tag:theconversation.com,2011:/fr/topics/adolescent-psychology-2619/articlesAdolescent psychology – The Conversation2022-05-05T19:00:12Ztag:theconversation.com,2011:article/1821812022-05-05T19:00:12Z2022-05-05T19:00:12ZExcessive mortality of young adults: a natural trait?<figure><img src="https://images.theconversation.com/files/460322/original/file-20220428-18-up9sna.jpg?ixlib=rb-1.1.0&rect=0%2C11%2C1920%2C1238&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The mortality rate among young adults is higher than it should be, statistically.</span> <span class="attribution"><span class="source">Sammie Chaffin/Unsplash</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>The risk of death is high at birth and during the first years of life, but it decreases through childhood until approximately the age of 10. It then begins a steady, exponential increase that continues throughout adult life. This U-shaped curve of age-specific death rates suggests that the risk of dying for young adults should be relatively low.</p>
<h2>Mortality can be high between ages 15 and 30</h2>
<p>It is not rare, however, to observe relatively high levels of mortality during a period in early adulthood between the ages of 15 and 30. This is called “excess mortality” because it exceeds the levels that would be expected due to biological factors and epidemiological circumstances.</p>
<p>The relative scale of this excess mortality appears to be independent of the general level of mortality, as illustrated by the age-specific mortality curves based on data from the <a href="https://www.cairn-int.info/article-E_POPSOC_590_0001--is-young-adult-excess-mortality-a.htm">Human Mortality Database</a> (Figure 1). They show situations for different periods between 1900 and 2018 in 45 countries with exhaustive vital statistics, mainly in Europe or other continents with populations of European origin, as well as a few Asian countries such as Japan.</p>
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<a href="https://images.theconversation.com/files/461249/original/file-20220504-11-u6dgt8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Age-specific mortality rates in 45 countries between 1900 and 2018" src="https://images.theconversation.com/files/461249/original/file-20220504-11-u6dgt8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/461249/original/file-20220504-11-u6dgt8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=411&fit=crop&dpr=1 600w, https://images.theconversation.com/files/461249/original/file-20220504-11-u6dgt8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=411&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/461249/original/file-20220504-11-u6dgt8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=411&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/461249/original/file-20220504-11-u6dgt8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=516&fit=crop&dpr=1 754w, https://images.theconversation.com/files/461249/original/file-20220504-11-u6dgt8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=516&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/461249/original/file-20220504-11-u6dgt8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=516&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<p>The absolute level of young adult mortality can be surprising. For example, <a href="https://www.google.fr/books/edition/Journal_of_the_Institute_of_Actuaries_an/v0UDAAAAYAAJ?hl=en&gbpv=1&dq=Thiele+T.+N.,+1871,+On+a+mathematical+formula+to+express+the+rate+of+mortality+throughout+the+whole+of+life,+tested+by+a+series+of+observations+made+use+of+by+the+Danish+Life+Insurance+Company+of+1871,+_Journal+of+the+Institute+of+Actuaries+and+Assurance+Magazine_&pg=PP12">in 1900–1904</a>, the mortality of Danish men was generally similar to or even lower than that of Norwegian men, but with practically none of the excess mortality between ages 15 and 40 observed in Norway. Starting from a much lower level of overall mortality, the curve of American men in 1990–1994 displays pronounced excess mortality, placing them above the absolute level in Australia in 1940–1944, despite a much higher level of overall mortality in the latter country.</p>
<p>Similar observations can be made for women, although they are generally less affected by this excess mortality than men. For example, in the immediate post-war period, while the overall mortality of Japanese and Portuguese women is identical up to age 15, their excess mortality is much higher in Japan above that age. Forty years later, while the absolute mortality rate of French and Ukrainian women was similar between ages 15 and 25, its level reflected high excess mortality in France but not in Ukraine, which has a strong female mortality disadvantage at all other ages. So, it is logical to conclude that for each country pair considered here, young adults are intrinsically more vulnerable in Denmark than in Norway, in the United States than in Australia, in Japan than in Portugal, and in France than in Ukraine, whatever the absolute mortality levels between ages 15 and 30.</p>
<p>Young adult excess mortality seems to be a distinct component of human mortality that stands alongside the other processes governing overall mortality. While called the “excess-mortality hump” because of the bulge it creates in the mortality curve, like that observed for Norwegian males in 1900, it may also resemble a plateau, as observed for American males in 1990 and for French females in 1980. Let us examine the possible causes of this phenomenon.</p>
<h2>Historically universal excess mortality?</h2>
<p>Young adult excess mortality is considered a <a href="https://www.cairn-int.info/article-E_POPSOC_590_0001--is-young-adult-excess-mortality-a.htm">worldwide phenomenon</a> particularly prevalent <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0014826">among men</a>. This is because we tend to view adolescence as a naturally tumultuous period, marked by the psychological upheavals associated with puberty*<em>, such as the production of sex hormones or the asynchronous development of different parts of the brain</em>*. It is believed these hallmarks of the “adolescent brain”, as it is sometimes called in the neuropsychological literature, are reflected in a lack of inhibition, excessive risk-taking, impulsiveness, and a general struggle to foresee the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2892678/">consequences of one’s behaviour</a>.</p>
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<a href="https://images.theconversation.com/files/461250/original/file-20220504-16-kl250i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Age-specific mortality rates in selected male populations showing little or no evidence of young adult excess mortality" src="https://images.theconversation.com/files/461250/original/file-20220504-16-kl250i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/461250/original/file-20220504-16-kl250i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=593&fit=crop&dpr=1 600w, https://images.theconversation.com/files/461250/original/file-20220504-16-kl250i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=593&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/461250/original/file-20220504-16-kl250i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=593&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/461250/original/file-20220504-16-kl250i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=745&fit=crop&dpr=1 754w, https://images.theconversation.com/files/461250/original/file-20220504-16-kl250i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=745&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/461250/original/file-20220504-16-kl250i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=745&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<p>These assumptions are only partially borne out by fact, however. Analysis of several thousand curves similar to those presented in Figure 1 shows that while excess mortality is a frequent reality for men, it is <a href="https://archive-ouverte.unige.ch/unige:73525">very limited or non-existent in certain cases</a> (Figure 2). Exceptions of this kind were especially common in the 1950s and 1960s, in both Southern Europe (Spain and Portugal) and Northern Europe (Ireland and Finland).</p>
<p>Excess mortality among young women is systematically lower than that of young men, if not non-existent. It is nonetheless widely observed in different contexts, not only in the past, when maternal mortality was still high, but also more recently (Figure 3).</p>
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<a href="https://images.theconversation.com/files/461253/original/file-20220504-27-81mfwi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Age-specific mortality rates in selected female populations showing clear evidence of young adult excess mortality" src="https://images.theconversation.com/files/461253/original/file-20220504-27-81mfwi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/461253/original/file-20220504-27-81mfwi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=692&fit=crop&dpr=1 600w, https://images.theconversation.com/files/461253/original/file-20220504-27-81mfwi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=692&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/461253/original/file-20220504-27-81mfwi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=692&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/461253/original/file-20220504-27-81mfwi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=869&fit=crop&dpr=1 754w, https://images.theconversation.com/files/461253/original/file-20220504-27-81mfwi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=869&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/461253/original/file-20220504-27-81mfwi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=869&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<p>It was especially high in the interwar period, both in Northern Europe (Finland and Norway) and in Southern Europe (Italy), perhaps due to the high incidence of tuberculosis (see below), a common disease after the Second World War in countries such as Japan and Bulgaria. More recently, pronounced excess female mortality among young adults has been observed in several industrialized countries including France, the United States, and New Zealand; only the 1950s and 1960s were free of this phenomenon. The excess mortality hump is thus not universal, and neither is it specific to males.</p>
<h2>Live fast, die young?</h2>
<p>Another common belief is that youths tend to die in higher numbers because of a greater inclination to take risks in the years after puberty. In the literature, the term “accident hump” is often used, with some authors seeing an explicit link between excess mortality and adolescent risk-taking resulting in <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0014826">more frequent accidental or violent deaths</a>. Here again, this explanation is only partially borne out by fact.</p>
<p>First, regarding the age range concerned, while the hump starts to form in early adolescence, it continues up to age 30 at least – well beyond the end of puberty. In the United States, young adult excess mortality in the 1960s disappeared at around <a href="https://pubmed.ncbi.nlm.nih.gov/29869068/">age 35 for men and age 25 for women</a>. This limit then shifted to later ages for both sexes, reaching 45–50 years in the early 1990s, partly because of the HIV epidemic which causes deaths at later ages, on average, than accidents do. Since then, the age limit of the US accident hump has fluctuated between 30 and 40 years, partly because of the current epidemic of <a href="https://pubmed.ncbi.nlm.nih.gov/29869068/">opioid overdose deaths</a>. Given the extensive age range covered by the hump, it cannot be attributed to a purely biological factor that leads to high-risk behaviour in adolescence.</p>
<p>Secondly, the breakdown of causes of death linked to the excess mortality hump is more complex than it appears, and while accidents have played an important role in recent decades, they are not always the leading cause of excess mortality at young ages. For example, in the United States, road traffic accidents, which accounted for around 60% of excess mortality in the 1960s, now only explain a quarter of young men’s deaths, on a par with <a href="https://pubmed.ncbi.nlm.nih.gov/29869068/">suicides and homicides</a>. For both sexes, the contribution of overdoses to excess mortality has risen from practically 0% to 20% in the last decade.</p>
<h2>The role of tuberculosis</h2>
<p>Historically, deaths from external causes have not always reached the levels seen in recent years. In the 22 countries, pulmonary tuberculosis was the main cause of excess mortality among youths <a href="https://books.google.fr/books/about/Causes_of_Death_Life_Tables_for_National.html?id=4nRqAAAAMAAJ&redir_esc=y">until the mid-19th century</a>. In the interwar period, the disease still accounted for around 50% of male excess mortality on average, with proportions of up to 90% in Portugal, and ranging from 70% to 90% in Sweden, Spain, France, England, Greece, Italy, the Netherlands, and Norway.</p>
<p>In the same period, maternal mortality accounted for less than 10% of female young adult excess mortality, excepting certain non-European countries (United States, Chile, New Zealand, and Taiwan), where it still represented 30% to 40% before the 1940s. Deaths from external causes (suicides, homicides, accidents including road traffic accidents) overtook tuberculosis deaths between 1940 and 1960, with varying patterns across countries. This turnaround coincides with the development of antibiotics (streptomycin, effective against tuberculosis, was discovered in 1944) and the boom in car ownership. In historical terms, the major role of violent and accidental deaths in young adult excess mortality is a relatively recent phenomenon.</p>
<hr>
<p>While the young adult excess mortality hump was <a href="https://www.google.fr/books/edition/Journal_of_the_Institute_of_Actuaries_an/v0UDAAAAYAAJ?hl=en&gbpv=1&dq=Thiele+T.+N.,+1871,+On+a+mathematical+formula+to+express+the+rate+of+mortality+throughout+the+whole+of+life,+tested+by+a+series+of+observations+made+use+of+by+the+Danish+Life+Insurance+Company+of+1871,+_Journal+of+the+Institute+of+Actuaries+and+Assurance+Magazine_&pg=PP12">first spotted 150 years ago</a>, it remains imperfectly understood. It is sometimes the object of misconceptions based on a purely biological conception of adolescence as a universal, gendered phenomenon linked to high-risk behaviour of young adults.</p>
<p>In reality, the hump evolves independently of overall mortality levels, is more pronounced for men than women, and is not universal. It often extends beyond puberty and fluctuates with changes in causes of death not necessarily linked to accidents or violence. While biological factors cannot be excluded, the historical context of the transition to adulthood plays a key role by placing young adults at heightened risk.</p>
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<p><em>This text is adapted from an article by the authors published in Population & Societies, no. 590, <a href="https://www.cairn-int.info/article-E_POPSOC_590_0001--is-young-adult-excess-mortality-a.htm">“Is young adult excess mortality a natural phenomenon?”</a></em></p><img src="https://counter.theconversation.com/content/182181/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adrien Remund received an Early Postdoc.Mobility Fellowship from the Swiss National Science Foundation and a Eugène Choisy and Charles Borgeaud Postdoctoral Fellowship from the Société Académique de Genève.</span></em></p><p class="fine-print"><em><span>Timothy Riffe has received funding from the Basque Foundation for Science.</span></em></p><p class="fine-print"><em><span>Carlo Giovanni Camarda ne travaille pas, ne conseille pas, ne possède pas de parts, ne reçoit pas de fonds d'une organisation qui pourrait tirer profit de cet article, et n'a déclaré aucune autre affiliation que son organisme de recherche.</span></em></p>The risk of dying changes over the course of a lifetime. Very high at birth, it falls and then gradually rises again… except for a peak after adolescence. Why such a statistical anomaly?Carlo Giovanni Camarda, Docteur, spécialiste des méthodes de prévision (mortalité, longévité, etc.), Institut National d'Études Démographiques (INED)Adrien Remund, Docteur, spécialiste des migrations et en démographie historique, University of GroningenTimothy Riffe, Docteur, spécialiste en santé des populations, Universidad del País Vasco / Euskal Herriko UnibertsitateaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1018822018-08-24T10:39:56Z2018-08-24T10:39:56ZTeens who feel down may benefit from picking others up<figure><img src="https://images.theconversation.com/files/232955/original/file-20180821-149466-195vxtr.jpg?ixlib=rb-1.1.0&rect=358%2C515%2C4455%2C2661&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Boosting someone else may deliver a mood boost to you too.</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/QqJiA8cZ3Ds">Mohamed Nohassi/Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p><em><a href="https://theconversation.com/como-apoyar-a-un-hijo-con-depresion-ensenale-a-ayudar-a-otros-102143">Leer en español</a></em>.</p>
<p>Think about the last time you helped someone out. Maybe you sent a supportive text to a stressed-out friend or gave directions to a lost stranger. </p>
<p>How did it make you feel? </p>
<p>If you said good, happy, or maybe even “warm and fuzzy,” you’re not alone. Research shows that helping others offers a number of important psychological and health benefits.</p>
<p>In daily life, people report better mood on days that they <a href="https://doi.org/10.1177/2167702615611073">assist a stranger</a> or <a href="https://doi.org/10.1037/emo0000084">offer an empathetic ear to a friend</a>. Adults who <a href="https://doi.org/10.1177/002214650704800408">volunteer</a>, <a href="https://doi.org/10.1016/j.paid.2014.05.013">spend money on others</a> and <a href="https://doi.org/10.1111/1467-9280.14461">support their spouses</a> also experience improved well-being and <a href="https://doi.org/10.1111/1467-9280.14461">reduced risk of death</a>.</p>
<p>Helping others is beneficial in part because it <a href="https://www.researchgate.net/profile/Richard_Ryan2/publication/41087502_When_Helping_Helps_Autonomous_Motivation_for_Prosocial_Behavior_and_Its_Influence_on_Well-Being_for_the_Helper_and_Recipient/links/02e7e53274d556c5f8000000.pdf">promotes social closeness and feelings of personal competence</a>. </p>
<p>As <a href="https://scholar.google.com/citations?user=6Y0_gc8AAAAJ&hl=en&oi=ao">a researcher who studies adolescent development</a>, I decided to investigate how all this might play out in teenagers. I’m interested in studying teens’ prosocial behavior – things like helping, comforting and sharing – in the context of their close relationships. Given that adolescence is a time of <a href="https://doi.org/10.1111/desc.12373">heightened emotional intensity</a>, do teens reap mood benefits from helping out others in everyday life?</p>
