Tagged Teenagers and Adolescence

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Adolescence

How to Help a Teen Out of a Homework Hole

The more students fall behind in the pandemic, the less likely they are to feel that they can catch up.

Credit…Marta Monteiro

Feb. 26, 2021, 2:33 p.m. ET

Pandemic school is taking its toll on students, especially teens. A recent study, conducted by NBC News and Challenge Success, a nonprofit affiliated with the Stanford Graduate School of Education, found that 50 percent more kids in high school report feeling disengaged from school this year than last. In December, Education Week reported that schools were seeing “dramatic increases in the number of failing or near-failing grades” on report cards.

A major symptom of school disengagement is not turning in homework, a problem that can easily snowball. The further students fall behind, the more overwhelmed they often become and the less likely they are to feel that they can catch up.

The good news is that finding out about missing homework is a first step to helping kids get back on track. You just need to keep a few considerations in mind.

Empathy will get you further than anger

At this point in the pandemic, finding out that your child has let schoolwork slide may trigger an angry response. Everyone is worn down by the demands of pandemic life and many parents are already operating on their last nerve. Getting mad, however, is likely to cause kids to adopt a defensive or minimizing stance. Instead, try to be compassionate. What students who have fallen behind need most are problem-solving partners who want to understand what they are going through.

If you’re having trouble summoning your empathy, bear in mind that there are many good reasons a student could fall off pace this year. For instance, Ned Johnson, a professional tutor and co-author of the book “The Self-Driven Child,” noted that most teens have very little experience managing email, which is now a main source of information for those in remote or hybrid arrangements. “We know how overwhelmed we as adults are by email. Imagine not being comfortable with it, and then suddenly getting everything — from Zoom links to assignments — that way.”

Some students learning remotely may also have unreliable broadband service; others may miss key information because their attention is split between the teacher on the screen and distractions at home.

“Many adults are having the exact same issues,” said Ellen Braaten, a psychologist and the executive director of the Learning and Emotional Assessment Program at Massachusetts General Hospital. “They are really productive when they can physically be at work, but may find themselves less attentive in the unstructured environment of working from home.”

Even teens who are attending school in person and using familiar systems for tracking assignments may be having a hard time managing their work now. The mental skills that help us stay organized — commonly called executive functioning — are being undermined by psychological stress, which is unusually high among today’s teens.

Work together to diagnose the problem

Finding out that your child is in academic trouble can tempt you to jump to solutions. It’s best, however, to properly diagnose the problem before trying to address it. Liz Katz, assistant head for school partnership at One Schoolhouse, an online supplemental school, suggested looking into the reasons students fall behind at school. Some don’t know what they’re supposed to be doing, others know and aren’t doing it, and still others “are doing their best and just can’t meet expectations.”

As you talk with a teenager about where things have gone off the rails, be kind, curious and collaborative. “This isn’t about you being in trouble or getting off the hook,” you might say. “It’s simply about figuring out what’s going wrong so we can solve the right problem.”

Students who are struggling to keep track of what’s expected of them may need to reach out to their teachers, either for clarification about specific assignments or for general guidance on where and when they should be looking for information about homework. As a parent or caregiver, you can coach them on how to approach their instructors. Start by pointing out that teachers are almost always eager to lend support to students who seek it. You can also offer to give feedback on a draft email to an instructor explaining where the student got lost and what they have already tried.

“For many students, the ability to ask for help is not fully formed,” said Ms. Katz, “or it can feel like an admission that they’ve done something wrong. Normalizing and praising self-advocacy is so important.”

For students who know what they’re supposed to do but aren’t doing it, other approaches make sense. They may be having a hard time sustaining motivation and need support on that front, or they may be swamped with commitments, such as caring for younger siblings, that make it impossible to complete their schoolwork. Here, parents and students will want to work together to make a realistic plan for addressing the biggest priorities in light of these circumstances. This might mean coming to an agreement about where the teen’s energies should be directed or exploring what additional support might be put in place.

In some cases, academic problems may be linked to issues with mental health. If there’s a question of whether a student is suffering from depression or anxiety; using drugs; or exhibiting any other significant emotional or behavioral concern, check in with the school counselor or family doctor for a proper assessment. Treatment should always take precedence over schoolwork. “If you’re depressed,” Dr. Braaten said, “no amount of executive function coaching is going to help, because that’s not the issue.”

Some students have subtle learning or attention disorders that became an issue only when school went online. Under regular conditions, said Mr. Johnson, instructors can notice when a student is tuning out and bring back his or her attention in a gentle way. Unfortunately, “Teachers really can’t do that effectively on Zoom.” If this is a concern, parents should consider checking in with teachers or their school’s learning support staff to get their read on the problem and advice for how to move forward.

Step back to see the big picture

“We all need to be easier on ourselves,” Dr. Braaten said, “and to sort through what students really need to do and what they don’t.” Well-meaning parents might hope to motivate students by emphasizing the importance of high grades, but that can make it harder for kids to recover from a substantial setback.

As students start to work their way back, give some thought to how comprehensive their turnaround needs to be. Do they really need to get equally high grades in every class? Could they instead direct their energy toward getting square with the courses they care about most? Could they work with their teachers to agree upon trimmed-down assignments for partial credit? According to Mr. Johnson, “Lowering expectations, for now, can actually help kids to get back on track.”

Dr. Braaten also noted that much of what students gain from school is not about content, but about learning how to solve problems. Engaging teens in constructive conversations to figure out how they fell behind can be an important lesson unto itself. “Having a 16-year-old who understands, ‘When I’m stressed, this is how I react,’” says Dr. Braaten, “may put us further ahead in the long run.”

In any school year, students learn a great deal beyond academic content. This year, more than most, might be one where students gain a deep understanding of how they respond when feeling overwhelmed and how to ask for help or rebound from setbacks — lessons that they will draw on long after the pandemic is gone.

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February 23, 2021

Imperfect Girls Make Perfect Role Models

Credit…Camila Rosa

Imperfect Girls Make Perfect Role Models

People who are “works in progress” can be more inspiring than the preordained successes of powerhouse figures.

Credit…Camila Rosa

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Katty Kay, Claire Shipman and

Feb. 23, 2021, 5:00 a.m. ET

Female role models, you might say, are having a moment.

Powerful female heads of state across the globe are out-leading their male counterparts in handling the pandemic. This year’s Nobel Prize in Chemistry went to an all-female team. In the United States, there is at last a female vice president, tough, powerful — and also the first Black and Indian woman to hold that office. The women’s soccer team isn’t just winning World Cups and widespread adoration but is also waging a public, uphill battle for equal pay. Women are making their way into what had seemed a permanent men’s club: the elite special operations ranks of the armed forces. Oh, and how about the youth poet who mesmerized the Inaugural audience and then moved on to the Super Bowl?

While we are still far from gender parity, it’s an incredible moment for girls, who, facing pandemic limitations, may be especially eager for glimmers of motivation and hope.

Role models inspire by showing us what is actually possible. Research supports that it works: These trailblazers not only help us imagine where we might go, they also help us map out the path to get there. Role models have also been shown to have a bigger impact on women and underrepresented communities — people who’ve not easily achieved their goals. Now that they see more women in the world of science (teachers, pioneering researchers or even their own peers), girls today are more likely, when asked to draw a scientist, to draw a woman than they were in past decades. Even one role model can benefit a child, helping her perform better in school and maintain a positive mind-set.

But the notion of “good role models” needs an update, especially when it comes to girls, or the steady stream of gleaming snapshots of achievement they see can actually lead to self-doubt. In addition to role models, our extensive work on girls and confidence has found that what girls could really use are “work in progress” models.

While representation is important, it’s not enough to point to the mere existence of these powerhouse women, shards of the broken glass ceiling in their wakes on their seemingly smooth trajectory to the top, and then expect inspiration to simply flow.

