Recovering from the Pandemic: What's the New Normal for Teens and How Can We Help?

June 27, 2023

Coming of age in the pandemic has been rough on a generation of teens. The pre-existing mental health crisis, intrusive social media, and real existential threats like gun violence and climate change, on top of normal developmental processes, have made for a perfect storm. How are teens faring, and how can they be supported in this new milieu? New guidance is emerging from science, practice, and policies.

WHAT DO WE KNOW?

The pandemic touched every area of life.

The impact of the pandemic affected every important area of young people’s lives across the age spectrum, according to a March 2023 report from the National Academies of Sciences, Engineering, and Medicine.[1]

Academic achievement suffered, especially in reading- and math- related subjects. School engagement was often difficult: Enrollment declined, absenteeism increased, and some children lacked access to virtual education. Parents, who under normal circumstances would have supported children’s learning, were themselves deeply stressed, especially those with young children, and some families were overwhelmed by financial hardship, food/housing insecurity, illness and loss. Many educators met the moment with ingenuity and passion, but others suffered high rates of anxiety and burnout, and many left the profession.

Young people’s physical health suffered, too. Though children were less likely to experience severe COVID-19 disease, a meta-analysis confirmed that they had increased risk for multisystem inflammatory symptoms, and 25% of children and teens who were infected with the virus got long COVID—namely prolonged mood disturbances, fatigue and shortness of breath, sleep disorders, loss of smell and taste, and fevers. Infected children’s rates of diabetes increased, and children’s health was more generally undermined by interrupted preventative care: Kids missed routine vaccinations, blood lead screenings, vision screenings, and dental care.

The pandemic’s toll on young people’s psychological wellbeing was uneven, but where it had an impact, it was intense and sometimes devastating. More than 265,000 young people lost a parent or caregiver to Covid-19, with Native American, Black, and Latinx children being two to four times more likely to lose a primary caregiver than white children. On almost any measure, impacts of all kinds were more acute for ethnic minority youth, low-income youth, LGBTQAI+ youth, and special education students, with their symptoms continuing to persist at higher rates.

Psychological impact varied by developmental period.

Stress affects children and teens differently depending on their developmental status and what they need from their environment. Those differences can be seen in the way the pandemic impacted young people:

Babies. Studies of babies born during the pandemic showed that while they didn’t seem to be harmed by exposure to the virus in utero, exposed and unexposed babies alike showed developmental delays by six months, especially in areas of gross motor, fine motor, and social and emotional development. Why? Babies need responsive and attuned attention, with a serve-and-return style of interaction. During the pandemic, rates of anxiety and depression in parents and caregivers nearly quadrupled, making it difficult to provide the normal emotional “nutrition” babies need to develop well. Early intervention can easily recover these lags, but ignoring the impact can have lifelong consequences.

Young children. A report synthesizing the findings of 76 high-quality studies on the pandemic and early childhood showed that preschool enrollment declined, and early learning in pre-literacy, math, and social-emotional skills declined with it. Nearly half of parents of children under five said they were worried about their children’s isolation and restricted social development during lockdown. This is a valid concern, since peer engagement helps children develop social coordination, communication, and peer play. Parents reported higher rates of behavior problems, hyperactivity, and peer problems in their young children, compared to reports from previous years. The problems were more intense in families with more hardships, and on days when school or care was disrupted, highlighting the need for stability and routine.

During the pandemic, anxiety and depression rose in school-age children, along with increased rates of ADHD, obsessive-compulsive disorder, and tics. Children ages six to 12 were more emotionally dysregulated; they exhibited more “internalizing” issues (e.g., withdrawal, low self-esteem, eating disturbances) and “externalizing” behaviors (e.g., agitation, conduct problems) compared to pre-pandemic rates.

In private conversations, several educators estimated to me that children are about two years behind in in their social skills; among other things, they’re having difficulty managing themselves and their emotions with their peers on the playground. Bay Area therapist Sheri Glucoft Wong reported that families are having a harder time organizing and coordinating themselves and making transitions as schedules fill up once again, a kind of real-world wayfinding problem seen in college students, too.

Teens. The pandemic poured fuel on the fire of the youth mental health crisis that’s been brewing for over a decade. Last fall, medical experts recommended that all children eight and older get screened for anxiety and that all teens get screened for depression. In March, the Centers for Disease Control and Prevention released a report showing that youth mental health was still worsening, particularly for female, LGBTQAI+, and Black students, all of whom are experiencing more violence, distress, and suicidality. Six in ten female-identified students reported feeling “persistently sad or hopeless,” and sexual assault rates rose, especially for female students, LGBTQAI+ students, and American Indian and Alaska Native students.

Children and teens worry about real events that are going on their lives, and the content differs by life stage. Young teens report in surveys that they worry most about their immediate experiences—e.g., school and friendships—while older teens worry about their future and the world they will enter. For about a decade, teens’ top worries have been gun violence and climate change. Many young people feel lonely and isolated; they feel that no one notices when they’re worried and that there’s no one to turn to for support.

Emily Frost and Quetzal François facilitate Bay Area mentoring and rites of passage program Love Your Nature for girls ages 10-20, nearly half of whom are BIPOC and/or queer- or nonbinary-identifying. I spoke with them about what they’re seeing in teens.

First, younger teens are worrying about their parents in new ways. “They’ve always been aware of their parents’ yelling or fighting,” Frost told me. “But now they’re overhearing their parents on the phone, late at night, discussing serious life decisions and struggles. Parents are stressed, so they’re less filtered, and teens feel scared about what they’re hearing. They’re also afraid to turn to their parents with their own problems because they don’t want to be an extra burden.”