<h2>Teens and depression</h2>
<p>Looking back on your own high school years, you might recall feeling intensely anxious about looking cool in front of classmates or being liked by your crush. During adolescence, youth become increasingly <a href="https://doi.org/10.1146/annurev-psych-010213-115202">preoccupied with the opinions of their peers</a>, including their friends and romantic partners. Indeed, adolescence is a time when experiences of social exclusion or rejection can <a href="http://doi.org/10.1177/0963721413476512">sting particularly badly</a>.</p>
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<span class="caption">The teenage years can be a hard time for some adolescents.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/noizephotography/3302465543">Paul De Los Reyes</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>The teenage years are also a high-risk time for developing depressive symptoms. Almost <a href="http://doi.org/10.1542/peds.2016-1878">1 in every 11</a> adolescents and young adults in the U.S. experience a major depressive episode. And, even youth with depressive symptoms who don’t meet criteria for an official diagnosis of depression are <a href="https://doi.org/10.1017/S095457941300093X">at risk for adjustment problems</a>, such as loneliness and romantic relationship difficulties.</p>
<p>Depressed adolescents, in addition to feeling hopeless and lacking self-esteem, often respond to <a href="http://psycnet.apa.org/record/2008-01178-004">social stress</a> with intensified negative emotions. For example, adolescents with major depressive disorder <a href="https://doi.org/10.1093/scan/nst175">take peer rejection harder</a> than do their healthy peers.</p>
<p>If depressed adolescents feel especially bad after negative social encounters, might they feel especially good after positive social encounters? Psychologists know that in general adolescents’ concerns about social approval can make positive interpersonal interactions – like offering a peer support or assistance – <a href="https://doi.org/10.1016/j.dcn.2016.11.008">all the more rewarding</a>. I wanted to see if that held even for teens who were feeling down.</p>
<h2>Did you help someone today?</h2>
<p>In <a href="https://doi.org/10.1037/emo0000494">our 2018 study</a>, <a href="https://dornsife.usc.edu/labs/margolinfamilystudies/graduate-students/">my colleagues and I</a> examined teenagers’ prosocial behavior in their everyday interactions with friends and romantic partners. Our goal was to understand whether giving help is particularly mood-enhancing for youth with depressive symptoms. </p>
<p>We recruited 99 late adolescents from the community around us in Los Angeles. Most of them were high school students or recent high school graduates. First we assessed their depressive symptoms in the lab so we could find out how they’d been feeling the prior couple weeks.</p>
<p>Then we asked them to complete 10 consecutive days of short surveys at home. Each of the 10 days, participants told us whether they helped out their friends or romantic partners – things like doing them a favor, or making them feel important. They also reported their own mood.</p>
<p>On days that teens helped their friends or dating partners, they experienced increased positive mood. Even if their mood wasn’t great the day before or if they themselves didn’t receive any social support that day, helping someone else was still related to a boost in their spirits.</p>
<p>But does helping help some teens more than others? The positive effects of day-to-day prosocial behavior on mood that we saw were strongest for teens with higher levels of depressive symptoms. So youth with elevated emotional distress reaped the greatest mood benefits from lending their peers a helping hand. </p>
<p>While we often talk about the importance of receiving social support when we’re feeling down, these findings highlight the unique value of providing support to others.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/233355/original/file-20180823-149490-11p3lz8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/233355/original/file-20180823-149490-11p3lz8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/233355/original/file-20180823-149490-11p3lz8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/233355/original/file-20180823-149490-11p3lz8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/233355/original/file-20180823-149490-11p3lz8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/233355/original/file-20180823-149490-11p3lz8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/233355/original/file-20180823-149490-11p3lz8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/233355/original/file-20180823-149490-11p3lz8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Teens felt better when they supported a friend.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/gRj8fOks0eg">Justin Groep/Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>Helping others helps yourself</h2>
<p>This study provides a glimpse into the potential benefits of help-giving for teens, particularly those experiencing depressive symptoms. Our finding builds upon previous research demonstrating that prosocial behavior is most rewarding for people experiencing <a href="https://doi.org/10.1037/a0027761">social anxiety</a>, <a href="https://doi.org/10.1111/jopy.12299">neuroticism</a> and <a href="https://doi.org/10.1016/j.paid.2017.10.042">body dissatisfaction</a>.</p>
<p>Although we did not test for underlying mechanisms for why this might be, it’s possible that providing help can make individuals feel <a href="https://doi.org/10.1371/journal.pone.0051380">appreciated by others</a> or promote <a href="https://doi.org/10.1080/17439760.2016.1209541">their sense of purpose</a> and <a href="https://doi.org/10.1016/j.adolescence.2017.04.002">self-esteem</a>. For youth with high levels of social-emotional distress, opportunities to strengthen social connections and feel competent within close relationships might be especially important for improving mood.</p>
<p>Many studies linking prosocial behavior to mood, ours included, are correlational — we cannot conclude that helping friends or romantic others causes more positive mood. Experimental studies that <a href="https://doi.org/10.1037/a0027761">randomly assign some participants to engage in acts of kindness</a> and others to engage in non-helping social activities will help rule out the possibility that it’s actually positive mood that drives subsequent prosocial behavior.</p>
<p>It’s also important to keep in mind that very few of our participants were clinically depressed. Research still needs to determine whether prosocial behavior is similarly linked to positive mood among adolescents with a diagnosed depressive disorder. An interesting question is whether some depressed youth experience emotional “burnout” from very frequent help-giving.</p>
<p>Although the word “adolescence” may conjure up images of reckless teens experiencing interpersonal conflict and emotional turmoil, the adolescent years are a time of great social opportunity and growth. Understanding when, how and why teens behave prosocially – and for whom help-giving most promotes well-being – can contribute to our understanding of adolescent social development.</p><img src="https://counter.theconversation.com/content/101882/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This material is based upon work supported by a National Science Foundation SBE Postdoctoral Research Fellowship awarded to Dr. Hannah L. Schacter under Grant No. 1714304.
This project is also based on work supported by NSF BCS-1627272 (Dr. Gayla Margolin, PI) and NIH-NICHD R21-HD072170 A1 (Dr. Gayla Margolin, PI).
Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author and do not necessarily reflect the views of the National Science Foundation or the National Institutes of Health.</span></em></p>Psychology researchers found that daily acts of kindness were linked to increases in positive mood – especially for teens who felt depressed.Hannah L. Schacter, Postdoctoral Research Fellow in Psychology, USC Dornsife College of Letters, Arts and SciencesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/798062017-07-06T14:06:57Z2017-07-06T14:06:57ZWhy psychologists have got it wrong on 13 Reasons Why<figure><img src="https://images.theconversation.com/files/176584/original/file-20170703-32631-1sko45c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Netflix</span></span></figcaption></figure><p>Since its debut the Netflix drama series, 13 Reasons Why, has been at the centre of a media firestorm. Psychologists and mental health groups have spoken out publicly against the show, especially its frank depiction of suicide, claiming that it sends out the wrong <a href="https://theconversation.com/popular-netflix-drama-13-reasons-why-sends-out-worrying-messages-about-suicide-78008">message to viewers</a>. </p>
<p>Vulnerable teens, so their argument goes, may strongly identify with the protagonist, Hannah Baker, and view the series as an instruction manual for suicide. The overarching fear is that 13 Reasons Why might not only encourage someone to take their own life, but may also <a href="https://theconversation.com/to-talk-or-not-to-talk-the-dilemma-of-suicide-contagion-46434">become contagious</a>. As if suicide works the same way as, say, the common cold or other airborne infections. </p>
<p>We have heard many exaggerated claims about research that supposedly proves that there is a link between fictional drama and suicide rates. Speaking to the Washington Post, Dan Reidenberg, executive director of Suicide Awareness Voices of Education, <a href="https://www.washingtonpost.com/news/arts-and-entertainment/wp/2017/04/14/the-problem-with-how-13-reasons-why-treats-suicide/?utm_term=.d88a5d40f1fd">argued</a> that young people are “not that great at separating fiction from reality” and “we see them actually replaying what they’ve seen”. In fact, <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1467-8624.2006.00973.x/full">research shows</a> that young people are adept at differentiating between reality and fantasy from infancy. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/176585/original/file-20170703-7743-rurcyu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/176585/original/file-20170703-7743-rurcyu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/176585/original/file-20170703-7743-rurcyu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/176585/original/file-20170703-7743-rurcyu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/176585/original/file-20170703-7743-rurcyu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/176585/original/file-20170703-7743-rurcyu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/176585/original/file-20170703-7743-rurcyu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Palpable nonsense.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/589801625?src=JqbGsoRXktXhumTyDQ8yww-1-1&size=medium_jpg">Kunst Bilder/Shutterstock</a></span>
</figcaption>
</figure>
<p>The idea of suicide contagion stems from <a href="https://www.jstor.org/stable/2094294?seq=1#page_scan_tab_contents">an academic article</a> written in 1974 by an American sociologist, David Phillips. Phillips named it “the Werther effect” after the protagonist in an 18th-century novel by Johann Wolfgang von Goethe, The Sorrows of Young Werther. The eponymous hero of the book shoots himself following an episode of unrequited love. Shortly after the publication of the book, it is said that followers of Goethe, especially those who identified strongly with Werther, began taking their own lives using the same method as the protagonist. Phillips study, however, did not look at the historical evidence of people committing suicide in the 18th century as a result of Goethe’s novel. He looked at the link between the modern reporting of suicide in the press and suicide rates. </p>
<p>Briefly, Phillips counted the number of front-page suicide news stories in the New York Times, between 1947 to 1968, and mapped them against national suicide rates in the month following the announcement of the suicide. Readers may well be asking: what does one have to do with the other? Quite. This is what psychologist Christopher Ferguson describes as <a href="https://www.netgalley.com/catalog/book/105159">“an illusory correlation”</a>, that is, believing there is a relationship between variables even when no such relationship exists. </p>
<p>Phillips’ methodology has been widely criticised and the research effectively debunked from <a href="http://www.tandfonline.com/doi/abs/10.1080/13576270500178112?journalCode=cmrt20">within the field itself</a>. After analysing the methodology and findings, James Hittner, associate professor of psychology at the College of Charleston, found that “the Phillips data were not supportive of the Werther effect”. </p>
<h2>Fiction v journalism</h2>
<p>13 Reasons Why is not journalism, it is fictional drama, so even if the statistical absurdity of Phillips’ study had any merit, he did not make these claims about fictional media. In fact, Australian academics, Jane Pirkis and Warwick Blood, <a href="https://www.researchgate.net/publication/11512033_Suicide_and_the_Media_Part_II_Portrayal_in_Fictional_Media">found</a> that the supposed link between suicide rates and fictional entertainment is not born out by research. The evidence is not only inconsistent, say the researchers, but “relatively weak”.</p>
<p>Novels, films, TV dramas and their ilk do not contain messages that can be transmitted into the minds of children and young adults. Audiences are not passive recipients like Pavlov’s poor hounds. They interpret, evaluate and use media in a wide variety of ways. Claiming that 13 Reasons Why can lead to real-life suicide is not only sensationalist but runs the risk of creating a <a href="https://www1.bournemouth.ac.uk/news/2017-05-25/open-letter-journalists-mental-health-campaigners-psychologists">moral panic</a>. Sending <a href="http://www.refinery29.com/2017/04/151731/13-reasons-why-school-sent-letters-warning-parents">cautionary letters</a> to parents, <a href="http://www.avclub.com/article/canadian-school-bans-discussions-13-reasons-why-254504">banning</a> the series from schools or <a href="http://nypost.com/2017/05/16/school-district-pulls-13-reasons-why-book-from-libraries/">the book from libraries</a>, or warning people about the dangers of watching the series, will not stop young people watching the show. </p>
<p>As we now surely know, from countless moral campaigns of this kind, scapegoating media as forbidden only challenges people to seek it out to learn what all the fuss is about. It is not the media, in whatever form, that should be causing anxiety, but substantial <a href="http://www.independent.co.uk/news/health/mental-health-nhs-funding-cut-millions-five-england-regions-1-billion-spent-2021-scarborough-walsall-a7700476.html">cuts in mental health funding</a> as well as the continuing <a href="https://www.time-to-change.org.uk/category/blog/stigma-and-discrimination">discrimination and stigma</a> attached to such conditions. As clinical psychologist David Swanson <a href="http://www.cbsnews.com/news/netflix-13-reasons-families-claim-show-triggered-suicide/">argues</a>, 13 Reasons Why will not cause people to take their own lives. It is anxiety, depression and major stress that are the triggers.</p>
<p>Perhaps our time would be best served by thinking of ways to help those most in need by protesting against the damage being done to suicide prevention services <a href="http://www.independent.co.uk/news/uk/politics/suicide-prevention-services-funding-cuts-samaritans-health-committee-a7391536.html">by policies such as austerity</a>, rather than awarding a TV series – or indeed a book – more power than it actually has. </p>
<hr>
<p><em>The Samaritans can be contacted in the UK on 116 123. Papyrus is contactable on 0800 068 41 41 or by texting 07786 209 697 or emailing pat@papyrus-uk.org. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found <a href="http://www.suicide.org/international-suicide-hotlines.html">here</a>.</em></p><img src="https://counter.theconversation.com/content/79806/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>William Proctor does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Many psychologists claim that 13 Reasons Why could incite young people to take their own lives. But their claims aren’t supported by evidence.William Proctor, Lecturer in Media, Culture and Communication, Bournemouth UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/469162015-09-04T10:35:16Z2015-09-04T10:35:16ZThe secret to a college football coach’s success<p>With the new college football season upon us, fans across the country are hoping their team could be the one crowned national champion on January 11 2016 in <a href="http://www.collegefootballplayoff.com/university-of-phoenix-stadium">Glendale, Arizona’s University of Phoenix Stadium</a>. Of course, who is ultimately successful will depend a lot on the talents of their players – and a healthy dose of luck. </p>
<p>Oh, and let’s not forget about the coach. </p>
<p>There are just a handful of coaches who have excelled at creating successful, sustainable programs over the course of many years. Nick Saban, Urban Meyer, Mark Dantonio and Gary Patterson come to mind. </p>
<p>How do they do it?</p>
<p>While all have their specific plans, I believe the most successful coaches emphasize success beyond the playing field. That may sound like a cliché, but it has to be more than just a platitude. There has to be a system.</p>
<p>After all, the stakes are too high for colleges and universities to employ coaches that are not dialed into their players’ developmental needs. We need only recall the <a href="http://sports.yahoo.com/news/ncaab--why-don-t-college-athletes-call-out-abusive-coaches--222535612.html?nf=1">recent scandal</a> involving former Rutgers basketball coach Mike Rice, who was fired after administrators discovered a pattern of abusive behaviors displayed toward his student athletes.</p>
<p>Ultimately, it’s coaches who are closely attuned to their players’ social and emotional development that seem to have higher degrees of sustainable, on-field success. </p>
<h2>Rites of passage: turning boys into men</h2>
<p>In an <a href="http://journals.humankinetics.com/iscj-current-issue/iscj-volume-2-issue-3-september/turning-boys-into-men-the-incentive-based-system-in-urban-meyerrsquos-plan-to-win">article</a> for the International Sport Coaching Journal, I present a case study with Urban Meyer, coach of The Ohio State University Buckeyes. The hope is to show how his particular system bears striking resemblance to a modern-day rite of passage. </p>
<p>The literature on <a href="https://en.wikipedia.org/wiki/Rite_of_passage">rites of passage</a> (also known as rituals of initiation) identifies three main phases through which children become adults: </p>
<ul>