“Even the idea of a role model can be immediately intimidating,” said Rachel Simmons, the author of “Enough As She Is,” and a consultant on raising emotionally healthy girls. “They seem designed to display outcomes like trophies.”

We were struck when one of our daughters, recently reading what was supposed to be an uplifting blurb about a teenage scientist’s pedigree, moaned, “Look at what she invented at 15! What have I done? Way to make me feel like a loser!”

Girls want to please, judge themselves harshly and suffer from rampant perfectionism. They need to see the screw-ups and failures and struggles in their role models, as well as heavy doses of perseverance. Anything that smacks of a trajectory preordained and success effortlessly attained can deflate instead of inspire, playing into girls’ worst flawed thinking patterns.

Phyllis Fagell, a middle school counselor, parenting columnist, and author of “Middle School Matters,” explains, “What you don’t want to do is layer another set of unrealistic expectations on girls. Ideally the portrayal is realistic and attainable.” Ms. Simmons agrees: “Young people need to see, especially these days, if they take a wrong turn, or are hit by an act of God, it’s not only OK, it could turn out even better.”

In our new book “Living the Confidence Code,” we looked for role models whose stories would really resonate with other girls. We highlighted not traditionally “accomplished” or celebrated girls, but those who had also stumbled, shown perseverance and were open about it.

Yekaba Abimbola, in Ethiopia, promised for marriage at 12, was candid about the conflict between her deep desire to please her family, indeed her whole community, and her passion for her independence. She fought against the conventions of her culture, stopping her arranged marriage and winning the right to continue her education.

Ciara-Beth Griffin, an Irish teen on the autism spectrum, struggled to develop an app for other neurodiverse kids. Voicing a theme we heard over and over, she told us, “You get taken over by ‘What if I fail? What will other people think?’ And the nasty perfectionist voice in your head …” Yet she, and all these girls, managed to find an infinite variety of ways to silence that voice and say, as Ciara-Beth puts it, “Knock it off!” and do what they set out to do.

What really works to make someone a role model? Think story and struggle — multidimensional women, with revealing flaws and failure, along with compelling, bumpy narratives.

We’ve put together some essential tips for increasing role-model wattage for parents, educators and all girl allies.

Tell a story

Storytelling as an exceptional teaching tool is well-documented. When we’re engaged in a narrative, our brains connect the information more deeply, making predictions and gaining perspectives that last. And girls hunger for the connections they find in a narrative. “Girls need to look under the hood, to see the process they went through,” Ms. Simmons said. “That’s what really hooks someone — it’s not who you are now, but how you got there and what you weathered.”

Details, details

Have a robust family discussion about a specific role model, suggested the child psychologist Bonnie Zucker, author of “Anxiety-Free Kids.”

“Say: What’s her life story? What was essential about it?” she suggested. “That allows a real connection, and that’s key. Think: What’s the idea of that person, not just the more one-dimensional image of change or achievement she represents.”

Values speak

Ms. Fagell said that a multilayered story also allows girls to understand they don’t have to share interests with role models. Those details offer a broader spectrum of relatable characteristics.

“It’s essential,” she said, “to focus on characteristics, traits and values, not simply achievement. That way the girls can share the values or admire the journey of an athlete, for example, and find something in common, even without the same skills or interests.”

Ordinary is extraordinary

Helping girls to see the extraordinary in the seemingly mundane, Dr. Zucker explained, is also a powerful antidote to unrealistic expectations. “Everyday heroes, who don’t get noticed, have special impact. Talk about the incredible values of a young girl who might be burdened with raising her siblings when her mother vanishes, for example. She might not have a splashy social media profile, but her bravery, her sacrifices, or her emotional labor, are, in fact, heroic.” Ms. Simmons suggested using role models as a jumping off point for discussions about: “What is the definition of success, anyway? Money? A purposeful life?”

We should, of course, collectively celebrate the notion of another first, of new ground broken. But a role-model makeover with some breadth and depth, story and struggle, will allow girls to find not only inspiration but also enough space and comfort to find themselves.

Katty Kay, Claire Shipman and JillEllyn Riley are the authors of “Living the Confidence Code.”

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February 12, 2021

Covid Vaccines for Kids Are Coming, but Not for Many Months

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Covid Vaccines for Kids Are Coming, but Not for Many Months

Pfizer and Moderna are testing their vaccines on children 12 and older and hope to have results by the summer.

A 15-year-old participating in Moderna’s teen Covid vaccine trial received a shot in Houston this month.Credit…Brandon Thibodeaux for The New York Times

Feb. 12, 2021, 5:00 a.m. ET

As adults at high risk for Covid-19 line up to be immunized against the coronavirus, many parents want to know: When will my child get a vaccine?

The short answer: Not before late summer.

Pfizer and Moderna have enrolled children 12 and older in clinical trials of their vaccines and hope to have results by the summer. Depending on how the vaccines perform in that age group, the companies may then test them in younger children. The Food and Drug Administration usually takes a few weeks to review data from a clinical trial and authorize a vaccine.

Three other companies — Johnson & Johnson, Novavax and AstraZeneca — also plan to test their vaccines in children, but are further behind.

When researchers test drugs or vaccines in adults first, they typically then move down the age brackets, watching for any changes in the effective dose and for unexpected side effects.

“It would be pretty unusual to start going down into children at an early stage,” said Dr. Emily Erbelding, an infectious diseases physician at the National Institutes of Health who oversees testing of Covid-19 vaccines in special populations.

Some vaccines — those that protect against pneumococcal or meningococcal bacteria or rotavirus, for example — were tested in children first because they prevent pediatric diseases. But it made sense for coronavirus vaccines to be first tested in and authorized for adults because the risk of severe illness and death from Covid-19 increases sharply with age, said Paul Offit, a professor at the University of Pennsylvania and a member of the F.D.A.’s vaccine advisory panel.

“We’re trying to save lives, keep people out of the I.C.U., keep them from dying,” Dr. Offit said. That means prioritizing vaccines for the oldest people and for those with underlying conditions.

People younger than 21 account for about one-quarter of the population in the United States, but they make up less than 1 percent of deaths from Covid-19. Still, about 2 percent of children who get Covid-19 require hospital care, and at least 227 children in the United States have died of the disease.

“It is a significant disease in children, just not necessarily when you compare it to adults,” said Dr. Kristin Oliver, a pediatrician and vaccine expert at Mount Sinai Hospital in New York.

Children will also need to be vaccinated in order for the United States to approach herd immunity — that long-promised goal at which the pandemic slows to a halt because the virus runs out of people to infect.

Scientists have estimated that 70 to 90 percent of the population might need to be immunized against the coronavirus to reach herd immunity, especially with more contagious variants expected to circulate widely in the country.

“Not all adults can get the vaccine because there’s some reluctance, or there’s maybe even some vulnerable immune systems that just don’t respond,” Dr. Erbelding said. “I think we have to include children if we’re going to get to herd immunity.”

It will also be important to immunize children in racial and ethnic populations that are hit hardest by the pandemic, she added.

Abhinav, 12, a participant in the Pfizer vaccine trial at Cincinnati Children’s Hospital last month.Credit…Cincinnati Children’s Hospital

Pfizer and Moderna’s clinical trials in adults each enrolled about 50,000 participants. They had to be that large in order to show significant differences between the volunteers who received a vaccine and those who got a placebo. But because it is rarer for children to become seriously ill with Covid-19, that kind of trial design in children would not be feasible, because it would require many more participants to show an effect.

Instead, the companies will look at vaccinated children for signs of a strong immune response that would protect them from the coronavirus.

The Pfizer-BioNTech vaccine was authorized in December for anyone 16 and older. The company has continued its trial with younger volunteers, recruiting 2,259 adolescents from 12 to 15 years of age. Teenagers are roughly twice as likely to be infected with the coronavirus as younger children, according to the Centers for Disease Control and Prevention.

