Tagged Teenagers and Adolescence

Attention, Teenagers: Nobody Really Looks Like That

Anna Parini

The universal truth of puberty and adolescence is body change, and relatively rapid body change. Teenagers have to cope with all kinds of comparisons, with their peers, with the childhood bodies they leave behind, and with the altered images used in advertising and in the self-advertising on social media.

It may be that the rapid way the body changes during these years can help adolescents believe in other kinds of change, including the false promises that various products can significantly modify their size and shape. A study published last month in the journal Pediatrics looked at two kinds of risky behavior that are increasingly common over adolescence: the use of laxatives for weight loss and the use of muscle-building products.

It used data from an ongoing study of more than 13,000 American children, the Growing Up Today Study (GUTS). The participants’ mothers took part in the Nurses’ Health Study II, and the children were recruited in 1996, when they were 9 to 14 years old, and surveyed about a variety of topics as they grew up.

By age 23 to 25, 10.5 percent of the women in this large sample reported using laxatives in the past year to lose weight; the practice increased over adolescence in the girls, but was virtually absent among the boys. Conversely, by young adulthood, about 12 percent of the men reported use of a muscle-building product in the past year, and again, this increased during adolescence.

So a lot of young women are taking laxatives to try to become very thin, and a lot of young men are using products to help them bulk up and become more muscular. The researchers were interested in how these practices were associated with traditional ideas of masculinity and femininity. They found that, regardless of sexual orientation, kids who described themselves as more gender conforming were more likely to use laxatives (the girls) or muscle-building products (the boys).

“The link is the perception that they are going to alter your weight, shape, appearance,” said Rachel Rodgers, a counseling psychology researcher who studies body image and eating concerns and is an associate professor of applied psychology at Northeastern University.

“The representations of ideal appearance in society are very restrictive and very unrealistic both for men and for women,” she said. “They portray bodies that are unattainable by healthy means.”

Jerel Calzo, a developmental psychologist who is an assistant professor at Harvard Medical School, and the lead author on the study, said that one important aspect of this research was the way it highlighted the vulnerability of those who identify with traditional gender ideals.

“Usually in research we tend to focus on youth who are nonconforming, who we might focus on as more at risk for negative health outcomes, depression, who might be ostracized or victimized,” he said. But there are risks as well for those who are trying to measure up to what they see as the conventional standard.

The GUTS participants were asked to describe themselves as children in terms of the games they liked and the movie and TV characters they imitated, and this was used to score them as more or less “gender conforming.”

The early patterns of gender conformity were significant, Dr. Calzo said, because they were linked to behaviors that lasted through adolescence and into young adulthood. “Laxative use increases with age, muscle-building product use increases with age,” he said. “There is a need for early intervention.”

Chronic use of laxatives can affect the motility of the bowel so that it can be hard to do without them, and overdoses can alter the body’s balance of electrolytes, to a really dangerous extent.

“There’s a lot of shame and guilt for laxative abuse,” said Sara Forman, an adolescent medicine specialist who is the director of the outpatient eating disorders program at Boston Children’s Hospital. And many products marketed as cleanses or herbal teas are not labeled as laxatives, though they contain strong laxative ingredients.

The muscle-building products in the study included steroids, creatine and several others. The risks of steroids are well known, from hormonal imbalances and shrinking testicles to acne and aggression. With other commercial muscle-building products, the risks may have more to do with the lack of regulation, Dr. Calzo said. The products can contain banned substances or analogues of banned substances, like the amphetamine analogue found in popular diet and workout supplements last year.

And of course, the muscle-building products won’t reshape you into the photoshopped model any more than the laxatives will.

As Dr. Calzo says, we need to worry about the vulnerabilities of children who are growing up with issues of gender identity and sexuality. But don’t assume that more “mainstream” or “conforming” kids have it easy when it comes to body image. Parents can help by keeping the lines of communication open and starting these conversations when children are young. We should be talking about the images that our children see, about how real people look and how images are altered.

And that conversation should extend to social media as well; in a review by Dr. Rodgers, increased social media use was correlated with body image worries. “Teenagers are looking at their friends on social media and seeing photos that have been modified and viewing them as something real.”

The other message for parents is about helping to model healthy eating, family meals, realistic moderation around eating and exercising, and to refrain from any kind of negative comments or teasing about a child’s body. “Research has shown people who have more body satisfaction actually take care of themselves better, which suggests that the approach of making them feel bad is actually not helpful,” Dr. Rodgers said.

Every adolescent, across gender, gender identity, gender conformity, and sexuality, lives with a changing body and the need to navigate body image and identity. There are a lot of unrealistic images out there to measure yourself against, and a lot of false promises about how you might get there.

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Myths About Teenagers and Risk-Taking

Stuart Bradford

Teenage risk-taking heats up in the summer. Studies show that during the summer months adolescents are most likely to experiment with first-time use of alcohol, marijuana and cigarettes. For car crashes, the perennial leading cause of death among teenagers, June, July and August hold the grim honor of being the three consecutive months with the most adolescent traffic fatalities.

These are alarming statistics, but a quick spin around the research gives parents reason to feel hopeful, not helpless. The emerging science on adolescent boundary-pushing debunks some old saws and shows us useful directions to point our energy. Here are some common misconceptions and illuminating findings.

Myth: We were better

Adults have long fretted about “kids today,” but on the whole our teenagers are much better behaved than we were. A report published last month from the Centers for Disease Control and Prevention shows that, compared to adolescents in 1991, today’s teenagers are less likely to carry weapons, smoke cigarettes, try alcohol, binge drink or have sex. And they are more likely to wear seatbelts and use condoms.

The report found an increase in marijuana use since 1991, but not a statistically significant one. Other studies confirm a rise in adolescent pot-smoking, and teenagers face new threats such as e-cigarettes and high rates of prescription drug abuse. But we are now raising the tamest cohort of teenagers in decades.

We might want to go so far as to give teenagers credit for this, because how we regard and talk about adolescents matters. One study found that parents who took a dim view of teenagers were likely to raise adolescents who ultimately lived down to their parents’ expectations. The study’s results held up even when the researchers washed out the conduct of older siblings (who might have soured the parents on teenagers) and the behavior of the children in question before they entered adolescence. In other words, low expectations can do harm, while high expectations have long been linked to positive outcomes for teenagers.

Myth: Teens think they’re invincible

Studies show that adolescents feel as vulnerable as adults do. In fact, when we ask teenagers to predict the likelihood that they will be jailed or dead before the age of 20, they grossly overestimate the actual probability of such events. Why do adolescents take so many risks if they feel so unsafe? Research provides an answer that shouldn’t surprise any ex-teenager: For adolescents, the wish to impress their peers often trumps their better judgment.

In a study demonstrating this phenomenon, the psychologists Margo Gardner and Laurence Steinberg compared adolescents and adults as they played a video game that allowed for risky choices. When individuals from each group played by themselves, teenagers were nearly as cautious as adults. When playing in front of people their age, however, the teenagers became reckless, while the adults drove much as they did when alone.

A finding like this helps explain how graduated drivers’ licenses have helped to reduce the rate of adolescent car crashes. Laws that limit the number of passengers allowed in cars driven by teenagers accord with solid evidence that adolescents make better decisions when they’re alone or with an adult than when they’re with friends.

What are the takeaways for parents? To start, striking terror into teenagers with dire warnings about their safety may be unnecessary and even counterproductive. Indeed some researchers suggest that teenagers may act rashly, in part, “because of an exaggerated feeling that they are not going to live.”

As an alternative, we might address the hazards posed by peer pressure. In addition to asking our teenagers who they will be with and what they’ll be doing, we could consider saying, “We love your friends, but if things are getting out of hand, please call. We’re always available to get you out of any situation that feels like it’s heading south.”

Myth: Teens are immune to adult influence

Parents offering guidance shouldn’t be put off by the occasional teenage eye-roll. Research consistently finds that adults can capitalize on their relationships with teenagers to reduce adolescent risk-taking.

In broad terms, adolescents who have open lines of communication with their folks and describe their parents as available and understanding are less likely to engage in dangerous behavior. More specifically, teenagers whose parents talk with them about sex and contraception have been found to take fewer sexual risks, conform less to their peers’ behavior and believe that their parents provide the most accurate information about sex. Teenagers drive more safely when their parents reinforce driving curfews and other motor vehicle laws. And adults who establish and uphold rules tend to raise adolescents who are less likely to use illegal drugs and alcohol. While peers certainly influence teenage behavior, parents do, too.

Adults must live with the nerve-racking reality that we cannot absolutely guarantee the safety of any teenager. But we can make choices that promote adolescent safety. With so much at stake, let’s ditch the myths about teenagers and ground our parenting in the objective, and in many ways encouraging, realities.

Lisa Damour is a psychologist in private practice in Shaker Heights, Ohio, a clinical instructor at Case Western Reserve University and the director of Laurel School’s Center for Research on Girls. She is the author of “Untangled: Guiding Teenage Girls Through the Seven Transitions Into Adulthood.” Follow her on Twitter: @LDamour.

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More Nonsmoking Teens Inhaling Flavored Nicotine

A study shows that many teenagers who would have never smoked are now vaping.

A study shows that many teenagers who would have never smoked are now vaping. Katie Orlinsky for The New York Times

Many teenagers who never would have smoked cigarettes are now “vaping” with flavored e-cigarettes, leading to a new generation using nicotine at rates not seen since the 1990s, a new study suggests.

The study, released Monday in the journal Pediatrics, tracked the use of cigarettes and e-cigarettes among 5,490 California high school seniors who graduated between 1995 and 2014. E-cigarettes do not burn tobacco, but are battery-operated inhalers that heat up and vaporize liquid containing flavors and nicotine, a practice known as vaping. The liquids used in vaping range in taste from traditional tobacco and menthol flavors to fruity and sweet combinations like gummi bear, banana bread and cotton candy.

When e-cigarettes came on the market in 2007, some public health experts hoped that they would serve as a substitute for traditional tobacco products and lead to declines in tobacco use.

But the data from the latest study, conducted by researchers at the University of Southern California, tell a different story. E-cigarettes do not appear to have made a dent in regular cigarette use — the number of high school seniors who reported smoking tobacco in the past 30 days has largely plateaued. In 2004, the number of 12th graders who reported smoking tobacco in the past 30 days was 9 percent; in 2014 that number was just under 8 percent.