<li><p>it begins with a separation phase, one that marks the beginning movement out of the individual’s childhood status</p></li>
<li><p>next, the transformation phase involves a “betwixt and between” period of uncertainty, characterized by wavering back and forth from less mature to more mature behaviors </p></li>
<li><p>finally, the reincorporation phase represents the individual’s integration of the attitudes, values and behaviors required of prosocial adults.</p></li>
</ul>
<p>There is overwhelming acceptance of the historical importance of <a href="http://rope.org/">rites of passage</a>, especially in terms of their use to foster cohesiveness within social groups. </p>
<p>Additionally, the absence of separation, transformation and reincorporation experiences in contemporary society is thought to be <a href="http://ncsu.edu/ffci/publications/2007/v12-n2-2007-summer-fall/scheer.php">significantly related</a> to youth violence, drug and alcohol use, gang involvement, bullying and delinquency. </p>
<p>These dysfunctional behaviors are believed to be the misguided attempts of young people to create rites of passage for themselves, in the absence of mentors or positive influences.</p>
<h2>Urban Meyer: the quintessential coach</h2>
<p>Why choose Urban Meyer as a case study? </p>
<p>Well, I have to admit that ease of access plays a part for me, since we both work at the same university. But Meyer is a worthy subject. After fielding two national football championship teams at the University of Florida during the 2006 and 2008 seasons, he led the 2014 Ohio State University Buckeyes to the first-ever <a href="http://www.collegefootballplayoff.com/">College Football Playoff National Championship</a>. </p>
<p>Throughout his 13-year career as a head coach, his teams have won five conference championships and twice (2004 at Utah and 2012 at Ohio State) have registered undefeated seasons. It’s hard to argue with those kinds of triumphs on the field.</p>
<p>But I believe his efforts to create <em>off-the-field</em> success for his players are closely tied to his teams’ on-the-field accomplishments. </p>
<p>Underlying these efforts is what Urban Meyer has dubbed his “Plan to Win,” a competitiveness doctrine based on a set of core values for players that includes behavioral commandments (honesty, respect for women, no drugs, no stealing and no weapons) and a strong emphasis on classroom success.</p>
<h2>Color-coordinating a ‘Plan to Win’</h2>
<p>The key component of the Plan to Win is what he has named his Blue-Red-Gold (BRG) incentive system. Three color-coded stages – Blue, Red, and Gold – represent a ladder of privileges climbed by players as they display mature behavior both on the field and off. </p>
<p>As Meyer explained in a 2012 Columbus Dispatch <a href="http://buckeyextra.dispatch.com/content/stories/2012/03/11/gold-diggers.html">article</a>: </p>
<blockquote>
<p>Blue stands for child, which means ill-equipped, defiant, disinterested. So if you’re in blue, we don’t think very highly of you, and we make that very clear. And every freshman who comes into the program is blue, for example… Guys who are red get nicer gear. If they want to change numbers, if they want to get a visor, if they want to move off campus, the answer for them then is maybe. You get up to gold, you do what you’ve got to do because gold means you’re a grown man. We don’t tell you when to study, things like that. Gold means you deserve to be treated like a man.</p>
</blockquote>
<p>The BRG system is a comprehensive player motivation method that contains a variety of inputs and outcomes. Meyer and his coaches closely monitor player adherence to academic demands and behavioral expectations across all status levels, with meaningful rewards bestowed for appropriate behavior – alongside swift consequences for infractions. </p>
<p>Transitions in status (up or down) are handled by the entire coaching staff, who meet as a group every week to discuss player progress and deliberate possible transitions. When the coaches decide to promote a player, an announcement is made to the entire team in the form of a “graduation ceremony” that recognizes the player’s newfound “status.”</p>
<h2>Transforming performance on – and off – the field</h2>
<p>The BRG incentive-based system mirrors the rites of passage conceptual framework discussed earlier. </p>
<p>Blue can be equated with the status of a young child and, as such, beginning movement out of this status parallels the “separation” component of the rite of passage. </p>
<p>In turn, red is equated with a middle stage, similar to the “betwixt and between” state of adolescence that is marked by a “transformative” stage of development. </p>
<p>Finally, gold status represents the adult stage of development and all of the privileges and responsibilities associated with this marker of full maturity.</p>
<p>Meyer’s BRG system is so successful because the expectations are clear about what it means to grow up in the eyes of the coaching staff, and the behaviors that players must enact in order to achieve that status are well-defined.</p>
<p>When everyone’s on the same page off the field, it makes it easier to work as a cohesive unit – and win – on the field.</p>
<h2>A recipe for success in sports – and all walks of life</h2>
<p>Simultaneously, there is an explicit recognition that coaches serve as powerful male role models for their players. </p>
<p>For example, Meyer regularly hosts Family Night dinners so that players are exposed to the coaches and how they act around their loved ones. </p>
<p>There is a more spiritual component to this work as well, with various community engagement activities centered on “setting the table” for players to understand the importance of living a life in service to things greater than themselves. </p>
<p>Coaches who use ceremonies to mark player transitions mine a tradition that honors and recognizes accomplishment. For generations, various forms of promotions and recognition have been used to inspire athletes, soldiers and students alike.</p>
<p>Simply put, it’s a formula that works, and these rituals and rewards carry great psychological meaning for individuals.</p>
<p>While the details of Meyer’s Plan to Win may be unique, I believe the overall aims and basic structure are shared by many of the most successful coaches. </p>
<p>Case studies of other highly successful men’s coaches bears this out. For example, Pete Carroll’s success at both the college and professional football levels has been <a href="http://www.multi-science.co.uk/sports-science&coaching.htm">discussed</a> as being based on factors related to self-knowledge, self-confidence and optimism. </p>
<p>The same can be said of coaches in high-performance women’s sports. Take, for example, legendary University of Tennessee women’s basketball coach Pat Summitt, whose coaching style was <a href="http://journals.humankinetics.com/TSP">reported</a> to have involved high degrees of instructional behavior and praise offered to her players within a high-intensity environment.</p>
<p>In a <a href="http://www.amazon.com/Urbans-Way-Urban-Florida-Gators/dp/B005B1JPVI">2008 book</a>, Meyer stated his desire to remain in contact with his players long after graduation, noting that if they “become the best husbands and fathers they can be, then we have won at the game of life.” </p>
<p>By tapping into the deep historical traditions of “rites of passage,” coaches can help get the most out of their players, both on and off the field. And along the way, a lot of boys can be turned into fine, upstanding men.</p><img src="https://counter.theconversation.com/content/46916/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephen M. Gavazzi works for The Ohio State University</span></em></p>For coaches like Ohio State’s Urban Meyer, it’s not just about X’s and O’s.Stephen M Gavazzi, Professor, Human Development and Family Science & Dean/Director, Ohio State Mansfield Campus, The Ohio State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/463982015-08-25T20:01:00Z2015-08-25T20:01:00ZIs ‘headspace’ really improving young people’s mental health?<figure><img src="https://images.theconversation.com/files/92880/original/image-20150825-17765-3lglbb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Mental health problems are common in young people but very few seek professional help.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/alainwibert/6014160506/">Alain Wibert/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p>Mental health problems are common in young people and often have their first onset during this period of life. But many affected youth either don’t seek or delay seeking professional help. </p>
<p>To help overcome this low rate of help-seeking, the Australian government set up a National Youth Mental Health Foundation, called <a href="https://www.mja.com.au/journal/2014/200/2/headspace-australia-s-innovation-youth-mental-health-who-are-clients-and-why-are">headspace</a>, in 2006. Its aim was to increase early intervention for mental health problems among people between 12 and 25 years old, by setting up youth-friendly enhanced primary health services. </p>
<p>The services were designed to provide not only mental health care, but help for alcohol and drug problems, as well as physical health and vocational assistance. </p>
<h2>Limited improvement</h2>
<p>With government funding, headspace centres have rapidly expanded in number from an initial ten in 2006-2007 to a planned 100 by 2016. But this expansion has occurred before any evaluation of whether headspace services actually improve young people’s mental health. </p>
<p>The government has commissioned an independent evaluation, but that’s yet to be completed. In the meantime, headspace has itself <a href="https://www.mja.com.au/journal/2015/202/10/services-provided-young-people-through-headspace-centres-across-australia">carried out some evaluation of outcomes</a> based on routinely collected data.</p>
<p><a href="https://www.mja.com.au/journal/2015/202/10/changes-psychological-distress-and-psychosocial-functioning-young-people">The results show</a> that young people attend headspace mainly for mental health problems involving anxiety or depression. It’s clear many headspace clients have major mental health problems and that these can have a negative impact on their functioning.</p>
<p>What’s less clear is whether headspace services produce any improvements in these mental health problems. The data show that 36% of clients had significant improvement in their symptoms, 51% had no significant change and 13% had significant worsening. </p>
<p>The fact that more people improved than worsened may have nothing to do with headspace services. It’s well known that many mental health problems tend to improve <a href="http://www.ncbi.nlm.nih.gov/pubmed/22410207">even without treatment</a>.</p>
<p>And because there was no untreated control group to compare the results with, it’s not possible to say whether headspace produced any of the improvement. But it is possible to compare the headspace rates of improvement with those from <a href="http://www.ncbi.nlm.nih.gov/pubmed/22410207">international studies</a> that have looked at <a href="http://www.ncbi.nlm.nih.gov/pubmed/22883473">changes without treatment</a> in people with depression. </p>
<p>Unfortunately, the comparison is not encouraging; rates of natural improvement are very similar to those reported for headspace. It’s quite plausible the changes seen in headspace clients are simply the spontaneous improvement that can occur even without treatment. </p>
<h2>Why not better?</h2>
<p>According to headspace data, most clients received types of psychological therapy that should be effective, but most received only a few sessions. </p>
<p><a href="https://www.mja.com.au/journal/2015/202/4/frequency-and-quality-mental-health-treatment-affective-and-anxiety-disorders">Recently published research</a> on the quality of treatment for depression and anxiety disorders in Australia has defined “minimally adequate treatment”. For psychological therapy, this involves six or more sessions with a therapist. </p>
<p>Using this definition, only 28% of headspace clients received minimally adequate treatment for depression and anxiety. Almost half (45%) received as few as one or two sessions, which is nowhere near the minimum. </p>
<p>Although young people are often difficult to engage for psychological therapy, the outcomes are disappointing given that <a href="http://bjp.rcpsych.org/content/202/s54/s30">headspace was specifically set up</a> to be “youth-friendly” and “stigma-free”. So it’s not unreasonable to expect that headspace would promote better engagement than traditional services. </p>
<p>The authors of the recently published headspace evaluation studies were appropriately cautious in their conclusions about the initiative’s effectiveness. But the promotion of the findings to the public by headspace advocates gives cause for concern, with claims such as <a href="https://orygen.org.au/About/News-And-Events/New-data-shows-headspace-improving-outcomes">“New data shows headspace improving outcomes for young people”</a>.</p>
<p>More importantly, there’s a broader lesson here. Like many mental health reforms, headspace centres are based on good ideas with an appealing logic. And the headspace concept has been effectively promoted to politicians who may be very pleased to announce a new centre in their electorate. </p>
<p>But once such an initiative is rolled out nationally, it becomes difficult then to take an alternative approach, even if the data eventually turn out to be unconvincing. </p>
<p>Real reform of Australia’s mental health care system is long overdue and keenly awaited by the sector. But if the community is to benefit, there needs to be piloting of reforms and rigorous evaluation before, rather than after, any national roll-out.</p><img src="https://counter.theconversation.com/content/46398/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anthony Jorm has received research grant funding for studies of headspace clients. He has collaborated with headspace staff on research projects. He was formerly associated with Orygen Youth Health Research Centre, which operates a number of headspace services. </span></em></p>The number of youth mental health centres known as headspace has rapidly expanded in the last decade. But we have yet to see evaluation of whether the services improve young people’s mental health.Anthony Jorm, Professorial Fellow and an NHMRC Senior Principal Research Fellow, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/450302015-07-22T10:29:31Z2015-07-22T10:29:31ZStudy shows most teenage friendships doomed to fail: but whose fault is that?<figure><img src="https://images.theconversation.com/files/89310/original/image-20150722-1487-oyi97f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Doomed to fail?</span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p>The psychiatrist <a href="https://en.wikipedia.org/wiki/Harry_Stack_Sullivan">Harry Sullivan</a> believed that nothing is a more significant determinant of psychological well-being than the nature of our closest social bonds. In adolescence, research has consistently linked the quality of friendships to important outcomes such as emotional health, self esteem, the ability to overcome social anxiety, and achievement at school.</p>
<p>A <a href="http://pss.sagepub.com/content/early/2015/07/16/0956797615588751.abstract">recent study</a> by researchers from <a href="http://www.fau.edu/">Florida Atlantic University</a> has explored the long-term stability of adolescent friendships in US schools. In particular, the researchers were interested in the breaking up of adolescent friendships, and the factors which predicted those break ups.</p>
<p>The study found that only 1% of friendships that started in seventh grade – when the pupils are 12-13 years old – lasted for the full five-year period of the study. Friendships that began in seventh grade were at greatest risk of dissolving within the first year (with a 76% hazard rate). When they made it beyond the hazardous first year, the chances of breaking up after three years (64% hazard rate), four years (47% hazard rate), or five years (30% hazard rate) was diminished.</p>
<p>The researchers discovered that a number of factors could help to predict the break-ups of teenage friendships. They found that the characteristics of individual teenagers – such as sex, age, ethnicity, aggressiveness, school competence – were not important when predicting the success of friendships. So, girls’ friendships were no more likely to break up than boys’. Instead, what mattered was whether or not two adolescent friends shared these characteristics. So, friends who differed in gender, peer acceptance, physical aggression, or school competence were much more likely to break up than friends who were similar in these respects. </p>
<h2>Fickle youth?</h2>
<p>It would be easy to suggest that this study is evidence that adolescents (or American adolescents, at least!) are a fickle bunch – at the mercy of a period of development characterised by instability, turbulence, and confusion about identity – all of which is reflected in their friendships (which may well be true).</p>
<p>I am already having nightmares involving those who like to micromanage young people’s education. For example, little Johnny and his parents might be “advised” not to invest in his friendship with Suzy because statistically, it simply won’t last – for a start, she’s a girl, they have mismatched test scores and she’s more popular than he is.</p>
<p>Clearly, we should be careful about the meaning we attach to such data. There are important questions to entertain before we jump to conclusions. For example, it could be that the perilous nature of adolescent friendships is a reflection of our education system’s deficiencies, rather than some inherent characteristic of adolescent psychological development. </p>
<h2>Banning best friends</h2>
<p>Increasingly, education is <a href="https://theconversation.com/excellence-is-not-the-only-point-of-education-38148">becoming a project</a> that views the production of the “knowledge worker” – that is, a well-qualified, market ready, intellectual product – as its reason for existence. The worry is that this erodes an important space for young people to nurture and develop the emotional closeness, intimacy, and relational skills that will enable them to form warm, nurturing, enduring friendships through life. </p>