Results from that trial should be available by summer, said Keanna Ghazvini, a spokeswoman for Pfizer.

“Moving below 12 years of age will require a new study and potentially a modified formulation or dosing schedule,” Ms. Ghazvini said. Those trials will most likely start later in the year, but the plans will be made final after the company has data from older children, she added.

Moderna’s vaccine, which was also authorized in December, is on a similar track for pediatric testing. In December, the company began testing adolescents ages 12 through 17, and plans to enroll 3,000 volunteers in this age group. The company expects results “around midyear 2021,” said Colleen Hussey, a spokeswoman for Moderna.

Based on the results, Moderna plans to assess the vaccine later this year in children between the ages of 6 months and 11 years.

Infants may have some antibodies at birth from vaccinated or infected mothers, but that maternal protection is unlikely to last through the first year of age. And with their relatively weak immune systems, babies might be particularly susceptible to infection if community transmission is high.

The trials will also assess the vaccine’s safety in children — and hopefully ease any fears that parents have. One-third of adults in the United States have said they do not plan to have their children immunized against the coronavirus, according to a recent poll conducted by Verywell Health.

Given the low risk of Covid-19 in children, some parents might be skeptical of the urgency to inoculate their children with a brand-new jab, Dr. Offit said. “For that reason, the vaccine would have to be held to a very high standard of safety,” he said.

More than 42 million people in the United States have been immunized so far, with few lasting side effects. And the F.D.A. has set up multiple systems to carefully monitor any serious reactions to the vaccine.

“They’re really looking at the data very, very closely,” Dr. Oliver said. “As a pediatrician and a mom, I have really good confidence that those systems work.”

Once a vaccine for children is available, schools can reintroduce extracurricular activities that involve close contact, like band practice, team sports and choir. But in the meantime, there is ample evidence that schools can reopen with other precautions in place, Dr. Oliver said.

“I don’t think we need to anticipate having a vaccine in order to open schools in the fall,” she said. “We should be planning now for opening schools.”

Dr. Oliver also urged parents to make sure children are immunized for other diseases. According to the C.D.C., orders for non-flu childhood vaccines through the Vaccines for Children Program are down approximately 10.3 million doses over all.

“Now’s the time to really catch up on missed doses of those vaccines,” she said. “Measles, HPV, tetanus boosters, pertussis boosters — all of that is really important.”

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February 6, 2021

How to Help When Adolescents Have Suicidal Thoughts

Credit…Grace J Kim

The Checkup

How to Help When Adolescents Have Suicidal Thoughts

Even when rates of suicidal ideation increase, there are ways to keep kids safe.

Credit…Grace J Kim

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Feb. 6, 2021, 5:00 a.m. ET

With some evidence suggesting that more adolescents have been reporting suicidal thoughts during the pandemic, experts and parents are looking for ways to help.

One issue is that the Centers for Disease Control and Prevention has not yet compiled and released statistics on suicide deaths, so it’s not clear whether the problem is worse than usual. But there are questions about whether suicide risks are increasing — especially in particular communities, like the Black and brown populations that have been hit hardest by the pandemic.

Even during normal times, many mental health problems tend to emerge in adolescence, and young people in this group are particularly vulnerable to social isolation. In Las Vegas, an increase in the number of student suicides during the pandemic spurred the superintendent’s recent decision to reopen schools.

“We don’t have the data to know the relationship of suicidality in children and youth and the Covid epidemic,” said Dr. Cynthia Pfeffer, a professor of psychiatry at Weill Cornell Medical Center who has worked extensively on grieving and bereavement in children and adolescents. “The tremendous stress for families might make a child feel like they need to get out, or feel depressed.”

During the early months of the pandemic, there may have been some sense of common purpose — the kind of spirit that can increase people’s resilience after a disaster. In a research letter published on the JAMA network in late January, researchers compared internet searches related to suicide during the two months before and four months after March of 2020, when the United States declared a national pandemic emergency. Searches using the term “suicide” went down significantly in the 18 weeks after the emergency was declared, compared with what was predicted.

In a new study in the journal Pediatrics , researchers looked at the results of more than 9,000 suicide screenings that had been performed on 11- to 21-year-olds who had visited a pediatric emergency department in Texas. Everyone coming in, for any reason, was asked to complete a questionnaire which asked, among other things, about suicidal thoughts or suicide attempts in the recent past.

The researchers compared the responses from the first seven months of 2019 with those from the same months in 2020. They wanted to see if there was evidence of more suicide-related thoughts and behaviors between March and July of 2020 as the pandemic took hold. Ryan Hill, an assistant professor of pediatrics at Baylor College of Medicine who was first author on the study, said that his team expected that while in January and February, the pandemic would not have been on people’s minds, “we expected to see some differences later — and we did see some, but they were not consistent.”

Dr. Hill and his team found higher rates of suicidal thoughts in some, but not all, months of 2020. “In March and July, the rate of ideation was substantially higher than in 2019,” Dr. Hill said. “Something’s going on — we interpret it as due to the pandemic, though other things were going on in 2020.”

Dr. Christine Moutier, the chief medical officer at the American Foundation for Suicide Prevention, emphasized that even when rates of suicidal ideation increase, suicide rates do not have to rise.

“I think it is terrific that there is more universal screening going on; it represents an opportunity to employ some of the evidence-based strategies that we know can help,” she said.

In a comment published in JAMA Psychiatry last October, Dr. Moutier wrote about how important it is to prioritize suicide prevention during the pandemic. She included several strategies for health care providers, communities, government, and also friends and family to do just that, with some designed to improve social connections by taking advantage of technologies for virtual check-ins and visits. Her foundation also recently released a statement on what parents can do to protect children’s mental health during remote learning.

“Now more than any other time is a time for parents, for any adults who work with adolescents and youth, to be paying attention to the well-being of all adolescents,” Dr. Moutier said. “It’s really a time to be checking in.”

Parents should think about the different ways adolescents might respond to stress, said Dr. Rebecca Leeb, a health scientist at the Centers for Disease Control and Prevention who led a team on emotional well-being and mental health in the pandemic. Perhaps they are withdrawing and sleeping more; eating more or less; or trying drugs, alcohol or tobacco.

Parents can encourage their teenagers to get out of the house and to use the right safety measures — masks, hand-washing, distancing — so that they can spend time outside with friends. She emphasized that “social interaction” is important, whether that’s “exercise or drawing or hiking or taking the dog for a walk.” Kids take cues from their parents, she added, so adults should do those things as well.

It’s also important to make sure that your own mental health is taken care of before you “jump in and start checking in on your kid’s mental health,” Dr. Moutier said. Find moments to relax and laugh, she said, and make sure to talk about how you’re maintaining your own wellness and resilience, so that you can acknowledge and model the importance of those coping strategies for your kids.

Checking in with your kids might also give them an opportunity to open up, said Dr. Moutier, which, for many families, is something that they used to do in the car.

“Our children will feel loved and cared for if we’re practicing that kind of dialogue,” she said. “Do not shy away from asking the deeper, harder questions.” Dr. Moutier recommended being curious about your teenager’s world, asking things like, “How is that situation at school affecting you and your friends?”

Laura Anthony, a child psychologist at Children’s Hospital Colorado and an associate professor at the University of Colorado School of Medicine, said that one common mistake that even she sometimes makes is trying to solve a child’s problems. “What I need to do is just listen,” she said.

She works as the co-leader of the hospital’s youth action board, and teenagers with mental health histories compiled suggestions about how they would like their parents to help. One suggestion: Don’t assume that your kids are struggling all the time, Dr. Anthony said. Instead, consider questions like, “What’s taking up your head space?” Or, “What are you grateful for?”