But the rate of teenagers using nicotine — either through tobacco cigarettes or e-cigarettes — is on the rise. About 14 percent of Southern California high school seniors in 2014 said they had smoked or vaped in the last 30 days. Researchers say they have not seen similar levels of nicotine use among teenagers since 1995, when 12th grade smoking rates were 19 percent.

The numbers suggest that rather than prompting teenagers to replace cigarette smoking with vaping, e-cigarettes instead have enticed an entirely new group of teenagers to use nicotine. While the study focused on California teenagers, researchers say the numbers are consistent with national trends.

“Kids are not just using e-cigarettes instead of cigarettes. That is what we were frankly hoping to find,” said Jessica Barrington-Trimis, the lead author of the study and a postdoctoral scholar research associate in the department of preventive medicine at the U.S.C. Keck School of Medicine. All of the teenagers that were expected to be using cigarettes in 2014 are using them, she said, “and then there is a whole group of kids using e-cigarettes on top of that.”

The amount of nicotine in the liquids used with e-cigarettes — often called “vape juice — varies, and users can purchase liquid with no nicotine or nicotine content ranging from 3 milligrams per milliliter to 18 milligrams per milliliter or even higher. While earlier studies have suggested that some teens are using nicotine-free vaping liquids, researchers say the majority of teens appear to be using nicotine-infused liquid in their e-cigarettes.

Dr. Jonathan Winickoff, professor of pediatrics at MassGeneral Hospital for Children and Harvard Medical School, who wrote an accompanying paper in Pediatrics, said this is the first study of e-cigarette use in adolescents to show such a strong longitudinal sample with such a drastic effect.

“We had a trend of decreasing nicotine use,” said Dr. Winickoff. “What the e-cigarette has done is halted that decrease in its tracks…. We don’t want a fifth of our high school students graduating with nicotine addiction.”

While e-cigarettes do appear to be safer than smoking tobacco, they are not risk free. Nicotine disrupts neurotransmitter activity and is highly addictive, particularly in a developing brain. And the liquids contain solvents, formaldehyde and other ingredients that pose health risks when inhaled.

While it’s true that there are nicotine-free vaping liquids, the e-cigarette industry is not regulated, which makes it hard to know what ingredients are actually in any given product. Though the Food and Drug Administration recently took jurisdiction over e-cigarettes, it will be years before any regulations are put into effect. Currently, many products continue to be made in China with little — if any — oversight by the United States.

“The F.D.A. has done tests on these vaping products that supposedly do and do not contain nicotine, and what is advertised is really not what’s in the product,” Dr. Winickoff said. “When the product is labeled as no nicotine, they’ve found nicotine. So kids don’t know what they’re getting, and as a pediatrician it really scares me.”

Not everyone agrees that e-cigarettes pose a significant risk to teenagers. Dr. Michael Siegel, professor of community health sciences at the Boston University School of Public Health, countered that many teenagers say they are using e-cigarettes that contain only flavorings and no nicotine, and therefore are not getting addicted.

“E-cigarette use among teenagers is a largely social phenomenon,” he said. “The fact that you tend to see teenagers doing this in groups, not out in the cold vaping alone, suggests that e-cigarettes are not addictive.”

But there is a growing body of research showing that e-cigarettes do serve as a gateway to traditional tobacco products. Last month, the U.S.C. researchers also reported in Pediatrics that adolescents who vape are six times more likely to smoke cigarettes in early adulthood as non users.

“Once kids get hooked on e-cigarettes, they are more likely to go on to become cigarette smokers,” said Stanton A. Glantz, director of the Center for Tobacco Control Research and Education at the University of California, San Francisco.

More Nonsmoking Teens Inhaling Flavored Nicotine Through Vaping

A study shows that many teenagers who would have never smoked are now vaping.

A study shows that many teenagers who would have never smoked are now vaping. Katie Orlinsky for The New York Times

Many teenagers who never would have smoked cigarettes are now “vaping” with flavored e-cigarettes, leading to a new generation using nicotine at rates not seen since the 1990s, a new study suggests.

The study, released Monday in the journal Pediatrics, tracked the use of cigarettes and e-cigarettes among 5,490 California high school seniors who graduated between 1995 and 2014. E-cigarettes do not burn tobacco, but are battery-operated inhalers that heat up and vaporize liquid containing flavors and nicotine, a practice known as vaping. The liquids used in vaping range in taste from traditional tobacco and menthol flavors to fruity and sweet combinations like gummi bear, banana bread and cotton candy.

When e-cigarettes came on the market in 2007, some public health experts hoped that they would serve as a substitute for traditional tobacco products and lead to declines in tobacco use.

But the data from the latest study, conducted by researchers at the University of Southern California, tell a different story. E-cigarettes do not appear to have made a dent in regular cigarette use — the number of high school seniors who reported smoking tobacco in the past 30 days has largely plateaued. In 2004, the number of 12th graders who reported smoking tobacco in the past 30 days was 9 percent; in 2014 that number was just under 8 percent.

But the rate of teenagers using nicotine — either through tobacco cigarettes or e-cigarettes — is on the rise. About 14 percent of Southern California high school seniors in 2014 said they had smoked or vaped in the last 30 days. Researchers say they have not seen similar levels of nicotine use among teenagers since 1995, when 12th grade smoking rates were 19 percent.

The numbers suggest that rather than prompting teenagers to replace cigarette smoking with vaping, e-cigarettes instead have enticed an entirely new group of teenagers to use nicotine. While the study focused on California teenagers, researchers say the numbers are consistent with national trends.

“Kids are not just using e-cigarettes instead of cigarettes. That is what we were frankly hoping to find,” said Jessica Barrington-Trimis, the lead author of the study and a postdoctoral scholar research associate in the department of preventive medicine at the U.S.C. Keck School of Medicine. All of the teenagers that were expected to be using cigarettes in 2014 are using them, she said, “and then there is a whole group of kids using e-cigarettes on top of that.”

The amount of nicotine in the liquids used with e-cigarettes — often called “vape juice — varies, and users can purchase liquid with no nicotine or nicotine content ranging from 3 milligrams per milliliter to 18 milligrams per milliliter or even higher. While earlier studies have suggested that some teens are using nicotine-free vaping liquids, researchers say the majority of teens appear to be using nicotine-infused liquid in their e-cigarettes.

Dr. Jonathan Winickoff, professor of pediatrics at MassGeneral Hospital for Children and Harvard Medical School, who wrote an accompanying paper in Pediatrics, said this is the first study of e-cigarette use in adolescents to show such a strong longitudinal sample with such a drastic effect.

“We had a trend of decreasing nicotine use,” said Dr. Winickoff. “What the e-cigarette has done is halted that decrease in its tracks…. We don’t want a fifth of our high school students graduating with nicotine addiction.”

While e-cigarettes do appear to be safer than smoking tobacco, they are not risk free. Nicotine disrupts neurotransmitter activity and is highly addictive, particularly in a developing brain. And the liquids contain solvents, formaldehyde and other ingredients that pose health risks when inhaled.

While it’s true that there are nicotine-free vaping liquids, the e-cigarette industry is not regulated, which makes it hard to know what ingredients are actually in any given product. Though the Food and Drug Administration recently took jurisdiction over e-cigarettes, it will be years before any regulations are put into effect. Currently, many products continue to be made in China with little — if any — oversight by the United States.

“The F.D.A. has done tests on these vaping products that supposedly do and do not contain nicotine, and what is advertised is really not what’s in the product,” Dr. Winickoff said. “When the product is labeled as no nicotine, they’ve found nicotine. So kids don’t know what they’re getting, and as a pediatrician it really scares me.”

Not everyone agrees that e-cigarettes pose a significant risk to teenagers. Dr. Michael Siegel, professor of community health sciences at the Boston University School of Public Health, countered that many teenagers say they are using e-cigarettes that contain only flavorings and no nicotine, and therefore are not getting addicted.

“E-cigarette use among teenagers is a largely social phenomenon,” he said. “The fact that you tend to see teenagers doing this in groups, not out in the cold vaping alone, suggests that e-cigarettes are not addictive.”

But there is a growing body of research showing that e-cigarettes do serve as a gateway to traditional tobacco products. Last month, the U.S.C. researchers also reported in Pediatrics that adolescents who vape are six times more likely to smoke cigarettes in early adulthood as nonusers.

“Once kids get hooked on e-cigarettes, they are more likely to go on to become cigarette smokers,” said Stanton A. Glantz, director of the Center for Tobacco Control Research and Education at the University of California, San Francisco.

Leaving the Pediatrician? Not at 26

Lule Rault, 26, talks with her doctor, pediatrician Ramon Murphy, who she’s visited since childhood at Uptown Pediatrics in Manhattan.

Lule Rault, 26, talks with her doctor, pediatrician Ramon Murphy, who she’s visited since childhood at Uptown Pediatrics in Manhattan. Yana Paskova for The New York Times

Lule Rault took a seat in the waiting room of Uptown Pediatrics on Park Avenue, across from several young mothers with babies in tow. A toddler played with the toys on the waiting-room floor.

“I felt like they might think I’m just another young mom or something,” she said, “since I am so close to their age.” But Ms. Rault, a 26-year-old medical student, was there this month for her own annual checkup. She has been a patient at Uptown Pediatrics since her own infancy. And she plans to remain so until she finishes her M.D. at Tulane University. At that point she will be 29.

She is not looking forward to the transition.

“I don’t have to leave Dr. Murphy, do I?” she said in an interview by email. “I’m only 26!” And she is not Dr. Ramon Murphy’s only patient long out of high school. “The last time I was there, he told me there was one patient older than me — a boy.”

A poll from the Pew Research Center last month found that for the first time in more than a century, young adults are more likely to live with their parents than with a partner or a spouse. So it should come as no surprise that many are perfectly happy to remain with their childhood physicians. The age at which patients leave the pediatric nest varies, depending on whether their doctors are trained to treat adolescents and young adult patients. Historically, that age has been 18 to 22. It seems to be moving up.