<p>From a psychological point of view, I have <a href="https://www.routledge.com/products/9781138022102">recently argued</a> that education policy which prioritises the production of knowledge workers could be fundamentally at odds with the idea that education should serve as a space for the formation of genuine human relationships. What we could be witnessing in this study is evidence that we simply aren’t providing the necessary conditions in which stable, enduring adolescent relationships can develop. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/89312/original/image-20150722-1479-qc5y5k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/89312/original/image-20150722-1479-qc5y5k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=370&fit=crop&dpr=1 600w, https://images.theconversation.com/files/89312/original/image-20150722-1479-qc5y5k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=370&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/89312/original/image-20150722-1479-qc5y5k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=370&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/89312/original/image-20150722-1479-qc5y5k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=465&fit=crop&dpr=1 754w, https://images.theconversation.com/files/89312/original/image-20150722-1479-qc5y5k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=465&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/89312/original/image-20150722-1479-qc5y5k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=465&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Besties breaking all the rules.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/amanjeev/8107039629/sizes/l">Amanjeev/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>You don’t have to look very far to find recent calls in favour of <a href="http://www.dailymail.co.uk/news/article-2116699/No-best-friends-policy-rise-primary-schools-critics-warn-teachers-interfere-childs-play.html">limiting and micromanaging children’s friendships in education</a>, on the grounds that they disrupt performance. A number of schools in the UK have looked at adopting measures to prevent children from having best friends. As <a href="http://www.telegraph.co.uk/education/educationnews/10031299/Children-shouldnt-have-best-friends-private-school-head-argues.html">one UK head teacher suggested</a>:</p>
<blockquote>
<p>There is sound judgement behind it. You can get very possessive friendships. I would certainly endorse a policy which says we should have lots of good friends, not a best friend.</p>
</blockquote>
<p>This leads us to question why relationships between pairs of young people who are different (in relation to factors such as sex and achievement) aren’t flourishing in our schools. It should also prompt us to take a closer look at the extent to which we’re fostering acceptance and diversity through human connections in our schools. </p>
<p>In her book <a href="http://www.amazon.co.uk/Educational-Binds-Poverty-Routledge-Education/dp/0415719399">Educational Binds of Poverty</a>, University of Bath sociologist Ceri Brown has highlighted the incredible struggles some children face to establish friendships in the context of such “difference”. She highlights the woefully inadequate structures in place to support children to develop fulfilling relationships, in a system that is focused on academic achievement above all else.</p>
<p>Close relationships in adolescence are a critical part of human development, and education must do more to ensure it becomes a space for young people to reflect upon, nurture, and develop them.</p><img src="https://counter.theconversation.com/content/45030/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sam Carr does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Only 1% of adolescent friendships last the distance - but could our schools be the real root of the problem?Sam Carr, Lecturer in Education, University of BathLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/422892015-06-23T09:58:24Z2015-06-23T09:58:24ZDoes Inside Out accurately capture the mind of an 11-year-old girl? A child psychologist weighs in<p>Pixar’s new film Inside Out provides an interesting spin on how to understand what’s going on in the mind of an 11-year-old girl. The bulk of the action takes place inside protagonist Riley’s head, where a group of emotions (Joy, Sadness, Fear, Disgust and Anger) work together (or not) to direct her behavior.</p>
<p>The film’s primary conflict is a compelling one: it depicts Riley’s response to a major, life-changing event – a cross-country move. But from the perspective of a practicing clinical child psychologist with 30 years of experience, it’s only partly successful in accurately depicting <em>why</em> children react the way they do.</p>
<p>Most tweens would have difficulty with a cross-country move at the start of middle school, and Riley is, understandably, sad, angry, disgusted and fearful. She loses interest in things she used to like to do. The fact that her parents are also stressed, making it difficult for them to pick up on her angst until it is almost too late, also rings true. </p>
<p>Riley’s life appears to be run by her emotions. The character Joy is chief among them: it’s a core part of who she is, and a great deal of energy is expended to keep her feeling and acting in positive ways. Sadness, Fear, Disgust and Anger all have roles, and their order of appearance makes sense, developmentally. </p>
<p>Joy not only tries to keep the other emotions in check, but she’s also in charge of making sure that the core memories – which seem to define key areas of Riley’s functioning – are intact. A lot of time is devoted to trying to keep Sadness away, since she could taint these happy memories. </p>
<p>But the notion that memories can be preserved unaltered is not in line with most current research thinking. Childhood traumatic events <a href="http://www.sciencedirect.com/science/article/pii/S1053810084710166">can be remembered accurately or inaccurately</a>, while the field of eyewitness testimony is <a href="http://psycnet.apa.org/journals/lhb/4/4/261/">rife with examples</a> of memories that are moderated by perception or time. </p>
<p>Furthermore, the emotions and behaviors of Riley are depicted using the same framework that adults often use to interpret their emotions. This misses the mark. </p>
<p>Children aren’t simply little adults; as developmental psychologists like Urie Bronfenbrenner <a href="http://psycnet.apa.org/journals/dev/22/6/723.html">have noted</a>, it’s important to take into account the extent to which children are embedded in systems like family and school, where parents and teachers play a huge role in teaching children Riley’s age how to mediate their feelings. </p>
<p>Most 11-year-olds can tell you that they have feelings – and can name a few (though most would not name Disgust) – but more often than not, these feelings can overwhelm them. Adults, then, help them understand and make sense of their feelings, which is a gradual process.</p>
<p>In the end, the different characters for the emotions are altogether too mechanistic. It might be a nice way to show children that they have feelings, but it’s not really the way feelings work.</p>
<p>The film does have some signature strengths. The most authentic aspect of the film was the portrayal of conversations among Riley and her parents. Seeing her mother’s and then her father’s “inner emotions” react (like Riley, the parents also have characters assigned to their emotions) was a wonderful mapping of the kind of patterns that we see whenever families interact. </p>
<p>For example, at the dinner table, Mom gives Dad a look that’s intended to signal that he needs to take her side during an argument with Riley. </p>
<p>Dad’s emotions frantically discuss what she might mean. (“I wasn’t paying attention.” “Did we leave the toilet seat up again?” “Wait for her to do it again.”) Meanwhile, Mom’s (annoyed) emotions decide that she would have been better off with a former suitor. The humor with which it was handled was truly refreshing. </p>
<p>Similarly, one of the best aspects of the film is that Joy realizes that she must work with Sadness to enrich Riley’s emotional life. This is an age-appropriate realization; increased empathy in girls, especially, <a href="http://psycnet.apa.org/psycinfo/1997-05622-003">occurs at around Riley’s age</a>.</p>
<p>Riley has a lot of experiences coming her way, as evidenced by the installation of the new control console at the end of the film with a red button labeled “puberty.” Like most adolescents, she will experience highs and lows, as her friends become more central and she discovers romantic feelings. </p>
<p>And it also sounds like groundwork being laid for a sequel centered on Riley’s pubescent years.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/seMwpP0yeu4?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The trailer for Pixar’s Inside Out.</span></figcaption>
</figure>
<hr>
<p><em>To read about whether or not Inside Out accurately depicts how memory works, click here.</em></p><img src="https://counter.theconversation.com/content/42289/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jane Timmons-Mitchell does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>In some ways, it’s spot-on. In others, not so much.Jane Timmons-Mitchell, Associate Clinical Professor of Psychology, Case Western Reserve UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/428132015-06-08T04:13:48Z2015-06-08T04:13:48ZNearly a third of early adulthood depression linked to bullying in teenage years<figure><img src="https://images.theconversation.com/files/83886/original/image-20150604-2935-1r4z9iv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">School bullying takes its toll later in life too. </span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/ashleyrosex/3679319717/">Ashley Rose/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Being bullied at school is an unpleasant and relatively common experience for many young people, but does it lead to long-lasting harm? A growing number of studies have found that being bullied is associated with an increased risk of developing <a href="https://www.researchgate.net/profile/Peter_Prinzie/publication/42371450_Peer_victimization_and_internalizing_problems_in_children_a_meta-analysis_of_longitudinal_studies/links/0a85e5359fdb714ddd000000.pdf">symptoms of anxiety and depression</a>, <a href="http://www.bmj.com/content/344/bmj.e2683">self-harm</a> and even <a href="http://wrap.warwick.ac.uk/45770/1/WRAP_Wolke_Sucide%20and%20bullying%20final%20word%20version%20Winsper%20et%20al.pdf">suicidal ideation</a>. </p>
<p>Many would argue that it seems obvious that bullying might cause some young people to develop depression – but how strong is the evidence that this is the case?</p>
<h2>Does teenage bullying contribute to clinical depression?</h2>
<p>In <a href="http://www.bmj.com/content/350/bmj.h2469">new research</a> published in The British Medical Journal, we built on the <a href="http://archpsyc.jamanetwork.com/article.aspx?articleID=1654916">work</a> of <a href="http://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.2014.13101401">other studies</a> to investigate the strength of the association between being bullied as a teenager and developing depression as a young adult. </p>
<p>We used data from the “<a href="http://www.bristol.ac.uk/alspac/">Children of the 90s Study</a>” - a large birth cohort study based at the University of Bristol, which has been charting the health of families since the early ‘90s. We were particularly interested in bullying occurring during the early teenage years, given this is a time both when the influence of peers rises, and rates of depression begin to increase. </p>
<p>At 13 years, participants filled in detailed questionnaires about their recent experiences of different types of peer victimisation. When they were 18 years old, participants came back into the lab and took part in clinic assessments that were used to derive diagnoses of depression.</p>
<p>Of the 683 children who reported frequent victimisation at 13 years, 101 (14.8%) were depressed at 18 years. Of the 1446 children reporting some victimisation, 103 (7.1%) were depressed, and of the 1769 children reporting no victimisation at 13 years, 98 (5.5%) were depressed. </p>
<p>Children who were frequently victimised had over a two-fold increase in odds of depression compared with children who were not victimised by peers. So is this enough to show that being bullied causes depression?</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/83887/original/image-20150604-2923-fkkneh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/83887/original/image-20150604-2923-fkkneh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/83887/original/image-20150604-2923-fkkneh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=697&fit=crop&dpr=1 600w, https://images.theconversation.com/files/83887/original/image-20150604-2923-fkkneh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=697&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/83887/original/image-20150604-2923-fkkneh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=697&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/83887/original/image-20150604-2923-fkkneh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=876&fit=crop&dpr=1 754w, https://images.theconversation.com/files/83887/original/image-20150604-2923-fkkneh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=876&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/83887/original/image-20150604-2923-fkkneh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=876&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Even if bullying starts earlier in life, the effects continue into later life.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/ankakay/4115699583/">Ankakay/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Sadly, some children are more at risk of being bullied by their peers than others. In particular, children who are more shy and withdrawn are <a href="https://www.researchgate.net/profile/Ernest_Hodges/publication/13063504_Personal_and_interpersonal_antecedents_and_consequences_of_victimization_by_peers/links/0c96052951d8ebb985000000.pdf">more likely to be bullied</a> than their less anxious peers. </p>
<p>This makes it difficult to disentangle cause and effect – does being bullied lead to an increased risk of depression, or are kids with higher levels of depressive symptoms simply more likely to be targeted by bullies? </p>
<p>Are there other characteristics that might explain this association? Using data on children’s mental health and their family experiences, we were able to adjust for a large number of factors that might have explained the relationship between bullying and depression. </p>
<p>Even when statistically controlling for these factors, we still found that teenagers who were frequently bullied were nearly twice as likely to be depressed at 18 compared to their non-bullied peers. The more frequent the bullying, the increased likelihood of developing depression as an adult.</p>
<h2>How important is bullying as a risk factor for depression?</h2>
<p>In our sample, up to 30% of depression at 18 years might be attributed to being bullied as a teenager <em>if</em> bullying really is a cause of depression. However with our type of study, we can never be certain that there isn’t some other, unmeasured variable that might explain our findings. </p>
<p>But given that researchers would never randomly assign children to be bullied or not in order to test whether this association is causal, we must rely on evidence from observational studies such as ours. </p>
<p>Also, we can’t say for sure whether our findings generalise to other populations. That’s why it is so important that research such as ours is replicated using different samples from different populations. </p>
<p>For now, the weight of evidence is sufficiently strong that bullying should be considered as an important risk factor for depression. There are <a href="http://sinohacesnadasosparte.org/Download/english/02_METAANALISIS_2011.pdf">effective school-based interventions</a>, and schools should be supported in implementing these.</p><img src="https://counter.theconversation.com/content/42813/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This research was specifically funded by a Wellcome Trust grant. The UK Medical Research Council and the Wellcome Trust and the University of Bristol provide core support for ALSPAC. Lucy Bowes is a Leverhulme Early Career Fellow, and is supported by a grant of the Jacobs Foundation.</span></em></p>Children who were bullied had more than a two-fold increase in odds of depression later in life compared with children not victimised by their peers.Lucy Bowes, Leverhulme Early Career Research Fellow, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/388862015-03-19T09:35:10Z2015-03-19T09:35:10ZAre doctors following best practice when prescribing antipsychotic meds to kids?<figure><img src="https://images.theconversation.com/files/75108/original/image-20150317-22277-1mw5g1d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Best practice?</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-48257575/stock-photo-looking-down-on-a-group-of-prescription-bottles-on-prescription-form-with-pills-spilled-horizontal.html?src=D8DBwAkjgtzM8j6PxYa6hg-1-28">Prescription pad and pills via www.shutterstock.com</a></span></figcaption></figure><p>There’s been a lot of attention in the media about the number of children taking antipsychotic and other psychiatric medications. The assumption behind most of these stories is that these drugs are being overprescribed, and given to children with minor behavioral issues. A recent story in a European newspaper about the increased use of ADHD medications, for example, was headlined “<a href="http://www.express.co.uk/life-style/health/485533/ADHD-drug-prescriptions-for-children-soar">Zombie Generation</a>.” Yet the reality is there’s very little data to tell us the degree to which these medications are being used appropriately or not. </p>
<p>Antipsychotic medications, such as Risperdal, Seroquel and Abilify, were developed to treat adults with major mental illnesses including schizophrenia and bipolar disorder. But in recent years, their use has extended to treat conditions such as autism and attention-deficit/hyperactivity disorder (ADHD) in children and adolescents. </p>
<p>How these medications work remains somewhat of a mystery, although we know they affect multiple brain neurotransmitters such as dopamine and serotonin. </p>
<p>Because these medications’ side effects include an increased risk for conditions such as obesity, <a href="http://dx.doi.org/10.1001/jamapsychiatry.2013.2053">diabetes</a> and movement disorders, they’re subject to extra scrutiny to make sure that the right medications are being prescribed to the right patients at the right time. </p>
<p>For instance, the American Academy of Child and Adolescent Psychiatry has a list of 19 “<a href="http://www.aacap.org/App_Themes/AACAP/docs/practice_parameters/Atypical_Antipsychotic_Medications_Web.pdf">best practice</a>” recommendations. These include using just one medication at a time, avoiding the medications in very young children, monitoring for side effects, and trying other treatments first for things like ADHD and aggressive behavior. </p>
<h2>Are doctors following prescribing guidelines?</h2>
<p>With the <a href="http://www.ncbi.nlm.nih.gov/pubmed/16754841">rise in antipsychotic medication prescriptions</a>, we wanted to know how well doctors were following these recommendations.</p>