[Click here for more of the Children’s Hospital Colorado teenagers’ advice on helping teens through the pandemic.]

Another suggestion: Parents should not discipline kids by taking away their phones. “Our teens say, this is not the time for a lot of punishment, you need to give us encouragement, help us have fun,” Dr. Anthony said, “and taking away the phone is really like taking away a lifeline.”

We need better data on mental health, Dr. Leeb said, and on well-being and quality of life. “We are learning a great deal,” she said. “I personally am hopeful for the future,” adding that she’s had several discussions with her children (who are 11, 15 and almost 18) about what the future looks like.

Ask teenagers, “How is this time affecting you?” Dr. Moutier said, and if they are experiencing any kind of struggle. And make it clear that no challenges are insurmountable, she said, “those are really important words for parents to say.”

Giving kids a sense of agency is also vital, said Dr. Sarah Vinson, an associate professor of psychiatry and pediatrics at Morehouse School of Medicine. “Think how kids can be part of the solution,” she said, whether that’s encouraging them to do volunteer work, or helping them understand that concrete steps, like wearing masks, can play a vital role in “reclaiming our day-to-day lives from this pandemic.”

If you’re concerned that your child is depressed or anxious, or if an adolescent talks about feeling overwhelmed, Dr. Anthony suggested asking directly, “Are you having any thoughts of suicide?” You don’t need to ask them every day, but if you’re having any concerns, you should definitely ask.

“Help is out there and it works,” Dr. Anthony said, pointing to the increased availability of virtual mental health services. “Suicidality is partly not being able to see the future,” she said. “If we can change that, we can see remarkable changes.”

Much as the hardships of the Great Depression and World War II forged what is known as “the Greatest Generation,” she said the challenges of the pandemic could strengthen today’s young people.

“I think we are going to have a generation of really remarkably resilient kids and teens who grow up to be really remarkable human beings as adults.”

If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK). You can find a list of additional resources at SpeakingOfSuicide.com/resources.

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February 5, 2021

At a Heavy Metal Concert, Balancing Independence With Boundaries

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At a Heavy Metal Concert, Balancing Independence With Boundaries

My mother, a freewheeling feminist, gave me freedom, while her mother gave me a nest of safety. Both shaped how I’m raising my own daughter.

Credit…Lucy Jones

Feb. 5, 2021, 5:00 a.m. ET

A cloud of marijuana smoke drifted by as my 13-year-old daughter asked, “Mom, can I walk around and meet people?” We were standing in an outdoor line for Warped Tour, a music festival with acts typically described as “pop punk” or “metalcore.” That is, hardcore heavy metal. Men in ghoulish masks playing electric guitars and growling lyrics about the devil.

It was 2018, long before the pandemic brought us the concept of social distance. Festivals like this one involved spending hours in extremely close range of other people’s breath and sweat as they screamed along with the bands. My daughter loved this music. I did not. I have no idea where she picked up a taste for it. All I knew was that she wouldn’t hold my hand anymore — she was too old for that, she said. She still had her blonde hair, but in a few months, she would dye it deep red and start adorning the corners of her eyes with eyeliner “wings.” She’s a smart kid — and even though she’s her own person, she’s also at the point in her development where it’s normal for her to “follow the crowd,” which scares me a little.

She asked me again if she could go explore. I said no. She asked me why, just as a car drove by with a shirtless woman hanging out of the sunroof screaming, “Unleash the beast!”

“I need to get inside and get my bearings before I feel safe enough for you to walk around on your own,” I told her.

“I know, but still!” she pleaded.

How many parents parent the way they were parented? Probably a fair number. Many of us also deliberately push back against what our parents did. I do both, perhaps because I was raised by two women — my mother and grandmother — who had very different parenting styles.

My mother, elated with the freedom of her fresh divorce, wanted to make me strong and independent, an adult before my time. Her mother, the martyr, shielded me from the world by giving me a nest of comfort and safety. Which parenting philosophy would inform how I raised my newly teenage daughter?

My own preteen years were intense. On my 10th birthday, my mother, whom I called “Mama,” gave me a private birthday celebration. She’d started her period at 10, so she expected mine any day. She told me that as soon as I started bleeding, I’d go on the pill. She’d had the traumatic experience of getting pregnant as a teenager, and then being whisked away by her mother to a town where no one knew them, giving birth and putting the baby up for adoption with Catholic charities. She’d insisted that the pill would give me freedom.

Not only was Mama my mother, she was also my best friend. I felt fortunate to be positioned as her confidante, even though that meant, according to her, that I was “too old” to hold her hand in public. In the months leading up to my 10th birthday, I heard all about her newfound dating life. This included a one-night stand with a 19-year-old bartender. Since she was 36 and he 19, she said, “we were both at our sexual primes.”

On my birthday, Mama served pink champagne and she-crabs — the egg-bearing females — and dared me to eat the roe. She played Helen Reddy’s “You and Me Against the World,” and when Helen sang “when one of us is gone / and one of us is left to carry on,” we cried in each other’s arms. I felt aching nausea at the fear of losing my mother; it started in my stomach and spread up across my chest.

When my period finally came, I was 13, but by then Mama no longer needed my friendship and confidences; she’d met the man who would become my stepfather. I became part of the wallpaper. Mama moved miles away to their new house. And I moved in with my grandmother and started drinking.

When Mama was 13, Grandma had left her with her mother for nearly a year so that she could try to find her husband who had run off with another woman.

By the time Grandma was 80, she was ready to make up for how she’d abandoned my mother, by providing the safest, warmest, most loving home possible for me. I hid my drinking as best I could, so I wouldn’t disappoint her. That limitation most likely saved my life, because I was, shall we say, wild.

Grandma doted on me. As soon as I got out of my bed, she’d make it. She woke up at 3 every morning to do my laundry, press my clothes for school, and make my meals. Living through the Depression made her a workhorse for ensuring everyone was properly clothed and fed. She was the opposite of my mother, who’d insisted that I cook for the family and do the dishes, but didn’t care if I made my bed or not. In return for everything she did for me, however, Grandma made sure I knew it: She’d show me the bones visible through the soles of her feet after she’d stood on them all day. I hated when she did that, almost as much as she hated it when I unmade my bed right after she made it, just to spite her.

By the time my daughter and I squeezed into the festival, pulsating with bass and throngs of leather- and spike-clad metal fans, my wild days were long gone. This was her heaven and my hell, but I was happy she had found something she felt passionate about. My wife and I have tried to bring our daughter up in such a way that she knows she is loved, and that we are happy when she is happy.

As we made our way toward our eventual meeting spot, I surveyed the landscape of the three stages and thought about what kind of parent I wanted to be. Should I nurture her independence to ensure she can survive this often-cruel world, or should I protect her for as long as I can to show her that I am always there? The truth is that although my mother was selfish and irresponsible, she cared that I would grow up to take care of myself, and I have. And although my grandmother martyred herself with her overabundance of attention and selflessness, she cared that I would be safe in the world, and I am. My parenting can be informed by both of my “mothers.” I can nurture my daughter’s independence and give her boundaries to make sure she is safe.

“Can I go now?” she asked impatiently.

I looked into her eyes. “Yes,” I replied. I’ll be right here.

I found the “parent tent,” also known as “reverse day care” — a cool, comfortable lounge perched atop a hill with a vantage point that allowed me to see all three of the stages, with the audience pumping heads and tattooed fists to the various screaming guitars. I was afraid. I wanted her to hold my hand. I wanted her to need me. But I reveled in her sense of freedom. The joy of her budding independence rippled through my heart and cracked it wide open. At one point, I caught a glimpse of her running through the crowd to make it to the next show. She was smiling and laughing. “There’s my daughter,” I told the mom next to me.

“They grow up so fast,” she said.

“I know,” I said. But still.