Lule Rault, 26, left, emerges from an appointment at Uptown Pediatrics in Manhattan. The waiting room there caters both to young children and to patients in their twenties.

Lule Rault, 26, left, emerges from an appointment at Uptown Pediatrics in Manhattan. The waiting room there caters both to young children and to patients in their twenties. Yana Paskova for The New York Times

Under the Affordable Care Act, children can remain under their parents’ insurance plan until they are 26, which since 2010 has added three million young people to the insurance rolls, according to the Department of Health and Human Services. But that doesn’t mean healthy young adults are regularly visiting any doctors.

“Young adults on the whole are not very connected to the health care system,” said Dr. Patience White, a director at the Center for Health Care Transition Improvement, a group that studies the transition from pediatric to adult health care. “They often turn to the emergency room when they get sick.”

In New York City, many pediatricians are willing to keep their older patients so that they won’t stray from the system. Dr. Murphy and other pediatricians also said many young adults have found it impossible to find an internist who will accept insurance from new patients. Some require an initial concierge fee that runs as much as $3,000; those who do take insurance often don’t have appointments available for four to six months.

“The patient, or parent, reasons that it makes more sense to just stay with the pediatrician,” Dr. Murphy said.

Furthermore, a growing number of pediatricians are trained to treat adolescents and young adults. Dr. Murphy’s practice reflects his 19 years at the Adolescent Health Center at Mount Sinai Hospital in Manhattan. It’s a different kind of rapport from the one he has with his grade-school patients.

“I ask them about friends, school, career choices,” he said. “I wasn’t cut out to wear clown noses and funny ties.”

His waiting room at Uptown Pediatrics even has two sides — one furnished with the familiar trappings of the Sesame-Street-and-K.C.- Undercover set, the other with seating and reading material for adult-size patients.

“I think it’s a New York City phenomenon,” said Dr. Ralph Lopez, whose Upper East Side practice focuses primarily on teenage boys and young men. “Your mom and dad may pick out an internist for you, but you don’t like the doctor, so you stay with someone like me.” He added, “I’m seeing two 25-year-olds later today.”

Andrew Ruvkun, 20, who runs varsity track at Carleton College in Minnesota, plans to stay with his Manhattan pediatrician, Dr. Sol Zimmerman, at least until he finishes college.

“He’s a nice guy, so for now this is it for me,” Mr. Ruvkun said. “He signs off on my N.C.A.A. forms, and he’s the only doctor I’ve ever known.”

Suzy Storr, 25, an artist who a year ago moved back to her Park Slope home after finishing her studies in England, would have liked to keep her old pediatrician, Dr. Sylvain Weinberger, but was told she had aged out of his practice.

“It was kind of sad to me,” she said. “I’d always had a fear of needles, and while I’m better about it now, he always knew how to comfort me.”

Dr. Weinberger suggests his patients find another physician when they leave for college. Up to age 19, “they can always call me,” he said.

As a practical matter, he noted, any patient 18 or older who needs to be hospitalized will go on an adult floor, where a pediatrician may not have admitting privileges.

Ms. Storr tried an internist, but she felt that she was“kind of rushed” and that the visit was about “doing a checkup and kicking you out.”

In New York City, several private practices devoted to adolescent medicine have sprung up to fill the gap for young adults whose needs have outgrown the so-called baby doctor.

“Many pediatricians are uncomfortable with talking about birth control, condom use,” said Dr. Karen Soren, director of adolescent health care at the NewYork-Presbyterian Morgan Stanley Children’s Hospital. “This is part of why adolescent medicine came into being.”

“Traditionally,” she added, “adolescent medicine was intended to deal with kids 12 to 18 years old. It became pretty clear kids didn’t suddenly change into adults at 18, so a lot of us kept them until 21 and beyond.”

Dr. Cynthia Pegler, whose private patients on the Upper East Side primarily are young women, will continue to treat patients until they are ready to be parents themselves.

“My official rule is it is really time to go when you yourself are ready to have a baby,” Dr. Pegler said.

Dr. Soren recalled one patient who returned to her adolescent clinic after a year at an adult internist.

“I tried to prepare her as best I could,” Dr. Soren said. “I printed out her vaccines, her medical records. I made an appointment for her with the new doctor. She went once, but said she went into the waiting room and there were all these ‘old people.’ A year later she came back to refill her birth control pills, so I began seeing her again.”

Dr. David Bell, medical director of the Young Men’s Clinic and the Family Planning program at NewYork-Presbyterian, said that when he started at the clinic 16 years ago, the age cutoff was 24. Now it’s 35.

“I pushed it up to 27, then 30, and now 35,” Dr. Bell said. “I’m kind of sticking to 35.”

Living with a Teenage Data Hog

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After children reach a certain age, most parents give in to their desire for a mobile phone. We like being able to find them at any moment, and they risk being left out if their friends can’t ping them. A Pew Research Center report from last year found that 88 percent of American teenagers now have phones.

But today’s smartphones have earned that name because of their ability to suck in and spit out data at ever-faster rates. That gets expensive, quickly, and figuring out who should pay for the data, how much, and according to what rules, can be a giant headache.

So first, an opening proposition: The ability to access the internet via a cellular signal, in those passing moments when Wi-Fi is not available, is a want and not a need for most teenagers. And if they want it, they should pay for it themselves.

But when I share that assertion with many parents I know, they often respond by patting me on the head and telling me to get back to them when my 10-year-old has a phone and all her friends do, too. To those parents, a data plan is no indulgence. Their kids are busy — constantly on the way to an athletic event or rehearsal. They don’t want to deprive their kids of the ability to stream music or stay connected with their friends on data-draining apps like Snapchat. So a data plan is a given, and the parents are willing to pay.

But just how high a bill is reasonable? I suggest the budgeting approach: Parents pay for a certain amount of data each month, the children track how much they’ve used, and then they pay for anything beyond that allotted amount.

It’s simple enough in theory. Carriers lets customers check to see how much data each person in a family plan has used so far during the month, and the privilege of having a phone should come with the responsibility of keeping track.

That approach does, however, require you to sit down with your teenager and identify the sources of data drain and perhaps set rules for when those apps ought to go off. The Times’s Wired Well columnist, Jennifer Jolly, lives with a data-draining teenager. She suggests turning off any features on a teen’s phone that drain data automatically in the background. Also, track the apps that use the most data and limit data hogs like Spotify or Snapchat to times when the teenager has Wi-Fi access. One additional hint: The more video an app records, transmits and receives, the higher the data bill is likely to be. Call your carrier or consult online forums if you need more help.

In an ideal world, this approach teaches patience, self-control and restraint. Your kids can always watch a video a little later over Wi-Fi, after all. And many messages – most, even – can wait a bit.

But in a less than ideal world, teenagers tend to go over their caps, especially if their friends send lots of videos back and forth via Snapchat. Some parents have enough money to simply pay for the overages. But discussions about those bills are useful. If we don’t set limits, after all, who will? And isn’t our job to get our kids ready for the moment when they really will be paying their own bills?

A few years ago, I wrote about the Russell Plan, named after Mary Kay Russell, a mother of four sons in Naperville, Ill. She added her sons to the family’s cellphone plan when they were ready for their first phones, and the cheap devices they received came with unlimited calls and texting. The boys were welcome to burn data to their hearts’ content on an upgraded phone, but if they wanted to do that, they would have to pay for the device and prepay $360 for a year’s worth of data. The oldest waited until age 21 to get his first fancy phone.

Perhaps his response to the family’s strategy was not such a big surprise. The cost of a smartphone plus data is a big pile of cash to a middle school student who may not have many ways to earn money. Parents who can afford it might consider raising a child’s allowance some to put the decision just within their reach – and make the possibility of waiting on an upgraded phone more enticing.

How much more allowance might they get? It depends on whether you’re asking them to use allowance to cover lunch, snacks, transportation and clothing, too. But you could increase the allowance enough to pay for 50 or 75 percent of a basic data plan, so that the choice to purchase it would involve some sacrifices elsewhere.

Yes, you’re technically “paying” for the data plan in this instance, but that’s true with allowance in general. Once your children have it, the money will feel like it’s their own, and the trade-off will feel real, too.

The Russell children could have asked for upgraded mobile devices and money toward data for birthdays or Christmas, but they often had other priorities. Which is great: We want our children making financial trade-offs, since that is what they’ll have to do as grownups just about every day of their adult lives.

Ron Lieber is the Your Money columnist for The New York Times and the author of “The Opposite of Spoiled,” about parenting, money and values.

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Parents Should Avoid Comments on a Child’s Weight

Stuart Bradford

Should parents talk to an overweight child about weight? Or should they just keep their mouths shut?

Parents in this situation are understandably torn. Say something, and they risk shaming a child or worse, triggering an eating disorder. Say nothing, and they worry they’re missing an opportunity to help their child with what could become a serious long-term health problem.

Now a new study offers some guidance: Don’t make comments about a child’s weight.

The study, published in the journal Eating & Weight Disorders, is one of many finding that parents’ careless — though usually well-meaning — comments about a child’s weight are often predictors of unhealthy dieting behaviors, binge eating and other eating disorders, and may inadvertently reinforce negative stereotypes about weight that children internalize. A parent’s comments on a daughter’s weight can have repercussions for years afterward, contributing to a young woman’s chronic dissatisfaction with her body – even if she is not overweight.

“Parents who have a child who’s identified as having obesity may be worried, but the way those concerns are discussed and communicated can be really damaging,” said Rebecca Puhl, deputy director of the Rudd Center for Food Policy and Obesity at the University of Connecticut. “The longitudinal research shows it can have a lasting impact.”

The impact on girls may be especially destructive, she said, because “girls are exposed to so many messages about thinness and body weight, and oftentimes women’s value is closely linked to their appearance. If parents don’t challenge those messages, they can be internalized.”

The new study included over 500 women in their 20s and early 30s who were asked questions about their body image and also asked to recall how often their parents commented about their weight. Whether the young women were overweight or not, those who recalled parents’ comments were much more likely to think they needed to lose 10 or 20 pounds, even when they weren’t overweight.

The study’s lead author, Dr. Brian Wansink, a professor and the director of Cornell University’s Food and Brand Lab, characterized the parents’ critical comments as having a “scarring influence.”