<p>As a member of the <a href="http://mentalhealth.vermont.gov/Committees%5CCAFU">Vermont Psychiatric Medications for Children and Adolescents Trend Monitoring workgroup</a>, we were tasked with offering recommendations to our state legislature and other government agencies about psychiatric medication use in youth. We knew antipsychotic prescribing rates in Vermont had been somewhat high, but had dropped in recent years relative to other states. Without digging deeper, we couldn’t actually tell what this trend meant. </p>
<p>To learn more about why and when these medications are prescribed, we sent a survey to every provider who had prescribed an antipsychotic medication to a child covered by Medicaid in Vermont. We focused on Medicaid because we did not have access to commercial insurance databases. </p>
<p>Our survey was required in order for the prescription to be refilled, which meant our return rate (80%) was much higher that it would have been for a truly voluntary survey. </p>
<h2>Clinicians aren’t always following guidelines</h2>
<p>To our knowledge the study, which was recently published in <a href="http://dx.doi.org/10.1542/peds.2014-2260">Pediatrics</a>, is the first one to compare antispychotic prescribing patterns to best practice guidelines. </p>
<p>We found evidence that these medications aren’t being doled out to treat minor behavioral problems, which is reassuring. But we also found places where doctors weren’t following best practice guidelines.</p>
<p>Perhaps the biggest finding was that an antipsychotic prescription followed best practice guidelines only about half the time. We also found that these medications were prescribed for an FDA-approved use only a quarter of the time. </p>
<p>By itself, this is bad news and means that there needs to be a greater effort to make sure these medications are being prescribed appropriately. Increasing access to child therapists who do evidence-based psychotherapy could help. So would making it easier for medical records to follow patients, particularly for kids in foster care who often move from place to place. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/75257/original/image-20150318-2467-aa88kd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/75257/original/image-20150318-2467-aa88kd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=432&fit=crop&dpr=1 600w, https://images.theconversation.com/files/75257/original/image-20150318-2467-aa88kd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=432&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/75257/original/image-20150318-2467-aa88kd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=432&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/75257/original/image-20150318-2467-aa88kd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=543&fit=crop&dpr=1 754w, https://images.theconversation.com/files/75257/original/image-20150318-2467-aa88kd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=543&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/75257/original/image-20150318-2467-aa88kd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=543&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Antipsychotic drugs aren’t being used to treat minor behavioral issues.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-83686891/stock-photo-silhouette-group-of-happy-children-playing-on-meadow-sunset-summertime.html?src=DZAQGzBlVtsenwX9aY4fCQ-1-21">Children playing via www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>It turns out that most providers who prescribe antipsychotic medications are not psychiatrists. About half are primary care clinicians such as pediatricians or family physicians. And 42% of the time the doctor who is responsible for maintaining the antipsychotic medication isn’t the one who originally prescribed it. This can be a problem because a doctor may be less comfortable stopping a medication that someone else started. He or she also may not know the whole story behind why the child was prescribed the medication in the first place.</p>
<p>The most common reason by far that prescriptions failed to meet best practice standards was because the patient was not getting the recommended lab work – for instance, monitoring blood glucose to check for early diabetes. This is a problem, but there are other ways to monitor for potential side effects of these medications. And new electronic medical records may make it easier to remind doctors when these kinds of tests should be ordered. </p>
<h2>Using antipsychotic drugs to treat bad behavior isn’t the norm</h2>
<p>While some of the study’s results are discouraging, there is also good news. For example, using antipsychotic medications for relatively minor behavior problems – like temper tantrums in young kids – was relatively uncommon.</p>
<p>Further, over 90% of the time antipsychotic medications were being used only when other types of interventions, including different medications or psychotherapy, had failed. However, in many cases the type of psychotherapy tried first was not of a type that’s been shown to be most effective in treating the child’s particular problem.</p>
<p>And in cases when the patient was diagnosed with a condition that antipsychotic medications are not officially approved to treat, such as physical aggression, the behavior targeted was often something with <a href="http://www.ncbi.nlm.nih.gov/pubmed/23228230">scientific evidence</a> to support using antipsychotic medication. </p>
<p>In our view, these medications do indeed have a place in treatment. But too many are getting to that place too quickly and without the appropriate level of monitoring. Our hope is that Vermont and other states will keep studying this issue and support doctors, patients and families to ensure that these medications are being used appropriately and safely.</p><img src="https://counter.theconversation.com/content/38886/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David Rettew does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>According to a study of Vermont doctors, best practice guidelines for prescribing antipsychotic medication to children are followed only half the time.David Rettew, Associate Professor, Psychiatry and Pediatrics, University of VermontLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/362802015-02-06T06:16:02Z2015-02-06T06:16:02ZAll the cool kids aren’t doing it: teens stink at judging peers’ behavior<figure><img src="https://images.theconversation.com/files/70872/original/image-20150202-13042-1mzui2v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Frustrated by having to keep up with false social norms? </span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-102482045/stock-photo-tired-high-school-student-using-book-cover-his-face.html?src=5O5uHJy13uHEqiVnMWAAWA-1-54&ws=0">Boy via michaeljung/Shutterstock</a></span></figcaption></figure><p>When you think about teenage peer pressure, plenty of images likely come to mind. Perhaps a classic after school TV special or dramatic <a href="http://en.wikipedia.org/wiki/Drug_Abuse_Resistance_Education">D.A.R.E. program</a> skit with a dimly-lit basement and one friend saying “Come on, <em>everybody’s</em> doing it.” Indeed, a good deal of <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=Beyond+homophily%3A+A+decade+of+advances+in+understanding+peer+influence+processes">prior research</a> has focused on direct forms of pressure between friends. But if these images don’t fully resonate with your own memories of high school, you may be onto something. <a href="http://dx.doi.org/10.1037/a0038178">Our research</a> suggests that although these direct forms of pressure may exist, teens likely are influenced in other, more indirect ways too.</p>
<p>Think back to high school. You probably had a pretty good sense of who the cool kids were, as well as who was getting high or having sex or who was studying all day long. Everyone knew what was going on, right?</p>
<p>But what if we were all wrong?</p>
<p>According to my group’s research, teens think they know how much their peers engage in a variety of potentially risky behaviors such as substance use, theft, vandalism and sex. They also think they know how much their peers engage in healthier behaviors, such as studying and exercising. The only problem is, they’re wrong. And not only that, but the more wrong they are, the more likely they’ll be to increase their own substance use over the next few years. </p>
<p>It’s a classic high school version of “Keeping Up With The Joneses” that may place some teens at risk for unhealthy or even dangerous outcomes.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/70871/original/image-20150202-13063-1u7pg68.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/70871/original/image-20150202-13063-1u7pg68.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/70871/original/image-20150202-13063-1u7pg68.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/70871/original/image-20150202-13063-1u7pg68.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/70871/original/image-20150202-13063-1u7pg68.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/70871/original/image-20150202-13063-1u7pg68.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/70871/original/image-20150202-13063-1u7pg68.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Keep up!</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-104764376/stock-photo-yalta-ukraine-may-unidentified-girls-age-at-the-hurdles-race-on-the-international.html?src=5O5uHJy13uHEqiVnMWAAWA-7-38&ws=0">Runners via Denis Kuvaev/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Overestimating the bad and underestimating the good</h2>
<p>So how did we find this out? We examined the perceptions of over 400 high school students at two different schools over the course of several years in two separate studies on peer influence. </p>
<p>In the first phase of the study, 235 10th-graders were studied at a middle-income, suburban high school in the Northeast. First, they identified which of their peers belonged in which social crowds – the jocks, popular kids, burnouts and nerds – using a validated system of peer nominations. Within this process, students could nominate which of their peers belonged to which crowd, and researchers could create standardized scores based on how often individuals were nominated. </p>
<p>Next, students reported their perceptions of how frequently those crowds engaged in behaviors including smoking, drinking, marijuana use, sexual intercourse, oral sex, vandalism, theft, studying and exercising. They also reported on how frequently they actually engaged in these same behaviors, enabling researchers to make direct comparisons between real behaviors and <em>perceptions</em> of behaviors.</p>
<p>It may come as no surprise that the jocks and popular teens consistently emerged as the highest status groups in the school. These teens were well-liked, respected and at the top of the social hierarchy. </p>
<p>What is surprising, though, is how much teens consistently overestimated the risk behaviors of their peers. In virtually every case, the jocks and popular teens did not use more substances, have more sexual partners, or break the rules any more than all the other kids at school. But they were perceived as doing all these risky behaviors a lot.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/70861/original/image-20150202-8997-x267y2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/70861/original/image-20150202-8997-x267y2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/70861/original/image-20150202-8997-x267y2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/70861/original/image-20150202-8997-x267y2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/70861/original/image-20150202-8997-x267y2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/70861/original/image-20150202-8997-x267y2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/70861/original/image-20150202-8997-x267y2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">‘Nerds’ spend the same amount of time studying as everyone else.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-160497188/stock-photo-high-angle-view-of-a-female-student-sitting-against-bookshelf-with-laptop-on-the-library-floor.html?src=0cwNII52MZM0umcodhPrAA-1-11&ws=0">Girl via wavebreakmedia/Shutterstock</a></span>
</figcaption>
</figure>
<p>And these misperceptions also ran in the opposite direction. Take studying, for example – a decidedly less “cool” thing to do during adolescence. Teens over-attributed studying to the nerds by far, even though the nerds really didn’t study more than anyone else in the school. </p>
<p>In short, the teens saw their peers through a caricatured lens. Jocks must be exercising and having sex all the time, then partying all weekend with the popular kids, right? <em>Because that’s what the cool kids do.</em> And nerds must be studying every waking moment…<em>because they’re nerds</em>. But these caricatures were simply wrong.</p>
<h2>Why misperceptions matter</h2>
<p>Perhaps if the research stopped here, you’d have an interesting tidbit to share at your next high school reunion. “See, we really weren’t all that different after all!” But there’s more. And this is where the misperceptions become concerning from a public health perspective.</p>
<p>In a second phase of the study, a separate group of 166 ninth-graders from a rural, low-income high school in the Southeast provided the same information – who are the cool kids, how much do you think <em>those</em> kids smoke cigarettes, drink alcohol, and smoke pot, and how much do <em>you</em> actually use those same substances? Only this time, the students were followed until the end of their junior year. </p>
<p>Not only were the cool kids misperceived all over again, essentially replicating the findings of the first study, but the misperceptions mattered. Thinking that the cool kids engaged in more substance use as a ninth-grader predicted a faster rate of growth in your own substance use over the high school years. Of course, many youth may increase their substance use over those years anyway. But these findings showed that the <em>rate</em> of increase was much steeper among those who misperceived the social norms the most. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/70868/original/image-20150202-13708-ns6htd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/70868/original/image-20150202-13708-ns6htd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/70868/original/image-20150202-13708-ns6htd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/70868/original/image-20150202-13708-ns6htd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/70868/original/image-20150202-13708-ns6htd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/70868/original/image-20150202-13708-ns6htd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/70868/original/image-20150202-13708-ns6htd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A portrait of typical ‘cool’ kids? Not so fast.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-169832495/stock-photo-portrait-of-a-cheerleader-in-action.html?src=0cwNII52MZM0umcodhPrAA-1-44&ws=0">Cheerleaders via View Apart/Shutterstock</a></span>
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<p>As you can see, this type of indirect “pressure” to keep up with the social norm is quite different from the “Come on, everybody’s doing it” pressure we often warn teens about. It is also difficult to address. Some <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=perception+and+reality%3A+a+national+evaluation+of+social+norms+marketing">prior work</a> has attempted to explicitly teach young adults about the “real” social norms. For example, fliers around a college campus might tell students exactly how often other students at their school drink alcohol.</p>
<p>Unfortunately, these campaigns typically are unsuccessful – either because they are easily dismissed as outright lies or because students think those “average” numbers don’t apply to their specific fraternity, sports team or social group. Additionally, there is always a risk that these campaigns inadvertently could suggest to infrequent substance users that they are “underperforming” compared to their peers – certainly not a winning public health message to spread.</p>
<p>At the end of the day, more research is needed to understand how best to intervene with teens. But the current work does show one clear message: all the cool kids are <em>not</em> doing it. Or at least not as often as you may think. Whether you’re a high school freshman or an adult surveying your own social landscape, this is probably an important message to keep in mind. Because striving to meet what you <em>think</em> is supposed to be the social norm seems to be a losing battle.</p><img src="https://counter.theconversation.com/content/36280/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah W. Helms does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Think back to high school: everyone knew who was getting high or having sex or studying all day long, right? But what if we were all wrong?Sarah W. Helms, Post-doctoral fellow, University of North Carolina at Chapel HillLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/334242014-11-06T09:48:42Z2014-11-06T09:48:42ZEverything you wanted to know about sexting, but were afraid to ask<figure><img src="https://images.theconversation.com/files/63781/original/26fdffc4-1415208516.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">When we talk about sexting, are we focusing on the real risks?</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic.mhtml?id=190741784&src=BygomhxmQukAh0NeQJKUVg-3-1">Image of people texting from www.shutterstock.com</a></span></figcaption></figure><p>Stories of teens taking and sending a naked picture of themselves with their phones have been all over the news media in recent years. The outcome? Shocking, according to reports which have suggested that humiliation and sometimes even suicide can follow.</p>
<p>But what is the reality? Sexting is often seen as a dicey electronic version of “I’ll show you mine, you show me yours”. Many teens (and adults) engage in it. Indeed, some are suggesting that it is becoming a “normal” part of <a href="http://www.utmb.edu/newsroom/article9957.aspx">adolescent sexual development</a>. And in general, few psychological problems (if any) are correlated with the behavior. </p>
<p>Here’s the bottom line: research suggests that most photos don’t end up in disasters, either socially (being passed around, teased, bullied) or criminally (being prosecuted). </p>
<p>Such outcomes are possible, but they aren’t highly probable. We should make kids aware of these possibilities, but we have to do that without suggesting that disaster is likely or, worse, inevitable.</p>
<h2>Risky behavior?</h2>
<p>Sexting is a crime when it involves sending nude pictures of anyone under 18-years-old. A study of thousands of <a href="http://pediatrics.aappublications.org/cgi/doi/10.1542/peds.2011-2242">sexting cases</a> found that those selected for criminal prosecution in the US in 2011 involved adults asking teens for pictures, or cases of obvious coercion, threats or blackmail. The researchers pointed out that the cases that come to the attention of authorities are more likely to have aggravating circumstances. </p>