Susannah Bell is a teacher and writer who lives with her wife and teenage daughter in the San Francisco Bay Area.

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January 29, 2021

Helping a Teen Who Is Angry About House Rules on Covid

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Helping a Teen Who Is Angry About House Rules on Covid

Our grandson’s friends don’t socialize safely, so we don’t want him to see them. How do we keep his anger about it from causing chaos in our home?

Credit…Chloe Cushman

Jan. 29, 2021, 5:00 a.m. ET

Our Adolescence columnist, the psychologist Lisa Damour, responds to a reader’s question. The question has been edited.

[To submit a question, email AskDrDamour@nytimes.com.]

Q. We are having an extremely difficult time with our 15-year-old grandson, who lives with us. He has finally found friends after struggling socially and wants to spend time with them, but they do not social distance or wear masks. Some of their families are not true believers in this pandemic. It is absolute chaos at our house because of him fighting to be able to do things. He says he is tired of Covid, because while he stays in, most of his friends do not and go about their lives like nothing has changed. He is angry and depressed and we are at a loss as to what to do.

A. You and your grandson are in a heartbreaking predicament for which there are no complete or satisfying solutions. I cannot tell you how much I wish this weren’t true. Above all, I want to acknowledge the painful reality of the circumstances you describe.

Even though there are no perfect remedies, it may still be possible to improve the situation at least a little bit. First, let’s note that you are contending with two distinct, albeit related, challenges. One is that the pandemic has uprooted your grandson’s budding social life. The other is that his perfectly warranted distress about falling out of touch with his new friends has ruptured his relationships at home. On the first front, you may be hard-pressed to offer your grandson more social opportunities than you already have. On the second front, however, there may be ways to repair your connection with your isolated teenager, who needs loving support now more than ever.

Empathy, empathy, empathy is the place to start. The situation in which he finds himself is miserable and not of his creation. It may be true that he is acting out and upsetting everyone around him, and that many other young people find themselves in similar straits, and that we are starting to catch glimpses of the light at the end of the tunnel. Try not to let these factors sap your sympathy for your grandson. The adjustments that we have been asking adolescents to make, both in how they conduct their social lives and how they learn, take almost all of the fun out of being a teenager and have been in place for nearly a year. No amount of compassion for this is too much.

Without any other agenda, deliver to your grandson the message that you are deeply sorry that the pandemic has wreaked havoc on his social life. Tenderly communicate that you grasp how painful it must be to know that his friends are getting together without him. Let him know that you cannot believe that the pandemic has gone on for so long (roughly one-tenth of the lifetime that he likely remembers) and that you understand that for teenagers in particular, the support of family cannot make up for losing touch with friends.

Compassion won’t alter the lousy circumstances, but it can still help to relieve his emotional suffering. Feeling alone with psychological pain is a lot worse than believing that your distress is seen and validated. So, do all you can to help your grandson know that you are entirely on his team.

There’s another way to look at this that may help you to move toward a better relationship with your grandson: Recognize that he may be turning an intractable, internal battle — between his desire to see his friends and his knowledge that their way of socializing isn’t safe — into an external battle between him and you.

It’s not at all uncommon for teenagers to turn vexing personal dilemmas into fractious family fights. Imagine a (post-pandemic) teenager who both wants to go to a concert and also feels unnerved by its sketchy venue. She might seek relief from being at odds with herself by recruiting her parents to take up one side of the battle. Picking this fight would be as simple as wholeheartedly lobbying to go to the concert while rolling her eyes when her folks pose reasonable safety questions.

Try to ease your grandson away from this instinctive approach by warmly and sympathetically articulating his dilemma. “It’s really frustrating,” you might say, “that your friends are doing things in a way that makes it impossible for you to safely see them. I get why you’re so upset.” This might open the door for him to welcome you as a strategic ally. “We’ll do whatever we can to help you see your friends in a safe way. Can you take bike rides together or go throw a ball around outside? We’re happy to take the blame if you want to pin the need to be outdoors and wear masks on us. Just let us know if there’s anything you can think of that we might do to make this work.”

It’s possible, of course, that your grandson won’t like your suggestion or want to test the strength of his friendships. If so, there is something else you can try. New research in the journal Child Development has found that teenagers are better able to bear pandemic conditions when their families support their autonomy. Are there choices you can offer your grandson that have not been left to him before? Perhaps you can give him more say over how or where he studies, what he does with his leisure time, who controls the remote or anything else you can bring to the negotiating table. Own the limits of what you are offering. Acknowledge that getting to pick the dinner menu won’t fix things with his friends. But having some new freedoms at home might just help him feel better enough.

Hopefully, your efforts will lighten your grandson’s mood. If he remains unhappy no matter what you try, make an appointment with his health provider to have him evaluated for depression which, in teenagers, often comes across more as irritability than sadness.

You and your grandson are not alone in feeling painted into a terrible corner by the pandemic. Even with so much beyond our control, let’s not overlook the ways, however incremental, that we can comfort and support our teenagers.

This column does not constitute medical advice and is not a substitute for professional mental health advice, diagnosis or treatment. If you have concerns about your child’s well-being, consult a physician or mental health professional.

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January 22, 2021

5 Ways Teens Can Get More Fruits and Vegetables Into Their Diets

A new study found that high school students aren’t getting enough produce.

January 12, 2021

When I Was Labeled a ‘Troubled’ Teen, I Obliged

The author in the Adirondack Mountains of upstate New York in 2007, during his second stay in a wilderness therapy program. Credit…via Kenneth R. Rosen

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When I Was Labeled a ‘Troubled’ Teen, I Obliged

I was sent to three “tough love” programs meant to redirect me. Trying to run away from one made me feel that I had no choice but to become what I had been told I was.

The author in the Adirondack Mountains of upstate New York in 2007, during his second stay in a wilderness therapy program. Credit…via Kenneth R. Rosen

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Jan. 12, 2021, 5:00 a.m. ET

All I heard was rain, my thumping heart harmonizing with the tempo of the tempest outside. I waited for the night watchman’s light to sweep over my bunk. He disappeared into the hallway, into the next room of clients who he noted to himself were present and asleep and so moved to the next room.

When he entered another room, I hurried behind him, crouching, to the central alcove, from where I made my escape. My plan included a list — backpack, peanut butter, headlight, rain gear, stolen MapQuest printouts, knife — and a destination, Boston. I’d run to an unfamiliar city, across a state to which I’d been taken against my will, to meet a future I could not be certain was any better. The rain seemed less like a portent, more an encouragement, as if each wind gust carried with its rivulets the words, It’s your time. They’ll never find you. Go now.

They were the escorts. Transporters. Redirection specialists. They, usually two men who take unsuspecting teenagers in the middle of the night to therapeutic programs across the country, went by different names. I was certain they were coming for me. They had come for me several months before the night of my escape, in late winter 2007, at the request of my parents who saw no other way to set me straight. My mom and dad hired the men, after consulting with school officials, psychologists and an education consultant, to take me from my bed and to deliver me like a wasted soul to an experiential therapy program in the Adirondack Mountains in upstate New York. They believed they were practicing “tough love,” making the difficult choice to send their child away to forge a better future away from home.

Some of the gear the group carried through remote stretches of New York State. Credit…Kenneth R. Rosen

From New York I’d go on to a program in Massachusetts. I did not know it then, but I’d become one of the tens of thousands of “troubled” or “at-risk” teenagers carted off to these unregulated, private industries each year.

The years leading up to my being taken and the eventual break out is now a blur of misanthropy. I was reckless, taking my mom’s car out for joy rides without permission, skipping class, distrusting authority figures like the high school principal and local municipal authorities sent to curb my behavior, to put me back on a path more, how should we say, normal.