“We asked the women to recall how frequently parents commented, but the telling thing was that if they recalled it happening at all, it had as bad an influence as if it happened all the time,” said Dr. Wansink, author of the book “Slim by Design.” “A few comments were the same as commenting all the time. It seems to make a profound impression.”

Some studies have actually linked parents’ critical comments to an increased risk of obesity. One large government-funded study that followed thousands of 10-year-old girls found that, at the start of the study, nearly 60 percent of the girls said someone — a parent, sibling, teacher or peer – had told them they were “too fat.” By age 19, those who had been labeled “too fat” were more likely to be obese, regardless of whether they were heavy at age 10 or not.

Comments made by family members had even stronger effects than comments made by unrelated people.

Several studies have found that when parents encourage overweight teenagers to diet, the teenagers are at higher risk of lower self-esteem and depression and of being overweight five years later.

Research by Dianne Neumark-Sztainer, a professor at the University of Minnesota, found that when parents talked to their teens about losing weight, teenagers were more likely to diet, use unhealthy weight-control behaviors and binge eat. Those behaviors are less likely to develop when conversations with parents focused on healthy eating behaviors, rather than weight per se.

Harsh comments about weight can send the message that parents are “tying weight to some kind of perception about how the child is valued,” Dr. Puhl said, and that can trigger negative feelings. “The children are internalizing that, and thinking they’re not O.K. as a person. And that is what’s leading to other outcomes, like disordered eating.”

So what’s a parent to do? Do they just stand by while their child gains weight?

Dr. Neumark-Sztainer was besieged by parents asking her this question, and wondering, “How do I prevent them from getting overweight and still feel good about themselves?”

In her book, called “I’m, Like, SO Fat: Helping Your Teen Make Health Choices About Eating and Exercise in a Weight-Obsessed World,” she notes that parents can influence a child’s eating habits without talking about them. “I try to promote the idea of talking less and doing more — doing more to make your home a place where it’s easy to make healthy eating and physical activity choices, and talking less about weight.”

For parents, that means keeping healthy food in the house and not buying soda. It means sitting down to enjoy family dinners together, and also setting an example by being physically active and rallying the family to go for walks or bike rides together. Modeling also means not carping about your own weight. “Those actions speak louder than words,” Dr. Puhl said.

While your children are young, “there doesn’t need to be a conversation at all – it really is just about what’s being done at home,” Dr. Neumark-Sztainer said.

If an older child is overweight, “wait for your child to bring it up, and be there to support them when they do,” she said. “Say, ‘Look, I love you no matter what size you are, but if you would like, I will support you. I suggest we focus not so much on your weight but on your eating patterns and behaviors. What would be helpful for you?’”

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The Teenager With One Foot Out the Door

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High school graduation can give way to an uneasy season in the raising of a teenager. In place of a summer of family togetherness, parents often feel out of step with adolescents who are preparing to leave home. Though there are certainly joys that come with having a young adult around the house, they can’t cancel out the parting tensions that many families face.

Parents sometimes warn one another about teenagers who feel compelled to soil the nest before flying off to college or other adventures. Home life can become so unpleasant that those who once dreaded their graduate’s departure can’t wait to pack his or her bags. There’s a hidden function to this friction: It’s easier to part from people whose company we can hardly stand.

But subtler dynamics can also be at work. Firm plans for moving out may heighten a teenager’s tendency, which the psychoanalyst Anna Freud observed in 1958, to live “in the home in the attitude of a boarder.” With one foot out the door, a teenager may treat his parents like meddlesome landlords if they should ask what time he will be coming home, or suggest that he drive younger siblings to soccer. And just when new grads are resisting rules and expectations that held sway only a few weeks ago, their folks are often itching to offer some last-minute guidance.

Parents who want to discuss sexual ethics, finances, the hazards of heavy drinking or even the importance of getting enough sleep rarely find an eager audience in teenagers who have already decamped psychologically. These moments may be easier to navigate if we consider why adolescents act like tenants in the first place. It’s a huge developmental step to leave home, a step that teenagers don’t take all at once. Tweens usually begin the slow process of departing by closing their bedroom doors to do the exact same things they used to do with their doors wide open. In their last weeks around the house, adolescents travel the final stretch of this path. They practice living on their own while still enjoying, if they’re lucky, the safety and support of a loving home.

We shouldn’t give up on talking with teenagers about how they will care for themselves and treat others once they move out. But we should set aside the expectation of lengthy heart-to-heart talks. When teenagers are broadcasting their detachment, the most successful conversations may be the ones that begin, “It might seem like we’ve already covered this, but there are just a few things I want to touch base about before you go. I promise to keep it short.”

When soon-to-depart teenagers aren’t rubbing family members the wrong way or holed up in their rooms, they’re often nowhere to be found. Feeling confident in their ties to their parents, adolescents cling to their friends. Or they immerse themselves in efforts to resolve a meaningful high school romance. My years of working with teenagers have taught me that a surprising number of recent grads find themselves in pop-up entanglements that bloom, out of nowhere, in late summer.

Parents who are trying to cherish a teenager’s last days under their roof may be reluctant to split time with high school friends or a serious romantic partner, much less with a passing fling. But adults don’t need to take a teenager’s consuming social life as a personal rejection. The intense focus on peer relationships is often connected to the psychological strain of parting with family. A teenager who preoccupies himself with saying goodbye to his friends often manages to distract himself from difficult feelings about leaving his family. Agonizing about the future of an obviously doomed 11th-hour relationship beats tuning in to the full sadness of moving away from a beloved sibling.

It’s no picnic to send a teenager into the world. Most parents feel both wistful about the past and anxious (and perhaps even a bit envious) about their adolescent’s future. Must we add feeling at odds with or ignored by our teenagers to this emotional stew? Perhaps we could simply discuss these common post-grad dynamics with our adolescents, then go on to enjoy our last summer together.

We could. But we probably shouldn’t.

With their parting maneuvers, young people are subconsciously tempering the emotionally intense, landmark moment of leaving home. In moving out, teenagers give up almost everything they have ever known, with little grasp of what they are getting. It’s no surprise that they rely on adaptive, if sometimes off-putting, psychological defenses to buffer such a stressful transition.

As for the adults, there may be some comfort in knowing that high school graduation isn’t the end of parenting. It simply marks the next phase of it: the one where we bear with our teenagers as they find their way to the door.

Lisa Damour is a psychologist in private practice in Shaker Heights, Ohio, a clinical instructor at Case Western Reserve University and the director of Laurel School’s Center for Research on Girls. She is the author of “Untangled: Guiding Teenage Girls Through the Seven Transitions Into Adulthood.” Follow her on Twitter: @LDamour.

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For Teenagers, the Pleasure of ‘Likes’

Jim Wilson/The New York Times

Move over sex, drugs and rock ‘n’ roll. For today’s teenager, it’s all about the “likes.”

A “like,” for the uninitiated, refers to the positive feedback given to a post on social media. And new research shows that likes appear to be somewhat intoxicating to teenagers. The same reward center in the brain that is involved in the sensation of pleasure and activated by thoughts of sex, money or ice cream also is turned on when teenagers see their photos getting a lot of likes on social media.

To learn more about what drives social media use among teenagers, researchers at the University of California, Los Angeles, conducted a novel experiment in which they recreated a photo-sharing social network similar to Instagram. The paper was published in the journal Psychological Science.

To do the study, the researchers recruited 32 people ages 13 to 18 and told them they were participating in a small social network modeled after Instagram, where friends or followers can endorse an image or video by clicking on a heart-shape icon.

In the experiment, researchers asked the teenagers to contribute some of their own photos, and then had them come in to the lab to look at nearly 150 images – including fairly bland photos, images of risky behavior and some of the teens’ own photos – while scientists analyzed their brain activity with functional magnetic resonance imaging.

As part of the experiment, the teens could also see how many likes had been given to each photo. Although the researchers had assigned the likes as part of the experiment, the teenagers were given the impression that the endorsements came from their peers.

When the youngsters viewed images that had a lot of likes, there was greater activity in neural regions of the brain involved with reward processing, social cognition, imitation and attention, researchers said, compared with neural reactions when the teens looked at photos with fewer likes.

The effect was magnified when they saw an image they themselves had contributed which had received a large number of likes, researchers said.

Teenagers were more likely to give a like to an image that had already gotten dozens of likes, even if it was a fairly banal picture of a plate of food or a pair of sunglasses. They were less apt to like the same kind of image if it had gotten few likes.

While the experiment focused on only a small group, it seemed to capture peer pressure in real time. But peer pressure is not always a bad thing, said the paper’s lead author, Lauren Sherman, and may play a critical role in teens’ accrual of social and cultural knowledge that’s essential to their development.

“Conformity is part of adolescence, and some of it is normal,” said Ms. Sherman, who prefers the term “peer influence” to “peer pressure.” “It’s how teenagers learn the rules of how to communicate and how to develop relationships.”

When the adolescents viewed images suggesting risky behavior (such as a bag of marijuana or pack of cigarettes), they were still influenced by their peers’ likes, but to a lesser extent, Ms. Sherman said. The researchers also did not see the same activation of the brain reward center, although they don’t know why. Teenagers viewing risky photos also exhibited decreased activity in brain regions involved in cognitive control and response inhibition, the regions that Ms. Sherman described as those that “put the brakes on, that tell us to be careful.”

Kate Mills, a postdoctoral fellow in developmental cognitive neuroscience at the University of Oregon, agreed. “Peer pressure gets bad press when peers are influential in a negative direction, but peers can also be influential in a good way,” Dr. Mills said. “The wonderful thing about our reward circuitry is that it’s not just involved with things we think of as hedonistically pleasurable. This is a circuitry that’s involved in learning about the environment.”

The likes are “potentially serving as a social cue, orienting them to what is cool or socially appropriate,” Ms. Sherman said. “Learning about the social world is a really important task of adolescence.”

The Seven Words I Cannot Say (Around My Children)

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“Don’t be stife with the bacon.”

I said this to my teenage son while he was picking perfectly cooked strips of pig fat out of a grease-filled pan and laying them on a paper towel to drain. I already knew he was planning to allot me only one slice, adding the rest to his heaping plate of eggs.