<p>Whether the authorities are actively choosing <em>not</em> to prosecute more run-of-the-mill sexting, or whether they are prosecuting teen-on-teen sexting but simply rarely seeing it, is unclear. The news media continue to cover stories such as <a href="http://www.freep.com/story/news/local/michigan/oakland/2014/10/15/teens-face-felony-charges-sexting/17316173/">the recent case in Oakland County, Michigan</a>, but true to form, that case went beyond two teens exchanging photos, and involved boys collecting groups of photos for purposes unknown.</p>
<p>If a teen sends a nude photo to a friend, how big is the risk that it will result in serious harm? Recent research is downplaying that risk. I have <a href="http://hepg.org/hep-home/books/bullying-and-cyberbullying">found</a> that more than three-quarters of teens who sext believe their photo went to the intended recipient and no one else. These teens might be wrong and spreading photos around might be more common; but if the sender believes it has been kept private, then they probably weren’t traumatized by a mass exposure. </p>
<p>When I studied the after effects of sexting, I found that most incidents didn’t have much of an outcome at all – either good or bad. Most kids didn’t describe trauma or bullying, but neither did they describe newly-acquired boyfriends or increased popularity. The most common outcome was generally “feeling worse”, but even that happened in only about one-quarter of the cases. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/63789/original/9zt8c37n-1415216899.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/63789/original/9zt8c37n-1415216899.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/63789/original/9zt8c37n-1415216899.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=417&fit=crop&dpr=1 600w, https://images.theconversation.com/files/63789/original/9zt8c37n-1415216899.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=417&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/63789/original/9zt8c37n-1415216899.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=417&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/63789/original/9zt8c37n-1415216899.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=524&fit=crop&dpr=1 754w, https://images.theconversation.com/files/63789/original/9zt8c37n-1415216899.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=524&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/63789/original/9zt8c37n-1415216899.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=524&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Not all sexting is about fun and games. Image via www.shutterstock.com.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-20009206/stock-photo-teen-aged-girl-text-messaging.html?src=CV3svCPHAv4MbpfzYnpo4A-5-79">Shutterstock</a></span>
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</figure>
<h2>Curiosity and coercion</h2>
<p>Yet there are risks to sexting that have been largely ignored. A lot of sexting is done to attract the recipient - either by an existing girlfriend or boyfriend, or by someone who wants a relationship with the recipient. </p>
<p>It’s becoming increasingly clear, however, that not all sexting is about fun and games. My biggest concern is when kids under 18 – often girls – are pressured by their peers to engage in sexting that they really don’t want to do. The younger they are when they sext, the more likely they are to report that they succumbed to pressure. And that pressure isn’t rare. </p>
<p>Overall, about two-thirds of the teens in my research studies report that they were pressured or coerced into sexting at least some of the time. Being pressured into sexting sometimes happened within a dating relationship, or it might come from a person (usually a boy) with whom a girl wants to have a relationship. Wanting to attract that boy, and wanting to be attractive to a boyfriend or girlfriend, were the most common reasons for actually sending the photo. About 92% of the teens who were not pressured reported no problems following sexting; but that number <a href="http://vc.bridgew.edu/cgi/viewcontent.cgi?article=1003&context=marc_reports">dropped to only 68%</a> of the teens who felt pressured into sexting. </p>
<h2>Is it time for sexting ed?</h2>
<p>Hannah Rosin’s <a href="http://www.theatlantic.com/magazine/archive/2014/11/why-kids-sext/380798/">recent article in The Atlantic</a> told the story of a town in Virginia that discovered an Instagram page featuring a compilation of nude pictures of local girls. </p>
<p>Officials also found – to their astonishment – that sexting appeared to be widespread and common, and that issues such as widespread exposure and criminal liability were far from the minds of the teens involved. Any parent might ask, why haven’t students been taught about the criminal nature of underage sexting? Why haven’t students been warned about how devastating it could be to have a nude photo become public? </p>
<p>The problem, in my experience, isn’t that adults don’t issue these warnings. The problem is that kids don’t hear them. That deafness probably results from credibility issues. Why should you trust a warning that contains inaccurate data? </p>
<p>Imagine that I warned you to wear your seat belt, because half of the car rides in America end up with someone going through the windshield. You might not listen to me, given that it’s obvious to anyone that half of the car rides in America don’t end up with people slamming on the brakes, much less going through the windshield. </p>
<p>Sexting warnings are the same. If our information isn’t correct, if we’re issuing dire warnings about outcomes that are, in reality, pretty rare, then our message isn’t heard. </p>
<p>The conversations that will ring true with kids aren’t about the law or about social humiliation. These conversations should address the common risks and problems sexting poses, like being pressured to send pictures, or pressuring someone else to send pictures. Some teens may not understand that pressuring someone into sending naked pictures can be sexual harassment. There are no social rules about when it’s OK to take or post a picture without someone’s consent - but 70% of the teens I study say that there should be commonly-accepted and agreed-upon guidelines. “Sexting ed” could help us all develop such social norms.</p>
<p>Both sex and technology are topics that can be anxiety-ridden for parents, and it can be difficult for kids to believe there is any risk when they see so many peers sexting without consequences. </p>
<p>It’s important for parents to discuss risk, but also to discuss them realistically. Talking with your children about obeying the law, respecting others’ privacy, everyone’s right to keep their bodies private, and what values you have about this issue is what parenting around sexting is all about.</p><img src="https://counter.theconversation.com/content/33424/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elizabeth Englander does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Stories of teens taking and sending a naked picture of themselves with their phones have been all over the news media in recent years. The outcome? Shocking, according to reports which have suggested that…Elizabeth Englander, Professor of Psychology, and the Director of the Massachusetts Aggression Reduction Center (MARC), Bridgewater State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/171692013-08-20T20:27:38Z2013-08-20T20:27:38ZAggressive and debasing: the real issues in porn debates<figure><img src="https://images.theconversation.com/files/29576/original/vy5bjfc4-1376979891.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Industry insiders spoke of how mainstream porn has moved from being 'lovey dovey' in the mid-1990s to rough and aggressive.</span> <span class="attribution"><span class="source">Cher Amio/Flickr</span></span></figcaption></figure><p>It’s a well-worn political trick that you caricature and call your opponents names when you don’t want to engage with the substance of their claims.</p>
<p>In debates about porn, pornography advocates often seek to dismiss criticism by claiming that, for example, the critics have <a href="http://www.onlineopinion.com.au/view.asp?article=12079">unresolved personal issues</a>, are offended by sex other than that which fits an <a href="http://www.pressdisplay.com/pressdisplay/viewer.aspx">extremely narrow, conservative definition</a>, or are engaging in a <a href="http://theconversation.com/do-we-need-to-protect-young-people-from-porn-13645">moral panic</a>.</p>
<p>No doubt there are some people who criticise porn for such reasons, just as there are some who are pro-porn precisely because they want to watch material in which women are objectified and humiliated. </p>
<p>But to seek to dismiss all criticism of porn by inaccurately portraying the position of its critics is both intellectually fraudulent and an attempt to avoid the real issues at stake. </p>
<p>Central to the “porn debates” are two key concerns: the nature of contemporary pornography, and its impact on attitudes and behaviours. </p>
<p>In exploring these issues, our film <a href="http://www.sbs.com.au/ondemand/video/37268547734/Love-And-Sex-In-An-Age-Of-Pornography">Love and Sex in an Age of Pornography</a> tells two parallel stories: one of participants in the pornography industry, and the other of young people’s engagement with pornography and its influence on their sexual understandings and experiences.</p>
<h2>Industry viewpoints</h2>
<p>People in the pornography industry speak surprisingly frankly of the way in which, to quote veteran performer Nina Hartley, “there has been an increase in what I would call the aggression that we see on camera.” </p>
<p>Similarly, aspirationally-named performer, Anthony Hardwood, tells us that when he first started in the industry in 1997, he would be filmed having “lovey dovey sex” on a bed. </p>
<p>But within a few years, producers and directors wanted “more energy, more rough.” They wanted him to “take over and just fuck her, to destroy her.”</p>
<p>The industry perspective on increasing levels of aggression in pornography is supported by credible academic research. </p>
<p>According to a recent content analysis of the most popular porn by <a href="http://g.virbcdn.com/_f/files/79/FileItem-273118-AgressionandSexualBehavior2010.pdf">US researchers</a>, 88% of scenes contain physical aggression and 48% contain verbal aggression. </p>
<p>Overwhelmingly (in 94% of cases), this aggression is directed towards female performers. </p>
<p>The research found that best-selling pornography commonly shows women gagging, being slapped or choked, and called abusive names – and, significantly, enjoying the experience. </p>
<p>The aggression documented in this research – and in what the porn industry told us and says <a href="http://books.google.com.au/books?hl=en&lr=&id=8yznvRX-hfAC&oi=fnd&pg=PA50&ots=Vmt_5D5uYF&sig=GI997kzVfIv1_kMU-h4c7Er2nco&redir_esc=y#v=onepage&q&f=false">elsewhere</a> – is in stark contrast to what pornography advocates <a href="http://books.google.com.au/books?id=_i5gWlPV7a8C&printsec=frontcover&source=gbs_ge_summary_r&cad=0#v=onepage&q&f=false">would have you believe</a>.</p>
<h2>Research about porn’s impact</h2>
<p>There are competing academic views on the impact of pornography consumption on young people. Media researcher Alan McKee, for instance, claims that pornography consumption does not “harm” <a href="http://eprints.qut.edu.au/41858/3/41858.pdf">young people</a>.</p>
<p>But his conclusion is based on an extrapolation from the statements of a <a href="http://www.xyonline.net/content/porn-report-%E2%80%93-critical-assessment">self-selected and unrepresentative group</a> of adult porn consumers, recruited in part from the pornography industry and advocacy networks. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/29577/original/3y33x886-1376980464.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/29577/original/3y33x886-1376980464.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=394&fit=crop&dpr=1 600w, https://images.theconversation.com/files/29577/original/3y33x886-1376980464.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=394&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/29577/original/3y33x886-1376980464.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=394&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/29577/original/3y33x886-1376980464.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=495&fit=crop&dpr=1 754w, https://images.theconversation.com/files/29577/original/3y33x886-1376980464.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=495&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/29577/original/3y33x886-1376980464.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=495&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Mainstream porn is full of portrayals of gendered aggression.</span>
<span class="attribution"><span class="source">Joe Abbruscato/Flickr</span></span>
</figcaption>
</figure>
<p>The research participants’ statements are reflections on when they first encountered pornography and how, looking back at it, they feel the experience affected them.</p>
<p>Other recently <a href="http://onlinelibrary.wiley.com/doi/10.1111/jsm.12157/full">published research</a> shows a significant correlation between porn consumption and “adventurous” and “transactional” sex. But, citing the potential influence of other factors, the authors downplay this correlation and signal the need for further research.</p>
<p>This research compares pornography consumers’ practices with those of non-consumers. This is not <a href="http://download.journals.elsevierhealth.com/pdfs/journals/1054-139X/PIIS1054139X08006587.pdf;%20http://crx.sagepub.com/content/35/5/579.abstract">new methodology</a>, and it is one that may reveal porn’s influence on consumers’ attitudes and behaviours. </p>
<p>But unless such research methods are carefully considered, they may substantially under-represent pornography’s influence; you don’t have to be a consumer to experience porn’s influence. </p>
<p>Indeed, for many people, particularly women, pornography’s influence is encountered through partners and peers who consume porn, shaping individual, relational and, ultimately, cultural sexual understandings, expectations and practices.</p>
<p>Then there are those whose response to concerns about porn’s negative influence is to suggest that young people could learn a range of <a href="http://theconversation.com/do-we-need-to-protect-young-people-from-porn-13645">positive lessons about sexuality</a> from sexually explicit materials. </p>
<p>Those advocating such a position suggest that pornography could teach young people safer sexual practices, for instance, and mutuality between partners, positive body self-image, negotiation and consent. While conceptually possible, in reality these are far from the common messages conveyed through the mainstream pornography most frequently seen by young people. </p>
<h2>What young people think</h2>
<p>In the parallel story in our film, young people speak candidly about the ways pornography has influenced their sexual imaginations, expectations and experiences.</p>
<p>The young people we interviewed – only a small selection of whom appear in the film - spoke of comparing their bodies and sexual performance unfavourably to what they see in porn. Young men spoke of aspiring to engage in the sort of sex they had seen in porn, and, indeed, of initiating porn-inspired sex with their partners. </p>
<p>For their part, young women regularly described the difficulties they faced repeatedly responding to such initiations, including fellatio-induced gagging, anal sex, and ejaculation on faces and bodies. Perhaps unsurprisingly, such acts often were inconsistent with their own desires. </p>
<p>It’s worth noting that while some women enjoy anal sex, which is a prominent element in the mainstream heterosexual porn script, <a href="http://std.sagepub.com/content/16/2/102.abstract">research</a> indicates that most women who have tried it don’t enjoy it and don’t want to do it again.</p>
<p>Young homosexual men told us of the liberation experienced by pornography’s assurance that they were not alone in their attraction to other men. But they also spoke of being disturbed by portrayals of gendered aggression by hyper-masculine “top boys” towards feminised “bottom boys”, and how these stereotypes limited their own experiences.</p>
<h2>Speaking out</h2>
<p>Our work is far from the only <a href="http://www.xyonline.net/sites/default/files/Flood,%20Young%20men%20using%20porn.pdf">research</a> pointing to such <a href="http://books.google.ca/books?id=3zI3YReBTTQC&pg=PA1&source=gbs_toc_r&cad=3#v=onepage&q&f=false">concerns</a>. </p>
<p>A <a href="http://www.childrenscommissioner.gov.uk/content/publications/content_667">report</a> recently released by the UK Children’s Commissioner, involving a literature review of thousands of papers, is another addition to this growing body of work. The report points to compelling evidence that children and young people’s exposure to pornography is pervasive, influences their attitudes, and is linked to risky behaviour.</p>
<p>But, the voices of those most likely to bear the brunt of porn’s influence are not always easily heard, especially by those whose <a href="http://www.theguardian.com/culture/2013/jun/16/internet-violent-porn-crime-studies">motivation and research agenda</a> is to de-stigmatise pornography consumption, and explore why consumers enjoy it. </p>
<p>It’s a curious thing to observe people who, in other spaces, would speak out against injustice or discrimination, not heed the voices of young women and gay men speaking of the ways in which contemporary mainstream pornography does not open up their sexual worlds, but represents a dominant sexual script that delegitimises their desire and pleasure and often defines sex as something that occurs at their expense.</p><img src="https://counter.theconversation.com/content/17169/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David Corlett is the co-director of Love and Sex in An Age of Pornography, an outcome of a community education project, ‘Reality & Risk: Pornography, Young People and Sexuality,’ funded by philanthropy and based at Brophy Family and Youth Services.</span></em></p><p class="fine-print"><em><span>Maree Crabbe is the co-director of Love and Sex in An Age of Pornography, an outcome of a community education project, ‘Reality & Risk: Pornography, Young People and Sexuality,’ funded by philanthropy and based at Brophy Family and Youth Services.</span></em></p>It’s a well-worn political trick that you caricature and call your opponents names when you don’t want to engage with the substance of their claims. In debates about porn, pornography advocates often seek…David Corlett, Adjunct Research Fellow, Swinburne University of TechnologyMaree Crabbe, Post graduate student, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/136452013-08-04T20:08:32Z2013-08-04T20:08:32ZDo we need to protect young people from porn?<figure><img src="https://images.theconversation.com/files/28307/original/8pn2ndx4-1375149048.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The latest research has found that quite a lot of young people are accessing sexually explicit material.</span> <span class="attribution"><span class="source">Alejandro Lorenzo</span></span></figcaption></figure><p>Porn. Just utter the word aloud and hearts pound, pulses quicken, and minds start racing. Depending on the context, these effects may be the result of concern for young people’s well-being rather than a sexual response. </p>