In the nearly 12 months I’d spend between the experiential wilderness therapy program (twice), a therapeutic boarding school in Massachusetts and a residential treatment center on a ranch in Utah, I lived up to the designation of a troubled teen. The programs were what the media called part of a tough love movement, which flourished in the early aughts but still exists today.

The Academy at Swift River, a former therapeutic boarding school for troubled children, in Cummington, Mass., in spring 2007. The author spent months here before trying to escape, after which he was sent to a remote ranch in Southern Utah.Credit…Kenneth R. Rosen

I’d return that type of love to my parents, ignoring their written letters, our only form of communication, vetted and censored by my “therapists.” I felt betrayed and discarded. They pleaded with me to accept the programs and to do my best to succeed in them. It felt like they wanted me gone. Really, I was being groomed for institutionalization. The juvenile and criminal justice systems the programs ventured to save me from instead prepared me for adult incarceration. By the end of my time away I recognized a bliss associated with handcuffs. Lockup and lockdown meant the familiarity of strip searches, drug tests, isolation cells and men who handled me like I was worthless: hallmarks of the programs that became synonymous with the word homebound.

But losing any self-actualization and inner-direction came later. On the night of my escape, I still believed I held some agency over my future, shrouded in uncertainty though it was. What would I do in Boston? I didn’t care. How would I earn money? Where would I stay? I would figure it out once I was far away from this place.

My parents were no longer trustworthy. They were part of the growing number of my adversaries working to keep me from personal liberties. At the program I was restricted access to food. I was allowed only communication with my parents, not my friends back home. If I chose not to respond to my parents, I would also be cut off from my peers in the programs. Either way, I’d lose.

The night the author tried to run away from the Academy at Swift River, he started from this alcove.Credit…Kenneth R. Rosen

I was given prescription medication to ease my anxiety and depression, which left me hollow and numb. I was made to answer questions about my life and emotions until, I was told, I got them right, framing things in a way the program and therapists felt more accurately told a story about my deviance that I then internalized. My journals were confiscated, their private contents used against me in “therapy sessions.”

I wasn’t troubled or bad. I was alone, all the angst and hormonal shifts of adolescence compounded and weaponized against me. I was backed into a corner and told to change, made to think I’d become reproachable and unwanted. What they wanted from me — to be happy, well-adjusted, open to therapy and the mind-numbing boredom I associated with schooling — seemed a betrayal of the very thing they wanted me to be: myself.

Meanwhile, I had broken a number of rules at the school — “cheeking” medication, drinking hand sanitizer, fraternizing with girls. I was certain then, by the fourth month at the program, that I was doomed for another “transport.” Then one night they came.

I’d been waiting, staring deep into the white ceiling overhead, my inability to sleep soundly forever cemented. Before I could jump down from the top bunk bed, the escorts announced that they were there for a different boy, my roommate. He stood from his bed, his head hanging. He pulled a pre-packed suitcase from underneath his bed (we all had our own type of go-bag), gave a weak smile, shrugged, told me he’d see me again, however unlikely, and left with the men flanking him out the door, choosing to go, as they called it, the “easy way.” He had already gone the “hard way.”

Picked off. Kidnapped. Taken. Call it what you wish, but trying to sleep each night with the notion that a pair of strangers could come to lift you from your bed, whether your actions were deserving of this treatment or not, haunts me, haunts thousands. Having watched my roommate get taken was surreal. It made real for the first time what had happened to me, brought into context that it was happening to others, and eventually sold me on my own desire to flee. I would not wait to be taken. I had to get out. No one would take me. I would lead myself away.

Now, standing outside the central alcove with my back to the doorways of the program, I stared into the fields of the Berkshire mountains, another expanse of seclusion and remove, the rain washing over me in blinding sheets. I bent into the storm, leaning into the wind that soon turned, pushed at my back, leading me away from this place into the deep, heaving thicket at the far end of the program’s property.

The author’s room at the academy in spring 2007. Sometimes the boys played Monopoly at night in the bathroom, seeking a rare opportunity for unsupervised recreation. Credit…Kenneth R. Rosen

I vaulted a fence and tore my rain pants. Water and a cold breeze swept into the tear. I began to shiver. Boston seemed farther than ever, the return to my previous life an impossibility. My mother once told me “to strive, to seek, to find, and never to yield,” cribbed from the Tennyson poem. But yield I would, turning around and greeting my future and any hope I had for making it my own. I was told I was troubled and believed it and ran because that’s what bad kids did.

I unceremoniously turned myself in to the night watchman because I had lost all strength to continue being bad. I wanted to be good, loved. It was as much a desire to get away that drove me from the program as it was a display of disapprobation and the final displacement of my waning emotional strength. I would fold into the programs, accepting that if I were to change it would be by a force better accepted than rejected, one that had overpowered and broken me into a shell of my former self.

Those programs are now a distant memory, but the contours of those inescapable feelings of rejection and dismissal, of living up to the expectations held by others and not myself, follow me. When I find the energy to keep those memories from chaining me to a different person, a different time, I do my best never to yield.

Kenneth R. Rosen is the author, most recently, of “Troubled: The Failed Promise of America’s Behavioral Treatment Programs.”

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January 7, 2021

Swimming With My Shirt Off

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Swimming With My Shirt Off

At 13, I was a guy with breasts, and I needed to get rid of them to survive my upcoming teenage years.

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Jan. 7, 2021, 5:00 a.m. ET

When I was 13, going to public pools was painful.

I loved the water, but I was convinced that dozens of judging eyes were on me every time I took my shirt off. I wish I could say this was only a product of my adolescent imagination, but I knew it was not when a swimming instructor singled me out and asked me to wear a shirt during class.

Being the only one with a shirt on was more shameful than being bare-chested. But the instructor was trying to save me from embarrassment, like my parents and every other caring adult around me.

The fact was that I had man boobs, and I needed to get rid of them to survive my upcoming teenage years. My parents took me for hormonal testing because the condition, called gynecomastia, is usually caused by a hormone imbalance.

“You can either exercise or have surgery,” said the endocrinologist. I chose the gym. No one in my class was going to the gym yet. It was around that age when all the boys in the class were obsessed with their naturally developing abs and other gifts from the Creator — gifts that I wasn’t lucky enough to get.

When it came to my body, I had learned that there were things I didn’t like about it. Things that would make my life a living hell during high school unless I found a way out of them.

Besides the issues I had with my chest, I also started to realize that every time I saw other boys, my body would react in funny ways. I was attracted to boys.

But in my world, in conservative Guatemala City in the mid 2000s, boys didn’t have boobs and boys didn’t like other boys. Whoever did was a freak — the joke of the school. I was not ready to be that person. All I wanted was to toughen up, tone my muscles, and turn the page. My visits to the gym were slowly starting to show results, but everything changed when I met someone in the showers.

He was twice my age; he asked if he could touch me. I said no. One thing I remembered from science class was that no one was supposed to touch me like he wanted to. But then I gave in because I was curious. And then I was confused. This was wrong and I needed to put a stop to it. Suddenly, the gym was not an option for me anymore.

No one in our household was a quitter, and whenever we set our eyes on something, Dad was there to remind us that we had to finish it. But that rule became null as soon as I told my parents what had happened in the showers. Dad was angry, Mom was upset, and I was crying my eyes out, knowing that I had failed the people I loved the most, but more important, I had failed myself and everything I stood for.

My parents talked to the gym owners about the incident and told them that we were not coming back. Taking legal action was too much for us; we just wanted to check out of it and start a new chapter.

By the time I was 15, it was agonizing to take my shirt off. Surgery was my ticket out, I thought. The endocrinologist referred me to one of his colleagues.

When I got out of the hospital I immediately noticed that the scars on my chest were bigger than I expected.