He turned from the stove, eyes hard, and I was sure we were going to have the Bacon Fight. But instead he said, “Please don’t ever say that word again.”

There are seven words I am not permitted to utter in front of my kids: Stife, Clutch, Fire, Dope, Swag, Fo’ Shizzle and Chill.

Actually, “Chill” is borderline. Meaning, there are some occasions I can use that word and my sons don’t affect a look as if I’d started dancing in the kitchen in front of their friends. I’m not a bad dancer, and I can easily pull off half those words – but according to my sons, who are 16 and 21, I may do either only in private or with my own friends.

A quick trip to Urban Dictionary provides several meanings for “Stife.” My younger son and his friends employ its third definition: “Used to mean stingy in the very negative sense.” I’ve done my due diligence, and in my view, that’s my initiation fee. But to my boys, I’m barging up the ladder to the tree house, blatantly ignoring the sign that says Keep Out.

When my older son and his friends are together, listening to them talk is like trying to decipher the clicking of the Bantu. It’s all delivered so fast – recognizable words cavorting with the unfamiliar – and there’s not even a moment to ground myself in context clues. I think of it as a unique dialect, perhaps specific to our town – possibly even to our high school. I take in conversations as if they were pieces of music, having no real idea if they’re complaining about finals or making plans to gather somewhere on a Saturday night. But their dialogue feels alive, and I love it.

I like words and I always have. I spent years of my boring youth browsing Merriam-Webster the way some foodies might thumb through Yotam Ottolenghi’s books: not for any real purpose – just to absorb what’s there and what one might do with it. My parents liked words too, and when you grow up in a home rich with vocabulary, it feels good and right to be curious and expand your personal lexicon.

“Explain to me how to use ‘swag.’Give it to me in three sentences. I want to understand,” I’d say to my sons.

Response: “Go away.”

I want talking to be fun, and for me that means discovering new ways to say old things. When I hear my boys talk, it feels as if I’m witnessing the evolution of language in real time. It probably feels to them as it did to me at age 13, when my mother walked into my bedroom and suggested I get some “groovy” wallpaper and window shades that were what she pronounced as “psycha-DILL-ic.”

Deborah Tannen, a professor of linguistics at Georgetown University and author of “You’re Wearing THAT?,” bears this out. “Every group has its own language — terms, expressions, usages that come to characterize the group and give them a sense of belonging when they all use it. When outsiders try to use the language, it’s like they’re trying to break into the group or pretend to be members when they’re not,” Ms. Tannen said.

Sometimes the signals my kids send me are mixed, and that doesn’t help. I’m not allowed to call my beloved new boots “dope,” but if I refer to “weed” as “pot,” they correct me, making sure I’m using the more current vernacular.

Obviously, some of my verboten words are fine to use in a middle-aged context. I am free to say “clutch” if I happen to be in a manual transmission automobile, or talk about “fire” if I’m standing at the grill. But both those words mean something different when my sons use them – namely: great, awesome, fabulous. How tired am I of using the word “great” to signify my enthusiasm about something? What’s the big deal if I find a poppin’ new word to break up the monotony?

But to them it is a big deal.

“Kids at that age are particularly eager to establish their identities separate from their parents, which is why they start identifying with friends instead in the first place,” Ms. Tannen said.

I hold out my plate and meet my son’s eyes. “More bacon, please,” I say, as if he hadn’t just kicked me out of the clubhouse (again). We both know this isn’t really about bacon. It’s about connecting. And he knows he’s being stingy, but he doles out another slice –and it is fresh, in every sense of the word.


Jessica Wolf is a freelance writer and editor.


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Early Puberty in Girls Raises the Risk of Depression

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When girls come in for their physical exams, one of the questions I routinely ask is “Do you get your period?” I try to ask before I expect the answer to be yes, so that if a girl doesn’t seem to know about the changes of puberty that lie ahead, I can encourage her to talk about them with her mother, and offer to help answer questions. And I often point out that even those who have not yet embarked on puberty themselves are likely to have classmates who are going through these changes, so, again, it’s important to let kids know that their questions are welcome, and will be answered accurately.

But like everybody else who deals with girls, I’m aware that this means bringing up the topic when girls are pretty young. Puberty is now coming earlier for many girls, with bodies changing in the third and fourth grade, and there is a complicated discussion about the reasons, from obesity and family stress to chemicals in the environment that may disrupt the normal effects of hormones. I’m not going to try to delineate that discussion here — though it’s an important one — because I want to concentrate on the effect, rather than the cause, of reaching puberty early.

A large study published in May in the journal Pediatrics looked at a group of 8,327 children born in Hong Kong in April and May of 1997, for whom a great deal of health data has been collected. The researchers had access to the children’s health records, showing how their doctors had documented their physical maturity, according to what are known as the Tanner stages, for the standardized pediatric index of sexual maturation.

Before children enter puberty, we call it Tanner I; for girls, Tanner II is the beginning of breast development, while for boys, it’s the enlargement of the scrotum and testes and the reddening and changing of the scrotum skin. Boys and girls then progress through the intermediate changes to stage V, full physical maturity.

In this study, the researchers looked at the relationship between the age at which children moved from Tanner I to Tanner II — that is, the age at which the physical beginnings of puberty were noticed — and the likelihood of depression in those children when they were 12 to 15 years old, as detected on a screening questionnaire.

“What we found was the girls who had earlier breast development had a higher risk of depressive symptoms, or more depressive symptoms,” said Dr. C. Mary Schooling, an epidemiologist who is a professor at the City University of New York School of Public Health, and was the senior author on the study. “We didn’t see the same thing for boys.” Earlier onset of breast development in girls was associated with a higher risk of depression in early adolescence even after controlling for many other factors, including socioeconomic status, weight or parents’ marital status.

Other studies, including in the United States, have shown this same pattern, with girls who begin developing earlier than their peers vulnerable to depression in adolescence. Some studies have found this in boys, though it’s not as clear. But there is concern that girls whose development starts earlier than their peers are at risk in a number of ways, and across different cultural backgrounds.

“Early puberty is a challenge and a stress, and it’s associated with more than depression,” said Dr. Jane Mendle, a clinical psychologist in the department of human development at Cornell University. She named anxiety, disordered eating and self-injury as some of the risks for girls. In her studies of puberty, she has found associations between early development and depression in both genders in New York children. In boys, the tempo of puberty was significant, as well as the timing; boys who moved more rapidly from one Tanner stage to the next were at higher risk and the increased depression risk seemed to be related to changes in their peer relationships.

Before puberty, Dr. Mendle said, depression occurs at roughly the same rate in both sexes, but by the midpoint of puberty, girls are two and a half times more likely to be depressed than boys.

Some of these children may already be at risk; Dr. Mendle said that early puberty is more common in children who have grown up in circumstances of adversity, in poverty, in the foster care system. But some of it is heredity and some of it is body type and some of it, probably, is chance.

Researchers have wondered about hormonal associations with depression; Dr. Schooling pointed out that their study found that depression was associated with early breast development, controlled by estrogens, but not with early pubic hair development, controlled by androgens. “There is no physical factor that we know about that would explain this; estrogen has been eliminated as a driver of depression in earlier research,” she said in an email. “We probably need to explore social factors to seek an explanation.” They also plan to follow up with their study population at age 17.

The biological transition of puberty, of course, occurs in a social and cultural context. One very important effect of developing early, Dr. Mendle said, is that it changes the way that people treat you, from your peers to the adults in your life to strangers. “When kids navigate puberty they start to look different,” she said. “It can be hard for them to maintain friendships with kids who haven’t developed, and we also know that early maturing girls are more likely to be harassed and victimized by other kids in their grade.”

Parents should be aware of the difficulties that children may experience if they start puberty earlier than their peers, but lots of children handle early development with resiliency, and even pride.

Children who start puberty early – say, 8 instead of 12 — are faced with handling those physical changes while they are more childlike in their knowledge and their cognitive development, and in their emotional understanding of what goes on around them.

Parents should keep in mind that the same protective factors that help children navigate other challenges of growing up are helpful here: All children do better when they have good relationships with their parents, and when they feel connected at school. And we should be talking about the changes to their bodies before they happen, and make it clear that all of these topics are open for discussion.

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How Much Do You Know About Raising Introverted Teenagers?

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One-third to one-half of all of us, including teenagers, are introverted, preferring quieter, more minimally stimulating environments. Test your knowledge of introverted teenagers with this quiz.

Susan Cain is the author of “Quiet Power: The Secret Strengths of Introverts” and  “Quiet: The Power of Introverts in a World That Can’t Stop Talking.” This quiz was adapted from those books, and from How Much Do You Know About Quiet Children on her website, quietrev.com.

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Is Your Teen’s Introversion a Problem for Your Teen — or for You?

When Cali Yost was a teenager, she loved having a busy social life. But her teenage daughter Maddie is different. Even in elementary school, she loved her friends, but sometimes turned down invitations to their homes.

“I would have chosen a playdate every day,” said Ms. Yost, a Madison, N.J., workplace consultant. For this outgoing parent, it’s been a challenge to accept that her child, now 15, still has less interest in the kind of busy social life she herself craved.

As many as one-third or half of all people are introverts, and that includes teenagers, says Susan Cain, whose new book, “Quiet Power: The Secret Strengths of Introverts,” focuses on the challenges that introverts face during their middle-school and high school years.

“There’s such an expectation that teenagers will embrace this natural rhythm of going from one thing to another,” and will be at their happiest when surrounded by other teens, said Ms. Cain.

Parents worry when teenagers don’t fit that mold, and schools and teachers often still favor the more outgoing child, said Ms. Cain, author of the 2102 best seller “Quiet.”

Children who match what she calls the “extroverted ideal” (charismatic, talkative, always surrounded by friends) are more readily seen as happy and successful, even within their own families. It’s much harder for parents like Ms. Yost to know whether a quieter child is making her own choice to be alone or if she is feeling excluded.

“I hear from extroverted parents all the time,” Ms. Cain said. “They derive so much pleasure from being in the mix socially that it’s hard for them to really understand a child who would rather stay home.’

Even parents who share a child’s quieter characteristics aren’t immune from worry, she said.

“For introverted parents, it’s easy to understand and relate to an introverted child’s needs and preferences,” Ms. Cain said. “But if we have a lingering discomfort or sense of shame about our own introversion, we tend to assume it’s going to be that way for our teen.”