<p>Consider the UK prime minister <a href="http://www.guardian.co.uk/technology/2013/jul/22/david-cameron-crackdown-internet-pornography?CMP=EMCNEWEML6619I2">David Cameron’s recent announcement</a> that every household in the country will have a porn filter unless adult content is specifically allowed. This opt-in system will mean service providers will ask their customers whether they want unfiltered porn.</p>
<p>The plan is aimed at the “corroding” impact of porn on young people. But, instituting a policy like this is may be a bit preemptive.</p>
<p>Society has a long tradition of <a href="http://www.sbs.com.au/ondemand/video/37268547734/Love-And-Sex-In-An-Age-Of-Pornography">moral concern about young people and sex</a>. And research in this field has long tried to prove or disprove that causal links exist between viewing explicit materials and actual behaviours. It hasn’t been very successful.</p>
<h2>New research</h2>
<p><a href="http://onlinelibrary.wiley.com/doi/10.1111/jsm.12157/abstract">Recent research</a> looking at the impact of sexually explicit material on young people’s sexual behaviour provides more information, but not sufficient evidence, to guide public policy.</p>
<p>The study, which involved surveying 4,600 young Dutch people, found some association between the two but the authors acknowledge and emphasise that they were small. The authors said sexually explicit material was related to some sexual behaviours, specifically adventurous sex and transactional sex. </p>
<p>Adventurous sex includes experience with more than one partner at a time, experience with a same-sex partner, or with a partner met online. </p>
<p>Transactional sex is defined as money or goods being exchanged for sex. But the authors posited that there were likely other factors involved in the associations. </p>
<p>It’s impossible to determine causality in a study that didn’t involve follow-up or longitudinal methods. In a cross-sectional study such as this one (a study performed at a single point in time), we can only determine associations. That means that we don’t know the variable is causing certain behaviour. </p>
<p>This is a common gap in research about many aspects of young people’s sexual development. And we’ll need to do more carefully-controlled longitudinal research to capture the true causes of risky sex and promoters of healthy sexual attitudes and behaviours. </p>
<h2>Is porn all bad?</h2>
<p>Another problem with research in the field about the effects of sexually explicit material is that most of it focuses on negative outcomes. This means that only associations with negative behaviours, such as risky sex, are sought and found. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/28243/original/h7xdnphm-1375074284.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/28243/original/h7xdnphm-1375074284.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/28243/original/h7xdnphm-1375074284.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/28243/original/h7xdnphm-1375074284.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/28243/original/h7xdnphm-1375074284.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/28243/original/h7xdnphm-1375074284.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/28243/original/h7xdnphm-1375074284.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Safer sexual practices, mutuality between partners, and healthy enjoyment of sex are all positive things for young people to see and can be portrayed explicitly.</span>
<span class="attribution"><span class="source">Kendra/Flickr</span></span>
</figcaption>
</figure>
<p>Australian researchers <a href="http://www.tandfonline.com/doi/pdf/10.1080/19317610903393043">have identified</a> 15 domains of healthy sexual development. They span consent, safety, relationship and communication skills, and self-acceptance, to name just a few. </p>
<p>These researchers contend that the impact of sexually explicit materials should be evaluated across this range of domains to fully understand their influence on young people’s development. There are many examples of sexually explicit material having positive influences that could be explored in relation to young people’s viewing. </p>
<p>Some pornography emphasises positive sexual or body self-image, for instance, and may contain helpful examples of communication and negotiation. Some of it provides examples of people enjoying sex without anxieties. </p>
<p>So it may be useful to not paint all sexually explicit materials with a broad negative brush. Safer sexual practices, mutuality between partners, and healthy enjoyment of sex are all positive things for young people to see and can be portrayed explicitly. </p>
<p>And this kind of material will likely have a very different effect on development of sexual behaviour than other forms of sexually explicit media, which often portray unsafe sex, demeaning attitudes toward women and sexual violence, or all of these things together. </p>
<p>One thing that we can take from the Dutch research is that there are quite a lot of young people accessing sexually explicit material (88% of males and 45% of females reported watching some in the past year). This suggests that most adolescents are viewing some type of explicit media (in other words, such behaviour is statistically normative).</p>
<p>This data is valuable for understanding young people’s viewing behaviours. It also suggests that efforts to limit access to sexually explicit materials may be extremely difficult. </p>
<h2>What else is important?</h2>
<p>The link between sexually explicit materials and sexual behaviours most certainly needs to be explored further if we are to have a more concrete understanding of its harms or otherwise. </p>
<p>With this in mind, the filters planned by the UK government seem to overzealous and akin to banning all beverages so people don’t drink alcohol. </p>
<p>There are many factors other than viewing explicit material that influence young people’s sexual attitudes and behaviours. The mainstream media, education, family and friends, genetics and an individual’s broader environment and experiences all play a role.</p>
<p>While the potential effects of porn are quite interesting, let’s not get too excited about it. Rather, we should focus our enthusiasm on questioning the government’s role in controlling media.</p><img src="https://counter.theconversation.com/content/13645/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Porn. Just utter the word aloud and hearts pound, pulses quicken, and minds start racing. Depending on the context, these effects may be the result of concern for young people’s well-being rather than…Spring Chenoa Cooper, Senior Lecturer, University of SydneyGregory Zimet, Professor of Pediatrics & Clinical Psychology, IUPUILicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/131592013-04-02T19:31:39Z2013-04-02T19:31:39ZGrowing up too fast: early puberty and mental illness<figure><img src="https://images.theconversation.com/files/21950/original/2znynyrq-1364880062.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Children who go through puberty early have poorer mental health than their peers. But it's not a simple case of cause and effect.</span> <span class="attribution"><span class="source">Image from shutterstock.com</span></span></figcaption></figure><p>Puberty has long been recognised as a transition point in which many emotional and behavioural problems emerge. These include depression and anxiety, substance use and abuse, self-harm and eating disorders. </p>
<p>We previously thought that children who entered puberty earlier than their peers were at greater risk of these problems because they were less equipped to cope with the transition. This may be part of the story. </p>
<p>But we’re increasingly realising that social and emotional disadvantages and stresses in childhood may trigger early puberty. This possibility was explored in a study published today in the <a href="http://www.jahonline.org/">Journal of Adolescent Health</a>, which found children who go through puberty early showed signs of poorer mental health in early childhood. </p>
<p>We studied a cohort of 3,491 children and families from the <a href="http://www.growingupinaustralia.gov.au/">Longitudinal Study of Australian Children</a>. Parents reported behavioural difficulties and emotional, social and school functioning in four surveys between ages four and 11. Around 16% of girls and 6% of boys had begun puberty by age eight to nine. </p>
<p>We found that boys with an earlier onset of puberty had greater behavioural difficulties and poorer emotional and social adjustment. These difficulties began as early as four to five years of age and continued to early adolescence. </p>
<p>Girls who reached puberty early also had more difficulties in emotional and social adjustment from early childhood. But these girls did not have the increased behavioural problems found in boys. </p>
<h2>When does puberty start?</h2>
<p>Puberty is the stage of development in which a child’s body matures to enable reproduction. This includes the development of breast tissue and the first period in girls, and maturation of the testes in boys. The hormonal changes that lead to sexual maturation during puberty are accompanied by major physical growth and maturation of the brain. </p>
<p>Puberty typically begins in late childhood. On average, girls begin puberty at ages ten to 11; boys start at 11 to 12. But the timing of puberty varies by four to five years among healthy children. This reflects the effects of nutrition, psychological status and socioeconomic conditions. Studies also suggest that <a href="http://pediatrics.aappublications.org/content/121/Supplement_3/S172.short">genes play a role</a>. </p>
<p>The age of first menstruation has dropped significantly since the 1840s, when the average age in Western European girls was around 16. Since the 1960s this trend has ceased in most developed countries and the average age is now 12 to 13. </p>
<p>Within countries, differences in pubertal age may be found according to socioeconomic status and racial origin. Data from the United States, for example, found that black American girls <a href="http://pediatrics.aappublications.org/content/121/Supplement_3/S172.short">begin puberty earlier</a> than white or Mexican-American girls. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/21960/original/vkt4pg7q-1364884297.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/21960/original/vkt4pg7q-1364884297.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=410&fit=crop&dpr=1 600w, https://images.theconversation.com/files/21960/original/vkt4pg7q-1364884297.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=410&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/21960/original/vkt4pg7q-1364884297.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=410&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/21960/original/vkt4pg7q-1364884297.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=515&fit=crop&dpr=1 754w, https://images.theconversation.com/files/21960/original/vkt4pg7q-1364884297.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=515&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/21960/original/vkt4pg7q-1364884297.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=515&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Boys typically start puberty at age 11 or 12.</span>
<span class="attribution"><span class="source">Image from shutterstock.com</span></span>
</figcaption>
</figure>
<h2>Emotional and behavioural problems</h2>
<p>We know that adversity in life – such as stressful family circumstances or a lack of care and warmth – can affect the rate and course of a child’s development. Early psychosocial stress can be a cue for environmental risk and trigger earlier reproductive development. From this perspective, emotional and behavioural problems would be expected to occur even before early puberty is evident. </p>
<p>Puberty is a time of increasing stresses and challenges, as children adapt to their changing social roles. For this reason, mental health issues often first emerge in adolescence. Younger children and those with fewer social and emotional resources may find this phase more difficult, which increases their risk of subsequent mental health difficulties.</p>
<p>These changes interplay with prenatal factors. We know, for instance, that children who had a low birth weight are more likely to have early puberty. </p>
<p>Social determinants and health-related behaviours are also highly influential. The families, peers and communities children grow up with can provide “social scaffolds” for their mental health. Equally, negative influences in children’s environments can be risk factors for mental health difficulties in adolescence. </p>
<p>Our research supports a “life course” hypothesis. This suggests that differences in pubertal timing and childhood adjustment may, in part, result from adversity early in life. In other words, early puberty may be part of an accelerated transition to adult development which begins early in life. This, in turn, heightens the risks for emotional and behavioural problems. </p>
<h2>Reducing the risk</h2>
<p>The early life factors that may be influencing children’s development and leading to early puberty are not yet fully understood. Finding out what lies behind early puberty may help us to understand the origins of emotional and behavioural problems of children and adolescents.</p>
<p>We hope to find preventive ways to avoid some of the mental health difficulties which can emerge in adolescence. Promoting healthy environments and behaviours from early in childhood may help children develop social and emotional resources. Whether these resources will then protect children’s mental health during puberty is an important question. </p>
<p>We need to be aware of the social and emotional stresses during puberty, particularly for children who reach puberty earlier than their peers. It is crucial that there are positive frameworks in place to support these children at this phase of their lives. These may include supportive families, peers and communities, as well education, counselling and health services.</p><img src="https://counter.theconversation.com/content/13159/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Fiona Mensah receives funding from Australian National Health & Medical Research Council (NHMRC) Early Career Fellowship 1037449 and previously Population Health Capacity Building Grant 436914. Murdoch Childrens Research Institute research is supported by the Victorian Government’s Operational Infrastructure Program. She is affiliated with the Murdoch Childrens Research Institute and the Royal Children's Hospital and has an honorary affiliation with the Department of Pediatrics, University of Melbourne.</span></em></p><p class="fine-print"><em><span>George Patton receives funding from the National Health and Medical Research Council for research into the effects of puberty on health. </span></em></p>Puberty has long been recognised as a transition point in which many emotional and behavioural problems emerge. These include depression and anxiety, substance use and abuse, self-harm and eating disorders…Fiona Mensah, NHMRC Postdoctoral Research Fellow, Murdoch Children's Research InstituteGeorge Patton, Population Health Studies of Adolescents, Murdoch Children's Research InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/97022012-10-24T19:34:47Z2012-10-24T19:34:47ZPsychiatric labels and kids: benefits, side-effects and confusion<figure><img src="https://images.theconversation.com/files/16574/original/bwpvfhyb-1350359143.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">As an adolescent and child psychiatrist, I dispense all sorts of labels – but what do they mean?</span> <span class="attribution"><span class="source">emildom</span></span></figcaption></figure><p><em>MATTERS OF THE MIND – a series which examines the clinician’s bible for diagnosing mental disorders, the DSM, and the controversy surrounding the forthcoming fifth edition.</em></p>
<hr>
<p>As a child and adolescent psychiatrist my daily work involves diagnosing children and young people with various mental disorders. There are diagnostic manuals to guide me: the <a href="http://www.psychiatry.org/practice/dsm/dsm-iv-tr">Diagnostic and Statistical Manual of Mental Disorders</a> (DSM-IV) and the mental disorders section of the the <a href="http://www.who.int/classifications/icd/en/">International Classification of Diseases of the World Health Organisation, 10th Edition</a> (ICD-10).</p>
<p>These manuals give algorithms and criteria by which diagnoses can be made. Since its <a href="https://theconversation.com/forget-talking-just-fill-a-script-how-modern-psychiatry-lost-its-mind-9569">third edition</a> in 1980, the DSM has mostly followed the “medical model” of diagnosing by checking off lists of symptoms with little reference to past or present life stressors or the person’s coping or personality style. And ICD-10 followed the same post-DSM-III model.</p>
<p>Thus I dispense labels such as <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Attention_deficit_hyperactivity_disorder">ADHD</a> (attention-deficit hyperactivity disorder) for mainly boys with hyperactive or inattentive behaviour; if they’re particularly naughty they get the label <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Oppositional_defiant_disorder">ODD</a> (oppositional defiant disorder) and if they’re being seriously nasty then <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Conduct_disorder">CD</a> (conduct disorder). </p>
<p>With troubled teenagers who are down in the dumps with disturbances of appetite, sleep, loss of interest in life then <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/781C84612938D1CDCA25727D0014932D/$File/whatdep.pdf">MDD</a> (major depressive disorder) or if it’s less severe, <a href="http://www.health.harvard.edu/newsweek/Dysthymia.htm">dysthymia</a> may apply. </p>
<p>Nervous children may get a number of overlapping anxiety labels – <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Obsessive_compulsive_disorder_explained">OCD</a> (obsessive compulsive disorder), <a href="http://www.nimh.nih.gov/health/publications/panic-disorder-when-fear-overwhelms/what-is-panic-disorder.shtml">panic disorder</a>, <a href="http://www.anxietyonline.org.au/anxiety-disorder-types/generalised-anxiety-disorder">GAD</a> (generalised anxiety disorder), social phobia, separation anxiety disorder, or a number of other labels. </p>