“They will disappear after a while,” said the doctor. But as time passed and the scars healed, it was evident that they were not going to fade away. My supportive mom, who was all about doing whatever made me feel more comfortable, saw a doctor on the morning news who was considered one of the best plastic surgeons in the country. She made an appointment.

He said he couldn’t do much about the scars. But some chin augmentation and rhinoplasty could help me a bit, he said.

“His nose is natural,” said my mom. “It runs in the family.” My mom wasn’t going to let him touch my face. She had taught me to love my nose and look at it as my heritage from my loving grandpa. And I didn’t want more knives cutting through my skin unless it was to remove my unwanted scars.

“I think his nose is broken, but it’s your call,” said the confident doctor. He wasn’t going to help me in the way I wanted. I was stuck with my scars forever.

I went home and stormed off to my room as teenagers do in movies when they’re tired of the world. I rarely did that, but honestly, the occasion called for it. I guess my mom was as tired and disappointed as I was, so she didn’t even follow me to my room.

But Dad was there, and he wanted to know how I was feeling. I told him about my unfixable issue. He was a fixer, but the time had come for him to stand still and embrace the fact that some problems couldn’t be solved. He just held me in his arms ensuring me that everything was going to be OK, even though we didn’t know what that meant.

All I knew was that from that moment onward, taking my shirt off in public meant that I was vulnerable to questions. Questions that I didn’t want to answer. No one was entitled to know who I liked or why I had scars on my chest, but leaving those questions unanswered meant that people were free to draw their conclusions.

At the same time, I didn’t want to miss the pool time during the trips with my school, so I had to come up with a strategy that would allow me to enjoy the water without being seen. I resolved that the best way to avoid questions was to take off my shirt when everyone was distracted. All I had to do was wait for everyone to jump in while I lingered on the edge, and I would then remove my clothes when no one was watching. Once I was in the deep end of the pool, there was no way they could see my scars. I also had to be the last one out so no one would see me.

But I forgot that there was a group of kids who never went in. They would hang outside the pool, desperately looking for something to entertain themselves. “What happened to your chest?,” one of them asked. He wasn’t trying to make me feel miserable or weird. He just wanted to know.

“I had a little accident,” I said. The truth is, it was kind of an accident. I had never intended to have those scars and I didn’t deserve to feel guilty about them. The surgery was an attempt to feel comfortable in my skin, but it had left me marked forever.

“I thought you had a heart surgery or something like that,” the kid said. “They look badass. You should get a tattoo.”

I had played with the thought of getting a tattoo on different parts of my body, but it had never occurred to me that my chest could be the perfect spot.

The problem was that I always changed my mind about things. There was no way that I could have a permanent mark on any part of my body, because I knew I would regret it immediately.

However, my scars were, in a way, a tattoo. And there was no way to get rid of them. They were part of a painful and difficult story, but they were also a symbol of resilience during a season that I never thought I would survive. People could think of me whatever they wanted, whether I gave them an explanation or not. But these scars became part of my story, and no one can ever take that from me.

J. Martinez-Paz is a writer and filmmaker from Guatemala City.

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December 18, 2020

Teaching My Kids to Drive While Black

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Teaching My Kids to Drive While Black

I’ve raised them to be confident and to advocate for themselves. Now here I was saying, don’t do it with the police.

Credit…Lucy Jones

Dec. 18, 2020, 5:00 a.m. ET

There was lightning, thunder and heavy rain the recent day I accompanied my 18-year-old son and 19-year-old daughter to get their driver’s licenses in Austin, Texas.

I wish I could say I thought nothing more of the passing storm. But the air felt moody and foreboding, as if it was urging my Black family to turn around, go home, lock our door and run the clock back to when my kids were little and couldn’t go anywhere without me. To when I did not imagine that any routine police interaction might play out as horrifyingly as it did in the cases of Sandra Bland, George Floyd, Philando Castile and others.

I kept my grim thoughts to myself because my children were already beyond excited to achieve this belated milestone after the many disappointments of a pandemic year. I did not want to be the cause of another, so on we went. Neither complained about the almost three-hour wait at the D.M.V., thanks to pandemic backlog. Both grinned ear-to-ear as they showed me their new licenses. I smiled back at them and meant it. They were now officially young adults. I refused to let what might happen to them dampen what had indeed happened.

I’d once read that teenage drivers need about 1,000 hours behind the wheel before they’re truly ready to go solo. Between boarding school, summer excursions and shared custody, my kids were never in any one place long enough to make a consistent go at learning to drive, much less for me to teach them as well as I wanted to. Then they came home to me because the pandemic shut down their high school and college for the rest of the school year.

One of the few upsides of having their academic and social lives limited to screens, and the roads near empty, was that there was finally enough time for them to get in a lot of driving hours. They practiced the right speed in residential neighborhoods, learned who goes first at a four-way stop sign if two cars arrive at once and braved getting on and off the two major highways that define Austin. Their confidence grew as spring rounded into the heady promise of summer.

But no amount of confidence behind the wheel can change my children’s maple syrup-colored skin, even if they wanted to — and they don’t. All the self-love lessons I’ve been instilling since birth have taken root and blossomed mightily.

Also blossoming mightily has been my fear of the ultimate ugly, of their untimely, unjustifiable deaths.

I began emphasizing things I thought might help keep them safe on the road when they were away from me. “YOU,” I told them, “do NOT have the luxury of speeding. Or joy riding. You, yes you, must pay attention. ALL the time!”

A friend recently went through the same D.M.V. ritual with her son. She and I say the same things, “No drinking and driving, no texting and driving, don’t fiddle with your music when you are changing lanes.” We both worry because driving at this age is the cause of many deaths. But where our shared concern stops, I must continue with lessons for Black children only. I’ve realized I feel secure only when my kids are home for the night, wherever they are, no matter their age.

Meanwhile, I wondered, what can Black people do without fear? When can we let go? When do my kids get to be just kids like their white friends? Sleeping; jogging; walking; wearing that teenage staple, the hoodie; heading home from a bachelor party; and leaving church have cost Black people their lives.

As they learned to give more gas going uphill and to always use their indicators, I tried pushing away the bird watcher incident in Central Park; and thoughts of the San Francisco homeowner whose neighbors insisted he didn’t live there, was illegally painting a Black Lives Matter sign, and called the police. My heart aches with each new incident, with unending, rolling waves of sorrow. I come up from one and another pulls me right back under.

I’ve drilled them on what to say: “Yes, officer. No, officer.” And with what to do: Turn your music off, especially if it’s rap; call me; start a recording on your phone before the officer gets to the car; put your hands on the steering wheel and keep them there; have your license and car registration handy.

Which left me torn about an ideal I’ve also drummed into them: Always self-advocate. Now here I was saying, don’t do it with the police. Know from Breonna Taylor’s case that things can turn deadly before you figure out what’s happening. Know that if you do speak, you might not be believed when you say you can’t breathe. I was both grateful for my son’s grace and devastated by his knowing when he said, “Don’t worry, Mom, I understand I have to live first so I can speak up later.”

The kids often said my driving corrections were too grumpy, that I yelled unnecessarily if they took a turn wide, didn’t look over their shoulder before changing lanes. I said we’d driven the same roads repeatedly, that they should know by now. I didn’t say how frustrated I was that as they continue on out into the world, they’re likely to be assessed first by the color of their skin and not the content of their character.

I’ve always known that motherhood involves starting to let go the minute the baby arrives. Earning a driver’s license is one of the great pit stops on a child’s road to independence. My kids are good drivers, but my fear remains. “It’s not you I worry about,” I tell them repeatedly, “it’s other people.”

As I watched my son adjust his mirrors, double check that he had his license and registration before nervously backing out and driving solo for the first time to a friend’s house, it was clear: I’ll need to make room to celebrate the good moments, not just mourn the bad. He waved and smiled one last time through the rearview mirror.