Both kinds of parents, she said, need to check their own mental outlook. “Do you see your teen’s personality as wonderful, or as a detriment that you have to overcome?” Parents who appreciate a teen’s quieter temperament can help him to embrace it and at the same time encourage him to push past the reluctance or even fear that sometimes accompanies introversion if it’s limiting his opportunities. But knowing when to push, and when to back off, is a challenge.

That was true for Karen Brown, a public radio reporter in Northampton, Mass., and an extroverted parent who has long struggled with her son’s introversion.

“This is exactly the age when he needs to be putting himself out there,” she said, referring to building his college applications and recommendations. “But because the stakes are higher doesn’t mean his personality has changed.”

She’s gently pushing him toward summer opportunities, and encouraging him to spend more time talking with teachers, coaches and guidance counselors. At the same time, she’s had to accept that his version of putting himself out there might not look like hers. She might think he should apply for five summer positions; he might inquire about one, but immediately go after the job. “There are things he does that surprise me and remind me that I don’t always understand how well he’s finding his way with his peers or in the world at large,” she said.

Ms. Yost is particularly conscious of the need to allow her daughter to find her own way. “I was an extrovert raised by introverts, and that was sometimes hard,” she said. “When I realized she and I were different I very consciously did not want to repeat that pattern.” Ms. Yost has found that she can help Maddie to find the right approach when she has to decide whether to stay home one night or join in when her friends get together.

“I remind her, ‘you said no a bunch of times so they may think you don’t want to come.’ That means you may have to make an extra effort next time,” she said. She also points out that her daughter’s more extroverted friends look at their gatherings differently. “They assume that if you want to be there, you’ll just go. They don’t sit back and wait to be invited.” She helps Maddie fight her natural tendency to worry about intruding and join in when she’s ready.

When Ms. Brown thinks her son needs to take a chance on a social gathering, she makes a deal with him — she’ll come to get him within an hour. “I get there in 55 minutes,” she said — and even when he seems to be enjoying himself, he’s also ready to go. That wouldn’t be her decision, but she’s learned to respect his.

Even parents who push on occasion also need to recognize that teenagers have reasons for the choices they make. “There are many weekend nights where it’s been a long week, and she’s just had it,” Ms. Yost says of her daughter. And some teenagers may deliberately avoid social situations that they know (but don’t want their parents to know) will include alcohol, drugs or sexual pressures.

One key, said Ms. Cain, is to consider — or ask your teenager to consider — whether he or she is making a decision out of a perfectly legitimate need or preference, or out of fear or discomfort. That will help prepare them to weigh their own choices when they’re in college and need to decide when to push themselves.

What’s most important, Ms. Cain said, is that children feel that it’s O.K. to be quieter than the typical teen.

“They need the freedom to say, ‘that’s not my thing,’” she said.

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Talking With Teenagers About Marijuana

Hilary Swift for The New York Times

Parents of teenagers face a confounding crosscurrent. While the legalization of marijuana in several American states now bolsters the common belief among adolescents that the drug is safe for recreational use, research documenting marijuana’s diffuse and possibly permanent harm to the teenage brain continues to pile up.

Normally developing teenagers question authority and are likely to be skeptical of adults bearing bad news about a widely used party drug. So how do we have successful conversations about the hazards of marijuana use? An open-ended exchange that credits the adolescent’s own observations may do more good than a single sit-down or lecture. Beyond that, we might consider how the facts are often received by adolescents.

With all the talk about cannabis legalization, parents may feel compelled to remind their teenagers that recreational marijuana is still banned for most American adults and for anyone under 21. Adolescents who use marijuana risk immediate legal consequences and, in districts with zero-tolerance policies, may be barred from organized school activities, suspended or expelled. They may also face long-term penalties affecting some jobs, internships, colleges and travel visas.

But the repercussions of being caught with marijuana don’t faze all teenagers. Most adolescents can name celebrities, famous athletes and classmates who use marijuana regularly, even flagrantly, without running into trouble. Teenagers tend to bristle at rules that seem arbitrary, such as the state-by-state regulations for marijuana and the fact that alcohol, which has a lot in common with pot, is legal. Further, adolescents can be understandably cynical about laws that aren’t applied evenly to everyone: While African-Americans and whites use the drug at similar rates, African-Americans are nearly four times as likely to be arrested for marijuana possession. However real and lasting the penalties for pot use may be, parents often run into resistance when trying to make this case to teenagers.

Taking another tack, adults sometimes point out that marijuana obtained through illegal channels may contain dangerous additives. This is one of the arguments for legalizing cannabis, and a great reason to abstain from sampling illegal drugs. We can note to our teenagers that, even if they trust the person offering them marijuana, somewhere down the line that drug was likely to have come from a dealer who doesn’t know or care about them.

While true, this claim often falls on doubtful adolescent ears. Most teenagers are aware of peers who smoke pot regularly, but few are aware of an incident where marijuana was indisputably laced with another substance. Adolescents know that frightened and well-meaning adults sometimes overstate dangers to make a point. Accordingly, teenagers weighing adult warnings against their own observations may conclude that mystery marijuana is more of an urban legend than a plausible risk.

Our most successful conversations might be the ones where we join our teenagers in questioning authority – that is, discussing what legalization does, and doesn’t, mean. Indeed, it’s easy to be on the right side of the law and the wrong side of science. Cigarettes and tanning beds serve as handy examples of legal ways to harm yourself. Savvy consumers are expected to look to the available evidence, not legislation, when making decisions about their own health and well-being. In terms of the science of marijuana, we know that adolescence marks a critical period of neurological development and that cannabis is harder on the developing teenage brain than on the comparatively static adult brain. Specifically, studies suggest that regular marijuana use during adolescence harms the parts of the brain responsible for learning, reasoning and paying attention.

Some teenagers will point out that research linking marijuana to neurological impairment often hinges on correlations. Teenagers may use pot because they have cognitive challenges, not the other way around. In a helpful clarification, a recent study in the journal Cerebral Cortex implicates the drug in brain impairment. The study found that, over time, the brain’s information processing centers flourished in the cannabis-free research participants and withered in the marijuana users. The same research also added to the body of evidence that regular pot use during adolescence lowers intelligence and slows mental functioning.

In talking with teenagers about emerging neurological findings, adults might say, “Whatever happens with the laws, I hope you’ll keep your eye on the science. You only get one brain for your whole life. I’m rooting for you to take great care of it.” Some parents underscore their safety-first approach by promising to spring their teenager, consequence-free, from bad situations involving drinking, drugs or any other dangers the parents may have asked their adolescent to avoid.

Adults can use the evolving marijuana regulations as a jumping-off point to talk with teenagers about how they’ll approach any number of dicey decisions. When discussing drugs, drinking, driving and other risky business, we can note that no authority – neither parents nor the government – can be trusted to supervise teenagers all of the time. Adolescence centers on the wish for independence. And independence centers on the willingness to look after oneself.

Lisa Damour is a psychologist in private practice in Shaker Heights, Ohio, a clinical instructor at Case Western Reserve University and the director of Laurel School’s Center for Research on Girls. She is the author of “Untangled: Guiding Teenage Girls Through the Seven Transitions Into Adulthood.” Follow her on Twitter: @LDamour.

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Bodily Changes Are Driving Girls Out of Sports

Harriet Lee-Merrion

Spring, finally!

So why aren’t more teenage girls out on the playing fields?

Research shows that girls tend to start dropping out of sports and skipping gym classes around the onset of puberty, a sharp decline not mirrored by adolescent boys.

A recent study in The Journal of Adolescent Health found a surprisingly common reason: developing breasts, and girls’ attitudes about them.

In a survey of 2,089 English schoolgirls ages 11 to 18, nearly three-quarters listed at least one breast-related concern regarding exercise and sports. They thought their breasts were too big or too small, too bouncy or bound too tightly in an ill-fitting bra. Beginning with feeling mortified about undressing in the locker room, they were also self-consciously reluctant to exercise and move with abandon.

Experts on adolescent health praised the study for identifying and quantifying an intuitive thought.

“We make assumptions about what we think we know, so it’s important to be able to say that as cup size increases, physical activity decreases for a lot of girls,” Dr. Sharonda Alston Taylor, an assistant professor of pediatrics at Baylor College of Medicine in Texas, who focuses on adolescent obesity.

The challenge is what to do about it.

After reading the study, some pediatricians and adolescent health specialists said they needed to do a better job informing girls about breast health and development. Almost 90 percent of the girls in the study said they wanted to know more about breasts in general, and nearly half wanted to know about sports bras and breasts specifically with respect to physical activity.

Joanna Scurr, the lead author of the study and a professor of biomechanics at the University of Portsmouth in England, said the breast itself had little internal support, so when a girl’s body moved, the breast moved independently, and the movement increased with breast size. In up to 72 percent of exercising women, she said, that movement was a cause of breast pain or discomfort.

Yet while sports and physical education programs frequently recommend protective gear for boys, like cups, athletic supporters and compression shorts, comparable lists for young women rarely include a mandatory or even recommended sports bra.

Only 10 percent of the girls surveyed said they always wore a sports bra during sports and exercise. More than half had never worn one.

Dr. Taylor said that lack of education about bra fitting and sizing was commonplace in her practice.

“The mom will say, ‘I don’t know what size she is,’ and the patient will say, ‘I just grab my sister’s or my mother’s bras to wear.’”

Using data from this study and others, the researchers from sports and exercise health departments at three British universities are trying to design school-based educational programs.

When researchers asked the girls how they would prefer to receive breast information — via a website, an app, a leaflet or a private session with a nurse — the overwhelming majority replied that they wanted a girls-only session with a female teacher.

At what age? “Most of them said 11,” Dr. Scurr said.

Andria Castillo, now 17 and a junior at Mather High School in Chicago, says she remembers that when she was around that age, she was painfully self-conscious about her breast size; she thought she was developing more slowly than everyone else.

“I felt boys and girls were making fun of me,” she said. “Even though no one called me out, I felt they were, behind my back. I was taking taekwondo, and I would look in the big mirror and try to find ways to cover myself up and hide. I asked my dad if I could stop going.”