<p>Some disorders such as <a href="http://thebutterflyfoundation.org.au/Uploaded_Files/CMS_Image/file/Anorexia%20Nervosa%20Fact%20Sheet(1).pdf">anorexia nervosa</a> or <a href="http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001924/">bipolar I disorder</a> (once called manic-depressive psychosis) define more discrete and serious mental illness. But others such as <a href="http://www.nimh.nih.gov/health/publications/bipolar-disorder/complete-index.shtml">bipolar II disorder</a> (with milder manic symptoms), and all the NOS (not otherwise specified) disorders can blur with other labels. </p>
<p>Although <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2810%2960532-6/fulltext">schizophrenia</a> is a very serious illness, transient psychotic symptoms are very common, even among the so-called normal young people who are under significant stress and of course under the influence of drugs.</p>
<p>Every few years an epidemic sweeps the nation’s schoolyards. In the mid-1990s it was ADHD; a few years ago an American epidemic of so-called <a href="http://www.tandfonline.com/doi/pdf/10.1080/15299732.2011.597826">PBD</a> (pediatric bipolar disorder) touched a few here. Since then it seems a plague of <a href="http://raisingchildren.net.au/articles/aspergers_disorder_signs_and_symptoms.html">Asperger’s disorder</a> or <a href="http://www.cddh.monash.org/assets/fs-autism.pdf">ASD</a> (autistic spectrum disorder) has struck many. </p>
<p>The DSM-5, due out next year, is likely to unleash a <a href="http://dsm5-reform.com/the-open-letter-to-dsm-5-task-force/">new epidemic</a> – <a href="http://www.dsm5.org/proposedrevision/pages/proposedrevision.aspx?rid=397#">DMDD</a> (disruptive mood dysregulation disorder), which has been <a href="http://www.psychologytoday.com/blog/dsm5-in-distress/201110/should-temper-tantrums-be-made-dsm-5-diagnosis">strongly criticised</a> by the former DSM-IV task force head <a href="http://www.psychologytoday.com/blog/dsm5-in-distress">Professor Allen Frances</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/16566/original/cyd3tfct-1350357007.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/16566/original/cyd3tfct-1350357007.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/16566/original/cyd3tfct-1350357007.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/16566/original/cyd3tfct-1350357007.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/16566/original/cyd3tfct-1350357007.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/16566/original/cyd3tfct-1350357007.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/16566/original/cyd3tfct-1350357007.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Child psychiatry is not a cookbook discipline of simplistic labels with drugs ready for each label.</span>
<span class="attribution"><span class="source">theloushe</span></span>
</figcaption>
</figure>
<p>The question is what do the labels mean? They are rarely complete explanations in themselves; they label surface symptoms but not underlying causes. </p>
<p>Labels are useful in research where simplification is necessary. In clinical practice they sometimes are useful too, but almost as often they can distract or obscure the real issues rather than point to the right treatment options.</p>
<p>In psychiatric training, we learn that what really counts is a <a href="http://en.wikipedia.org/wiki/Biopsychosocial_model">biopsychosocial</a> (biological, psychological and social) formulation. This is a few paragraphs which accompanies the diagnosis, summarising the main relationships, genetic inheritance, stressful events, temperament and psychological coping style of the person. The biopsychosocial formulation seeks to uncover and put in perspective all the causes of their symptoms and point to what help is needed, even if not readily available.</p>
<p>Child psychiatry is not a cookbook discipline of simplistic labels with drugs ready for each label on some shelf. At worst, DSM labels totally obscure the real underlying causes by making everyone think they have an answer. University of Adelaide psychiatry professor <a href="https://theconversation.com/profiles/jon-jureidini-1609">Jon Jureidini</a> has referred to such use of diagnostic labels to explain people’s predicaments as “<a href="https://theconversation.com/time-to-go-back-to-the-drawing-board-on-mental-health-reform-5041">unexplanations</a>”. </p>
<p>This sentiment has been echoed elsewhere in the profession. In an <a href="http://informahealthcare.com/doi/abs/10.1080/j.1440-1665.2006.02241.x">address</a> to the Royal Australian and New Zealand College of Psychiatrists, University of Sydney Professor of Psychiatry <a href="https://theconversation.com/profiles/philip-boyce-1146">Philip Boyce</a> commented:</p>
<blockquote>
<p>“The current paradigm seems to be that if a patient suffers from a specific DSM disorder, then there is a specific medication for this. If that medication does not work, try some other medication… a number of trends have contributed to this: increased service demand, the deification of DSM, the influence of the pharmaceutical industry, a misunderstanding of evidence-based medicine (EBM), managerialism and the influence of consumerism. … The (simplistic) DSM approach is exemplified by …treating DSM disorders rather than individuals.”</p>
</blockquote>
<p>Oxford Professor <a href="http://sociology.ucsd.edu/faculty/bio/scull.shtml">Andrew Scull</a> summed the issue up in a <a>Lancet article</a> where he described the DSM-III as “an anti-intellectual system published in book form: a check-list approach to psychiatric diagnosis and treatment” by which “Patients and their families learned to attribute mental illness to faulty brain biochemistry”.</p>
<p>To be fair, three DSM diagnoses do relate to stress and trauma: </p>
<ul>
<li><a href="http://www.mayoclinic.com/health/reactive-attachment-disorder/DS00988">RAD</a> (reactive attachment disorder) in young children due to highly disturbed relationships with their primary caregivers;</li>
<li>PTSD (post-traumatic stress disorder) but criteria are restricted to mainly life threatening events; and </li>
<li>Adjustment disorder, where someone has more trouble than usual coping with a serious stress. </li>
</ul>
<p>But stress weaves in through everyone’s life. In particular, complex childhood trauma and long-term outcomes of attachment problems are <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1601-5215.2010.00478.x/abstract;jsessionid=03A07A008355A88D7337D13DC78FE1F7.d02t04">under-represented</a> in the DSM.</p>
<p>One remedy would be the inclusion of <a href="http://www.traumacenter.org/products/pdf_files/preprint_dev_trauma_disorder.pdf">DTD</a> (developmental trauma disorder) into the DSM-5. But DTD seems to have lacked sufficient support in the APA’s DSM-5 committee. Most child psychiatrists find this a grave pity as DTD would add increased focus on the ongoing need for good child protection services.</p>
<p>In the end I’m glad my daily work involves broader, deeper and more commonsense thinking than simply dispensing <a href="http://www.clinicalpsychiatrynews.com/index.php?id=2407&cHash=071010&tx_ttnews%5Btt_news%5D=95430">diagnostic labels</a>. </p>
<p>Taking the time to engage with young people, their families, and sometimes school counsellors and others, to explore and understand all the interacting causes and meanings of the troubling symptoms is rewarding. And it’s often successful, as natural healing mechanisms are unleashed when real causes are addressed.</p>
<p><strong>This is the sixth part of our series <em><a href="https://theconversation.com/topics/matters-of-the-mind">Matters of the Mind</a></em>. To read the other instalments, follow the links below:</strong></p>
<p><strong>Part one:</strong> <a href="https://theconversation.com/explainer-what-is-the-dsm-and-how-are-mental-disorders-diagnosed-9568">Explainer: what is the DSM and how are mental disorders diagnosed?</a></p>
<p><strong>Part two:</strong> <a href="https://theconversation.com/forget-talking-just-fill-a-script-how-modern-psychiatry-lost-its-mind-9569">Forget talking, just fill a script: how modern psychiatry lost its mind</a></p>
<p><strong>Part three:</strong> <a href="https://theconversation.com/strange-or-just-plain-weird-cultural-variation-in-mental-illness-9679">Strange or just plain weird? Cultural variation in mental illness</a></p>
<p><strong>Part four:</strong> <a href="https://theconversation.com/dont-pull-your-hair-out-over-trichotillomania-10163">Don’t pull your hair out over trichotillomania</a></p>
<p><strong>Part five:</strong> <a href="https://theconversation.com/when-stuff-gets-in-the-way-of-life-hoarding-and-the-dsm-5-10074">When stuff gets in the way of life: hoarding and the DSM-5</a></p>
<p><strong>Part seven:</strong> <a href="https://theconversation.com/redefining-autism-in-the-dsm-5-6385">Redefining autism in the DSM-5</a></p>
<p><strong>Part eight:</strong> <a href="https://theconversation.com/depression-drugs-and-the-dsm-a-tale-of-self-interest-and-public-outrage-9912">Depression, drugs and the DSM: a tale of self-interest and public outrage</a></p>
<p><strong>Part nine:</strong> <a>Why prolonged grief should be listed as a mental disorder</a>)</p>
<p><strong>Part ten:</strong> <a href="https://theconversation.com/internet-use-and-the-dsm-5s-revival-of-addiction-10346">Internet use and the DSM-5’s revival of addiction</a></p><img src="https://counter.theconversation.com/content/9702/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter Parry is affiliated with Healthy Scepticism <a href="http://www.healthyscepticism.org">www.healthyscepticism.org</a> .</span></em></p>MATTERS OF THE MIND – a series which examines the clinician’s bible for diagnosing mental disorders, the DSM, and the controversy surrounding the forthcoming fifth edition. As a child and adolescent psychiatrist…Peter Parry, Child and adolescent psychiatrist & senior lecturer, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/59402012-03-21T06:02:56Z2012-03-21T06:02:56ZSerious themes for young adults sets The Hunger Games apart<figure><img src="https://images.theconversation.com/files/8824/original/v4qjb25m-1332294007.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Cast – Elizabeth Banks (L-R), Liam Hemsworth, Jennifer Lawrence and Josh Hutcherson – and director Gary Ross at the premiere of The Hunger Games in Germany.</span> <span class="attribution"><span class="source">EPA/BRITTA PEDERSEN</span></span></figcaption></figure><p><em>The film adaptation of the first of Suzanne Collins’ trilogy, The Hunger Games, will premiere nationally tomorrow. The books and film are set in a post-apocalyptic America, where teenagers are forced to fight each other to the death. The whole saga is broadcast to a television audience.</em></p>
<p><em>Young-adult literature expert Dr Sue Page, from the University of South Australia, explains the attraction of the series and dismisses some of the risks such content poses for young minds.</em></p>
<p><strong>What is the readership of The Hunger Games?</strong></p>
<p>Like quite a few young adult novels, it has a huge appeal for a general audience. So it’s published for a teenage audience but is actually read by a lot of adults as well. </p>
<p><strong>What do you think attracts people to the themes of these books and the film?</strong></p>
<p>This is the story of a powerless person put in a situation requiring her to make extraordinary decisions. She is resourceful and becomes increasingly powerful. The trilogy is also about relationships – with friends and romantic partners – and family responsibilities versus social responsibilities in a broader sense.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/8820/original/8jwwpjvs-1332293070.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/8820/original/8jwwpjvs-1332293070.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=906&fit=crop&dpr=1 600w, https://images.theconversation.com/files/8820/original/8jwwpjvs-1332293070.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=906&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/8820/original/8jwwpjvs-1332293070.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=906&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/8820/original/8jwwpjvs-1332293070.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1139&fit=crop&dpr=1 754w, https://images.theconversation.com/files/8820/original/8jwwpjvs-1332293070.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1139&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/8820/original/8jwwpjvs-1332293070.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1139&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The Hunger Games is the first of Suzanne Collins’ dystopian trilogy.</span>
<span class="attribution"><span class="source">Scholastic Inc./Flickr</span></span>
</figcaption>
</figure>
<p>And there’s always the appeal of adventure, of conflict between people and the environment, and of conflict against government. </p>
<p>What’s more, the protagonist is conflicted within herself in terms of how she feels about people and how she feels about the prospect of having to kill somebody. </p>
<p>There’s a lot of drama in the stories and it’s fast moving. Dystopic settings are also very popular at present.</p>
<p><strong>How do you expect people will react to the idea of teenagers fighting to the death?</strong></p>
<p>I think the way the government is using teenagers is one of the appealing aspects of the story. The anti-authoritarian theme is very strong in a lot of adolescent minds. </p>
<p>And the fact that it’s set up as reality television show is something that readers can identify with. They see the nastiness and the game-playing on all kinds of reality television shows already and this takes it to the next level.</p>
<p>It’s not just about who loses the most weight or wins a cooking competition, we’re talking about ways of keeping groups within society down, so that power can be held centrally. And I think a lot of young people feel disenfranchised and that things aren’t within their control.</p>
<p><strong>The story highlights how we enjoy watching other people suffer. Do you think this holds some truth?</strong></p>
<p>In a general sense, that’s what a lot of reality shows are designed to do. The development of conflict provides drama to viewers. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/2szX6ClpNrA?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<p><strong>Would you say people enjoy this sort of drama purely as entertainment or on a deeper psychological level?</strong></p>
<p>I think the way in which different groups react to what’s being shown is quite important. People who live in the city, for instance, don’t have to sacrifice their children for The Hunger Games so they see it as pure entertainment. The way people in many of the provinces see it is completely different, because it affects them in a different way. </p>
<p>The author indirectly encourages young people to look at what happens in reality shows, and to realise that they aren’t necessarily reality. It’s all stage managed and participants don’t necessarily know that people behind the scenes set things up - change the game rules and the rest of it. </p>
<p><strong>Is Suzanne Collins is trying to send a message about the construction of reality television shows?</strong></p>
<p>I think all kinds of fiction make us think about society, the people around us, and the way we deal with the world. And I think science fiction does this more directly sometimes than general or contemporary fiction. </p>
<p><strong>Do you think there are negative implications for younger people reading or watching The Hunger Games because of violence?</strong></p>
<p>No, I don’t. Violence has been part of drama and fiction since the start of history. It’s not a new thing, and it’s not a new thing for young people either. There’s a history of books depicting violence written specifically for a young audience, such as The Outsiders (1965) by S.E Hinton, which is about gang violence. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/8823/original/vwhm3vrm-1332293867.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/8823/original/vwhm3vrm-1332293867.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=853&fit=crop&dpr=1 600w, https://images.theconversation.com/files/8823/original/vwhm3vrm-1332293867.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=853&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/8823/original/vwhm3vrm-1332293867.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=853&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/8823/original/vwhm3vrm-1332293867.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1072&fit=crop&dpr=1 754w, https://images.theconversation.com/files/8823/original/vwhm3vrm-1332293867.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1072&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/8823/original/vwhm3vrm-1332293867.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1072&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Film poster for The Hunger Games.</span>
<span class="attribution"><span class="source">Film_Poster/Flickr</span></span>
</figcaption>
</figure>
<p>I don’t think there’s any concern about people reading or even possibly watching this kind of violence, which is only one aspect of the story anyway. Especially as it’s not particularly graphic in the book. A lot of the deaths we learn about with faces appearing on giant screens every night, but we don’t actually read how they took place. </p>
<p>I think Suzanne Collins has done a good job at giving people a bit of a barrier between what’s happening and what she’s showing. The fact that we’re seeing everything unfold through the protagonist’s eyes as opposed to the eyes of the stage managers, who would be seeking the violence, helps us participate in her revulsion of the violence. Other tools include the language used and who instigates the violence. </p>
<p>The Hunger Games balances out much of its violence as well – through the care shown to family and friends; the protection of other competitors and working together; and the growing knowledge about what’s actually happening and how they’re being manipulated. </p>
<p>All of these things well and truly counteract any possible influence of violence. I hope that the film manages to keep the tension and drama without losing the focus on other aspects.</p><img src="https://counter.theconversation.com/content/5940/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sue Page does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The film adaptation of the first of Suzanne Collins’ trilogy, The Hunger Games, will premiere nationally tomorrow. The books and film are set in a post-apocalyptic America, where teenagers are forced to…Sue Page, Lecturer in the School of Communication, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.