Born and raised in Kingston, Jamaica, Suzanne McFayden is a writer, philanthropist and mother of three.

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December 14, 2020

Depression in Childhood Tied to Physical Illnesses in Young Adulthood

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Depression in Childhood Tied to Physical Illnesses in Young Adulthood

Youths with depression had elevated risks of liver disease, thyroid illness and other problems in their 20s.

Dec. 14, 2020, 5:15 p.m. ET

Children and adolescents diagnosed with depression may be at increased risk for physical diseases and premature death as young adults, researchers report.

For a study published in JAMA Psychiatry, researchers used Swedish health registries to track a group of 1,487,964 children, of whom 37,185 were diagnosed with depression between ages 5 and 19. The investigators followed the group until they ranged in age from 17 to 31.

Of 69 physical diseases they were able to track, people with depression had a higher risk for 66 of them, even after controlling for other psychiatric illnesses.

For example, compared to their peers who were not depressed, they had eight times the risk of sleep disorders, more than three times the risk of liver disease, and nearly five times the risk of thyroid illness.

Boys had higher risks than girls for most diseases, but both boys and girls with depression had a rate of all-cause mortality six times as high as those without depression. Their rate of suicide was 14 times as high, and deaths from natural causes more than twice as high, as their peers who were not depressed.

“Our observational study can’t address whether this is causal,” said the lead author, Marica Leone, a Ph.D. student at the Karolinska Institute in Stockholm. “We need further research to determine that. But physicians need to look for other diseases, and not just psychiatric disorders, that flow from youth depression.”

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December 10, 2020

Talking to Kids About O

I teach sex ed. In light of a recent report on exploitation of children on the site Pornhub, I have some talking points for parents.

December 3, 2020

How Teenagers Use Free Time Affects Mood

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Adolescence

How Teens Use Downtime to Connect, Distract or Reflect

Different choices for how young people use free time lead to different kinds of relief.

Credit…Antonio Giovanni Pinna

Dec. 3, 2020, 5:00 a.m. ET

When pandemic-weary adolescents get to take a break, what should they do with themselves? The main aim, of course, should be to feel better after the break than before it. But different downtime choices lead to different kinds of relief. Adolescents (and adults) might want to reflect on the options for how they spend their free time — whether they’ve got 20 spare minutes today or can anticipate more unscheduled time in the weeks ahead.

Here’s a look at three ways teenagers tend to spend their downtime, and the particular benefits and challenges that come with each.

Connecting With the World Digitally

Young people often use their downtime to text with friends or check their social media accounts — and with good reason. Particularly under the restrictions of the coronavirus pandemic, teenagers rely on these platforms to connect with peers and to keep up with headlines. Spending time online might deliver the boost of an amusing exchange with a friend, a clever meme or good news about a favorite sports team. If it does, that makes for a restorative break.

But, of course, it can go another way.

Checking in on social media or the 24-hour news cycle is the psychological equivalent of sidling up to a slot machine. Hitting the jackpot — receiving digital love from a friend or finding an encouraging update about a vaccine — feels good. Pulling the lever and losing — whether that’s your messages being “left on read,” meaning the recipient doesn’t respond, or catching a depressing headline — is pretty much bound to happen from time to time.

For teenagers, especially in the context of the pandemic, turning to social media as a way to recharge can be a high-stakes gamble. Jill Walsh, a Boston University sociologist who studies technology use among adolescents, finds that having fewer in-person interactions has left many teenagers feeling “incredibly uncertain about their friendships.” Previously tolerable ambiguity in communications can now be highly distressing. Dr. Walsh notes that “getting a text that simply reads ‘k,’” — shorthand for OK that can be read as friendly, curt or angry — “can create a huge amount of emotional labor as a kid tries to figure out what it means.”

Before defaulting to downtime scrolling, teens might weigh the possibility of seeing a mood-lifting post against the chance that they’ll run into something distressing. A well-spent break should help to ease the mind; it shouldn’t open new tabs to worry over in our mental browsers.

Getting Lost in Distractions

There’s a lot to be said for taking occasional, all-consuming mental vacations, especially during a pandemic. Research on chronic stress shows that engrossing, happy distractions, such as competing in a sport or losing oneself in a movie or a book, can help young people weather persistently difficult circumstances.

Happy distractions may be a particularly apt choice when teenagers find themselves dogged by worries about school, peers, rising Covid-19 rates or anything else. Peggy Zoccola, an associate professor of psychology at Ohio University who studies the impact of stress and coping on the body, has found that ruminating over unpleasant events raises blood pressure and heart rate and triggers the ongoing release of stress hormones. Distraction, however, stops or attenuates the biological stress response. “It’s important,” she says, “to be able to recover and not always be pumping out these stress hormones.”

In fact, transporting diversions can be useful in two ways at once. According to Dr. Zoccola, they both draw our minds away from negative events that can trigger our biological stress response and at the same time pull them toward positive experiences that may prompt the release of natural mood-improving substances in the body that work much like opioids to help us feel better.

That said, it’s possible to have too much of a good thing. While pleasant distractions provide valuable mental and physiological breaks from stressful conditions, “my hesitation with recommending distraction,” Dr. Zoccola said, “is that while it can get people out of the moment, if it goes on too long, that might prevent folks from addressing an issue, or might create a new one.” Teenagers can run an easy check for themselves by asking, “Are my distractions getting in the way of what I need to do?”

Creating Space for the Mind to Wander

As a third option, young people sometimes use openings in their schedule for pursuits that are engaging, but only to a degree. Researchers use the term “soft fascination” in connection with activities that require attention but don’t entirely occupy the mind, such as spending time in nature or taking a long shower. More absorbing endeavors, such as playing a video game or solving a puzzle, recruit what’s known as “hard fascination.”

Compared to hard fascination, soft fascination uses less mental bandwidth and leaves more room for the mind to wander and reflect. Avik Basu, an environmental psychologist at the University of Michigan who researches soft fascination, explains that activities that “don’t swamp the mind” are more likely to be restorative because “a softly fascinating environment allows for reflection — and that’s when the problem-solving part of our brains can really get to work.”

In other words, soft fascination relieves stress by helping us close those mental browser tabs; unhurried reflection lets us sift through mental clutter, quiet internal noise and come up with fresh, useful solutions. According to Dr. Basu, “the ‘aha’ moments you have in your shower — that’s the problem-solving mechanism of the mind working. The answer just bubbles up!”

Unfortunately, for many young people, the pandemic has swept away previously routine occasions for soft fascination. Indeed, many of us have come to appreciate how much mental housekeeping we used to do as we made our daily commute or walked along a familiar route to work or school. Teenagers might now have to go out of their way to seek low-key activities when their minds feel cluttered. And they may need adults’ encouragement to do so, because simply going for a stroll or looking out a window can seem boring compared to the allure of online catching up or consuming distractions.

When it comes to self-restoration, we all have options — with connection, distraction and reflection being chief among them. Caring for our mental and emotional health matters now even more than usual, so it’s essential for people of all ages to take the breaks that best address the needs of the moment.

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August 1, 2016

Attention, Teenagers: Nobody Really Looks Like That

Credit 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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July 13, 2016

Myths About Teenagers and Risk-Taking

Credit 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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July 11, 2016

More Nonsmoking Teens Inhaling Flavored Nicotine Through Vaping

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

July 11, 2016

More Nonsmoking Teens Inhaling Flavored Nicotine

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

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.

June 23, 2016

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.Credit 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.Credit 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.”

June 22, 2016

Living with a Teenage Data Hog

Credit iStock

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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June 16, 2016

Parents Should Avoid Comments on a Child’s Weight

Credit 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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June 15, 2016

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.

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June 14, 2016

For Teenagers, the Pleasure of ‘Likes’

Credit 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.”

June 8, 2016

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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June 6, 2016

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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May 20, 2016

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?