She had a friend who had been active in sports. But in the sixth grade, the girl’s breasts developed rapidly. “She eventually stopped going to gym altogether,” Ms. Castillo said. “Instead, she just went to a classroom and did her homework.”

In time, Ms. Castillo turned her attitude around; she is now on her school’s varsity water polo and swim teams. She credits not only her mother, but also a Chicago-based project, Girls in the Game, which has body-positive, confidence-building programs, including single-sex athletics.

Some experts in female adolescent obesity and fitness suggested that young girls would be more comfortable in single-sex gym classes. But others said that option had its disadvantages, too.

Kimberly Burdette, a doctoral candidate in psychology at Loyola University Chicago who looks at the psychological factors that promote well-being and healthy weight in girls, says such separation might be helpful at a time when adolescent girls had a heightened awareness that others were looking at their bodies.

“It’s hard to be in the zone, focusing on athletic movement, on what your body can do, if you’re thinking about what others think your body looks like,” she said. “I like programming that is for girls only, where a girl can try a sport, regardless of her ability, without the male gaze.”

But Elizabeth A. Daniels, an assistant professor of developmental psychology at the University of Colorado Colorado Springs, disagreed. “I’m not sure the concern or embarrassment is always just about boys,” she said, noting that girls can make derisive comments about one another. “So do we change the structure of the gym class or address respectful behavior?”

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Gap Year May Have Benefits Long After College

Not every child who gets into college is ready to go. For some, taking a “gap year” — deferring admission for a year after high school graduation — may prove invaluable, helping a child thrive in college and after graduation as well. That’s among the messages in Jeffrey J. Selingo’s newest book, “There Is Life After College: What Parents and Students Should Know About Navigating School to Prepare for the Jobs of Tomorrow.”

Many colleges now endorse the gap year, including Harvard, which “encourages admitted students to defer enrollment for one year to travel, pursue a special project or activity, work or spend time in another meaningful way.” Students who take time off tend to do better academically and are more likely to be satisfied with their choices after graduation, and we’ve written about how students who take time off may be able to make better choices about things like alcohol and sex and have a better understanding of what they want from college. As Lisa Damour, who writes a column on adolescents for Well Family, puts it, “teenage years are like dog years: a year of maturation at age 18 is worth at least seven in later life.”

But parents often remain dubious about the gap year, worried that their student, once off education’s main highway, will never attend college at all. High school guidance counselors, who may be judged by the number of seniors who attend college rather than the number who graduate, don’t always support the idea, either. And funding a gap year can feel like a barrier for many families — some programs can cost the equivalent of a year’s tuition. Those that don’t can be as challenging to get into as college itself. City Year, for example, which receives funding from AmeriCorps and which pays students to tutor in schools around the country, selects 2,700 students from among 13,000 applicants.

Mr. Selingo, a professor at the University of Arizona and a former top editor at the Chronicle of Higher Education, says parents should let go of their fears. In his book, he explores what happens to our children after they graduate from college – and why it doesn’t look much like the journey we ourselves took a generation or so ago. A lot has changed, he says, and those changes make a gap year more valuable than ever.

“It used to be that if you could get into college and graduate, you were essentially golden,” Mr. Selingo said. Once a child was admitted to college, “parents could breathe a giant sigh of relief and essentially say, as long as you graduate, you’re O.K.”

That’s no longer true, he says. “College has changed. Recruiting has changed. The economy has changed.” Some students may sprint straight toward traditional success, while others wander along the way or appear to straggle behind. For parents of adult children in those last groups, helping them to find the time and space to mature into the life they want is critical. A gap year is one of the many options he describes for helping students form their own understanding of why they’re going to college, and what they want once they get there.

“We shouldn’t rush this transition,” Mr. Selingo said. “We are rushing too many kids off to college who aren’t ready or don’t know why they’re there.”

It’s important, Mr. Selingo noted, that the gap year itself be meaningful. “Students who delay college to work odd jobs for a while to try to ‘find themselves’ don’t do as well as everyone else when they get to college,” he writes. “They get lower grades, and there’s a greater chance they will drop out.” A gap year needs to provide either “meaningful work experience, academic preparation for college, or travel that opens up the horizon to the rest of the world.” It’s also important that a student has a plan for closing the gap — Mr. Selingo, like many others, recommends that students apply for and accept a place in college before starting a gap year.

To increase their investment in the gap year experience, some students can find meaningful work experience, perhaps working as a nanny or as a language instructor overseas. Others might work those odd jobs with the goal of funding, or partially funding, a paid gap experience. Even if parents end up footing all or most of the bill, though, Mr. Selingo argues that it’s worth it. At most public universities, fewer than 20 percent of students graduate in four years. Many students take six years to finish a degree, or never finish at all. An investment in a gap year, he writes, “might be money saved later if students are more directed when they eventually go to college.”

Above all, parents and students should think of a gap year not as a break in an education, but as a part of it. “We need to remember that lifelong education is no longer rhetoric, but reality,” said Mr. Selingo. “We still think of an education as this thing you get, at this one place, once in your life,” he said. “That’s not the way it works anymore.”

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Where’s the Magic in Family Dinner?

John Donohue and Sarah Schenck, from Brooklyn, eat dinner with their family, Aurora, 7, and Isis, 5.

John Donohue and Sarah Schenck, from Brooklyn, eat dinner with their family, Aurora, 7, and Isis, 5. Richard Perry/The New York Times

Like many families, we strive to eat dinner together as often as possible. And when my husband and I meet our tween and her younger sister at the table, we sometimes have worthwhile conversations or manage to crack each other up. But, at least as often, dinner devolves into a failing effort to find out what happened at school or a nag-fest over mealtime manners. After an especially short or harried supper, I can find myself wondering how the family gathering that just transpired could possibly help to raise my daughters’ grades, improve their psychological well-being or lower their risk of substance abuse.

I’m not the first to question whether family dinners are truly responsible for the many happy results to which they are famously linked. If we zoom out from the tight focus on the evening meal, we can see bigger picture factors that, in their own right, support positive outcomes for children while also helping families get to the dinner table. For example, one study of adolescents found that living in an economically secure home with both biological parents accounted for some, but not all, of the benefits that are typically chalked up to family meals.

Still, eating together seems to have effects that go beyond the advantages of having financial means or married parents. So what accounts for the magic of the evening meal, especially when sparkling banter is a fickle dinner guest in most homes? Reflecting on the families I’ve worked with in my practice, I’ve come to suspect that regular meals serve as an easily measured proxy for one of the longest-standing and sturdiest determinants of adolescent well-being: authoritative parenting.

In the early 1970s, the psychologist Diana Baumrind identified two essential components of parenting: structure and warmth. Authoritative parents bring both. They hold high standards for behavior while being lovingly engaged with their children. Decades of research have documented that teenagers raised by authoritative parents are the ones most likely to do well at school, enjoy abundant psychological health and stay out of trouble. In contrast, adolescents with authoritarian parents (high on structure, low on warmth), indulgent parents (low on structure, high on warmth) or neglectful parents (low on both) don’t fare nearly so well.

What does this have to do with dinner? Getting adolescents to the table requires a surprising amount of structure; it’s not easy to hold the expectation that our teenagers will join us even for a quick bite. If it were, we wouldn’t have a recent report showing a decline in adolescents eating dinner with their parents despite the many loud champions of the family meal. Securing a teenager’s mealtime presence serves up further opportunities for authoritative structure. Adolescents can prepare or clean up the spread, or field questions about their summer employment plans. Luckily, the rewards of authoritative parenting do not require an enthusiastic teenage response.

Simultaneously, getting parents to the supper table presumes a degree of warmth. To make a priority of spending mealtimes with our children, we must manage our own commitments and slay the scheduling dragons that keep us from family dinner. Then there’s the caring gesture of putting a meal together and the fact that we are setting the table for the possibility of enjoying one another’s company. In short, to find a teenager and at least one parent sharing a regular meal suggests the presence of authoritative parenting and all the good that goes with it.

Viewing dinner through Dr. Baumrind’s lens helps me fret less about our rushed or unhappy meals. Simply making it to supper together may be a win unto itself. And focusing on the broad factors of structure and warmth reminds me that, as with many aspects of family life, there are lots of ways to get it right. If a family’s schedule means that dinner can’t happen, maybe breakfast can. Indeed, planned meals are just one of many routine interactions that can weave structure and warmth into the fabric of family life.

Of course rigidly observing mealtimes, or any other ritual, cannot guarantee that our adolescents will go on to lead contented and fulfilling lives. But for parents who are looking to communicate high expectations and an interest in their children, aiming to dine together isn’t a bad place to start. Shared meals are likely to be both a cause and a consequence of a sustaining family life. Either way, let’s eat.

Lisa Damour is a psychologist in private practice in Shaker Heights, Ohio, a clinical instructor at Case Western Reserve University and the director of Laurel School’s Center for Research on Girls. She is the author of “Untangled: Guiding Teenage Girls Through the Seven Transitions Into Adulthood.” Follow her on Twitter: @LDamour.

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Study of Teenagers Asks: Who’s Happier, Boys or Girls?

Teenagers in Hungary. A W.H.O. report on the well-being of European adolescents found that 15-year-old girls were perhaps the worst off of any group surveyed.

Teenagers in Hungary. A W.H.O. report on the well-being of European adolescents found that 15-year-old girls were perhaps the worst off of any group surveyed. Dave Yoder for The New York Times

Belgian and Polish adolescents are among the least happy in Europe, more than half the teenagers in Greenland smoke, and Eastern European boys are far more likely than girls to have had sex, according to a report from the World Health Organization. But over all, the report found, 15-year-old girls were perhaps the worst off of any group surveyed.

The report on adolescent health and happiness was based on surveys of more than 200,000 young people in 42 countries in Europe and North America. Conducted mainly between September 2013 and June 2014, it was released on Tuesday. (American teenagers did not participate.)

Partly titled “Growing Up Unequal,” the report found that 15-year-old Polish, British and French girls were among those expressing the least satisfaction with their lives. They were the most likely to report a decline in their well-being, and on average, one in five reported poor or fair health. They also displayed an increased dissatisfaction with their bodies, “particularly in western and central European countries, despite actual levels of overweight and obesity remaining stable,” the report said.

