asian parents. They suggest that focusing on improving parent-child relationships, as opposed to altering parents' expectations, might lead to improved mental health outcomes for Asian American youth, particularly for those in affluent communities.