W.H.O.’s regional director for Europe, Zsuzsanna Jakab, wrote, “Despite the considerable advances made in the W.H.O. European Region over the decades in improving the health and well-being of young people and recent actions to reduce the health inequalities many of them face, some remain disadvantaged from birth by virtue of their gender.”

Boys reported higher life satisfaction over all. But the report highlighted some elevated risk factors for male adolescents. It found that boys were more likely to engage in physical fights and to experience injury. They smoked tobacco and drank alcohol more often, though in some countries, gender differences in those behaviors were narrowing “as girls adopt behaviors typically regarded as masculine.”

Early tobacco use has declined significantly since 2010, the last time the study was conducted. In many countries, fewer than 20 percent of 15-year-olds reported smoking at least once a week. But in Greenland, 53 percent of girls and 51 percent of boys said they smoked at least weekly.

Drinking was heavily skewed by gender in many countries, with 15-year-old boys in Croatia, Malta, Bulgaria and Italy reporting some of the highest incidences of alcohol use. On average, 16 percent of 15-year-old boys drink alcohol at least once a week; the number for girls is 9 percent.

Frequent marijuana use was also divided along gender lines —in some countries, boys used the drug more than girls — though that factor seemed to matter less where it was most popular. French and Canadian 15-year-olds were among the most enamored of marijuana, with boys and girls similarly reporting they had used it in the previous 30 days. Over all, 15 percent of those surveyed had used.

Boys were more likely than girls to have had sexual intercourse in about half the countries and regions surveyed, particularly in Eastern Europe. Forty percent of male 15-year-olds surveyed in Bulgaria said they had had sex, compared with 21 percent of female Bulgarians of the same age. The numbers were even more skewed in Albania, where 39 percent of boys there said that they had had sex, while 2 percent of girls the same age reported such behavior. Over all, 21 percent of the 15-year-olds surveyed reported having sex.

Apart from surveying the habits and health practices of young people, the latest report added new questions to track the health risks posed to the thousands of young migrants uprooted from their homes, and warned that new communications technology could prove a double-edged sword, particularly when it comes to young people bullying their peers over social media.

“Technology is unquestionably a positive presence in all our lives, but we must remain vigilant to the threats it poses to children and young people,” Jo Inchley and Dorothy Currie, two executives who helped coordinate the study, wrote in its preface.

The report concluded that policy makers must strive to recognize girls’ unhappiness and find structural solutions, and called for efforts to address the “clear gender-difference issue.”

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The Best Way to Fight With a Teenager

iStock

When raising teenagers, conflict usually comes with the territory. A growing body of research suggests that this can actually be a good thing. How disagreements are handled at home shapes both adolescent mental health and the overall quality of the parent-teenager relationship. Not only that, the nature of family quarrels can also drive how adolescents manage their relationships with people beyond the home.

In looking at how teenagers approach disputes, experts have identified four distinct styles: attacking, withdrawing, complying and problem solving.

Adolescents who favor either of the first two routes — escalating fights or stubbornly refusing to engage in them — are the ones most likely to be or become depressed, anxious or delinquent. But even those teenagers who take the third route and comply, simply yielding to their parents’ wishes, suffer from high rates of mood disorders. Further, teenagers who cannot resolve arguments at home often have similar troubles in their friendships and love lives.

In contrast, teenagers who use problem solving to address disputes with their parents present a vastly different picture. They tend to enjoy the sturdiest psychological health and the happiest relationships everywhere they go, two outcomes that would top every parent’s wish list.

So how do we raise teenagers who see disagreements as challenges to be resolved?

Compelling new research suggests that constructive conflict between parent and teenager hinges on the adolescent’s readiness to see beyond his or her own perspective. In other words, good fights happen when teenagers consider arguments from both sides, and bad fights happen when they don’t.

Conveniently, the intellectual ability to consider multiple outlooks blossoms in the teenage years. While younger children lack the neurological capacity to fully understand someone else’s point of view, adolescence sparks rapid development in the parts of the brain associated with abstract reasoning. This leads to dramatic gains in the ability to regard situations from competing viewpoints. We also have evidence that parents can make the most of their teenagers’ evolving neurobiology by being good role models for taking another person’s perspective. Adults who are willing to walk around in their teenagers’ mental shoes tend to raise teenagers who return the favor.

But research findings rarely translate cleanly to the realities of family life. Conflict comes with heat, and we can only contemplate another person’s viewpoint when heads are cool. Imagine an adolescent announcing his plan to spend Saturday night with a former friend known for serious wrongdoing. Any reasonable parent might respond “Absolutely not!” and trigger an eruption, retreat or gloomy submission in a normally developing teenager.

An interaction that ends here is an opportunity lost. But hard starts can be salvaged if we allow for the possibility that first reactions can give way to second ones. The parent in this scenario might soon find a way to say, “I’m sorry that got ugly. I need you to help me understand why you want to spend time with Mike when you don’t even like him that much. And can you put words to why I’m so uncomfortable with the idea of you hanging out with him?”

No parent or teenager can, or needs to, turn every dispute into a thoughtful consideration of opposing outlooks. And some families weather toxic battles that go far beyond the squabbles inherent in raising adolescents. Still, the balance of research suggests that garden-variety disagreements offer the opportunity to help young people better understand themselves and others, building in them the lifelong skill of finding room for civility in the midst of discord.

No parent looks forward to fighting with his or her teenage child. But the friction that comes with raising adolescents might be easier to take when we see it as an opening, not an obstacle.

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The Always Hungry Teenage Boy

Anna Parini

Ah, the adolescent male appetite. Those always hungry growing boys who eat standing up, drain the quart containers of milk or juice, and are fully capable of finishing off as an after-school snack the whole lasagna or pot of stew or cold roast beef that was supposed to serve as dinner for the family. I have come home to this myself: the teenager who greets his parents in the evening with an empty refrigerator, a sink full of dirty dishes, and the hopeful question, “What’s for dinner?”

In January, when the recently revised Dietary Guidelines for Americans came out, adolescent boys were specifically mentioned in a slightly unexpected context: “Some individuals, especially teen boys and adult men, also need to reduce overall intake of protein foods by decreasing intakes of meats, poultry and eggs, and increasing amounts of vegetables or other underconsumed food groups.”

Are teenage boys eating too much protein? What do we actually know about the dietary habits of adolescent males, beyond the sitcom jokes?

Dr. Elsie Taveras, the chief of general pediatrics at Massachusetts General Hospital for Children, is an expert on childhood obesity. “The forces that are working against good diet quality in adolescent boys,” she told me, begin with that famous appetite. “They’re always hungry, and that hunger, and a lack of satiety with small portions, leads to impulsive eating and eating large portions. And the foods they are choosing aren’t really keeping them full, since foods with high fiber levels are the kinds of foods which do keep people full.”

The dietary guidelines include graphs of what people in different age groups eat, drawing on data from the large National Health and Nutrition Examination Survey and showing, for each food group and at each age, how those amounts compare with the recommended daily intake. No one will be surprised to hear that when it comes to vegetables, both males and females of all ages eat significantly less than what is recommended.

For protein, the graphs look very different. For males, intake rises steadily from the 9- to 13-year-old category up through 31- to 50-year-olds, so that by the time they reach late adolescence and young adulthood, males report eating significantly more protein than recommended. Females, on the other hand, report eating quantities at the bottom of the daily standards, and 14- to 18-year-old girls say they’re eating less protein than recommended.

“There’s so little research focused just on boys,” said Alison Field, an obesity and eating disorders expert who is the chairwoman of epidemiology at the Brown University School of Public Health. “We know that at puberty, boys will acquire more muscle mass, and females will end up with more fat mass,” she said. “When males go through their growth spurt, which is longer than females’, their appetite is tremendous.”

These hungry fellows have big appetites, and as a group, they don’t tend to fill up on salad. So the primary dietary advice for them is probably “eat more vegetables,” and the hope is that would mean less meat. “What this recommendation really says is that teen boys should be eating more of their calories from vegetables but less from meat to better balance their nutrient intake,” Marion Nestle, a professor of nutrition, food studies and public health at New York University wrote in an email.

We know as much as we do about the dietary habits of teenage girls because there has been so much concern about obesity and also eating disorders. Many, if not most, adolescent girls are trying to lose weight whether they need to or not. Eating disorders are less common in males, but adolescent boys, on the other hand, are often preoccupied with building muscle, particularly if they are athletes in a sport like football, where size matters. “Males may want to bulk up, may want to be big,” Dr. Field said.

“We really underestimate how important weight and shape are to males,” she told me, suggesting that airbrushed images of models and sports figures in the media promise quick results. “Young men are just as influenced as young women by these images.”

The extra protein in the supplements that many boys buy in hope of bulking up may be useless. “The body can only absorb so much protein,” said Jerel Calzo, a developmental psychologist who studies eating disorders in adolescent males and is an assistant professor of pediatrics at Harvard Medical School. Boys who are eager to build muscle may exceed the recommended amounts, he said. “If you’re doubling up, you’re only getting the extra calories — sugars and fats.” Further, he said, the supplements are under-regulated, and the marketing is often deceptive.

In the worst-case scenario, these protein supplements can damage your kidneys, especially if you get dehydrated, so boys who dabble in protein supplements have even more reason to keep drinking fluids. But again, that can lead to problems, since sports drinks, also heavily marketed to young men with athletic ambitions, include additional refined sugars and empty calories. “We do a lot to push the fact that children don’t need sports drinks,” Dr. Taveras said. “Water is just fine.”

Although some teenage boys are clearly preoccupied with their bodies, others manage to eat their way right through adolescence without ever making very clear connections between any aspects of diet and health.

The unbounded adolescent male appetite, the athletic ambitions and the concomitant desire to add muscle, taken together with the very deliberate drumbeat of marketing, can add up to a poor diet. “To me, protein is a nonissue,” Professor Nestle said. “You can’t talk about protein in isolation from everything else people eat.”

The most essential message for adolescent boys and young men is a variant of the basic unsurprising message in the overall report: Eat more vegetables, and substitute healthier, less processed foods for the junk. Oh, and while you’re at it, guys, be careful of the protein powders. By and large, extra protein is not what you need.

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