In normal circumstances, young teens would begin individuating, i.e., seeking greater psychological autonomy while maintaining their connections. In typical individuation, young teens need to take their parents’ availability and stability for granted in order to push out; they might even create more conflict in order to practice gaining a separate mind. But it’s very challenging to individuate from someone you’re worried about, or have to take care of. And in lockdown, not only were young teens stuck in the same physical space as the adults from whom they were individuating; they were also cut off from access to the non-parental people—primarily their peers, but also mentors, teachers, and coaches—they needed in order to individuate.

Older teens in Frost and François’ groups, who are poised to launch into adulthood, express an acute sense that their future is uncertain. In stable situations, adolescents are designed to rush into the future—they’re creative risk-takers who excitedly move with their peers, their generation, toward what’s new and interesting. But these teens have deeply experienced losses of things they’d taken for granted—loved ones dying from COVID-19, school closures and the elimination of their educational and social worlds, and even disappointing college admissions that seem to be increasingly selective. Add to that a sense of impending doom about the climate crisis, gun violence, and health concerns, and teens don’t have access to the embodied feeling of confidence they need in order to launch.

What’s more, these dynamics create chronic stress that burden the nervous system and teens’ development.

“The cellular experience of young people,” Frost said, “is, ‘I’m not safe, this is not safe, and I don’t know what to do about it.’”

A 2022 Stanford University study bears this out: Neuroimaging of brains of 163 young teens before and during the pandemic showed accelerated brain aging due to the pandemic. Areas affected include memory formation, emotion management, and executive function. The changes are similar to those resulting from chronic adversity like violence, neglect, or severe family dysfunction.

Parents’ ability to help regulate kids’ stress decreases at adolescence, creating more vulnerability.

It’s a feature of development that children’s bodies are keenly attuned to signals of stress in their environment, as though they’re “emotional Geiger counters.” Beginning in-utero, signals of stress cross the placenta, causing epigenetic changes that direct a cascade of hormonal, endocrine, and neurological reactions that comprise the body’s hypothalamic-pituitary-adrenocortical (HPA) system, also known as the stress regulation system.

I spoke with developmental scientist Megan Gunnar at the Institute of Child Development at the University of Minnesota, who’s been studying the impact of stress on children—and how the body regulates it—for 45 years. “The stress system is very plastic [modifiable] for the first 18-24 months, and then it’s set for awhile,” she explains. “Then puberty helps to reopen it, and adolescence becomes another period of heightened plasticity—for good or for ill.”

About a year before signs of puberty are visible, the sex steroids begin to remodel the brain in preparation for adulthood. An over-blooming of synaptic connections between neurons allows for creative potential, and synaptic pruning eliminates unused connections. As a result, the influences in teens’ lives at that time carry inordinate importance. Teens also become highly sensitive to others, especially their peers. Their reward circuitry is remodeled, boosting their desire to explore their world—and outpacing their “braking system” which takes longer to develop and will make them more cautious, especially in the presence of peers. Some evidence shows that part of the plasticity taking place may involve some alterations to the stress regulation system.

“Adolescents are interested in new experiences, novelty-seeking, especially with their peers,” Gunnar says. “In normal circumstances it’s a wonderful, fabulous time of emotional development,” Gunnar said. But there’s also a feature of the plasticity that makes them more vulnerable. “In adolescence, the parents get ‘booted out’ of their hypothalamus.”

What does that mean? “In childhood,” she explained, “there’s a very powerful capacity of parents, especially in secure relationships, to buffer the child’s reactivity of the HPA axis. The child produces less cortisol (stress hormone) when they’re in the presence of their secure caregivers. But we find in our research that that goes away about the midpoint in puberty. At that time, the parent’s presence no longer automatically dampens the body’s stress response, and teens begin to regulate more on their own—at least in individualistic cultures. (This effect hasn’t been studied in other cultures.) Gunnar’s research is congruent with other research that shows, for example, that, unlike in earlier childhood, teens’ brains are more activated by unfamiliar voices than by their mothers’ voice, consistent with the biological drive to focus beyond the family.

Along with individuation and a greater peer orientation, the downgrade of parental stress regulation may be part of an evolutionary design that nudges young people away from the nest and drives them to form new communities. “Later, when they form an attachment to an adult romantic partner, that partner is ‘let into’ the nervous system,” Gunnar says, “and they will be able to help buffer stress. But in the meanwhile, adolescents are vulnerable.”

Still, Gunnar says, parents can continue to be a regulatory source, helping their teens figure out how to regulate themselves in other ways. “We see in our research that when parents help with emotion coaching, teens are better able to regulate their cortisol response than kids whose parents don’t.”

Teens are extra sensitive to social evaluation.

Is the teen brain biologically disposed to increased stress? “There is some evidence that there may be a heightened level of cortisol production, overall, in adolescence, but we’re not exactly clear on the mechanisms of that yet,” Gunnar told me. “But work in the Netherlands has shown that there is a heightened level of cortisol production in particular to social evaluative stressors. Adolescents are freaked out by social evaluation, and girls become more sensitive to it before boys.”

In the lockdown, virtual access to others was vital; kids connected with friends and supportive communities across the internet, including on social media and gaming platforms. But some of the interactions may have harmed some of them. In May, the U.S. Surgeon General issued a bracing advisory about the risks of social media to young people’s mental health. It cautioned parents to set limits around social media use, and urged greater regulation and oversight of social media technology companies. One provocative—but nonscientific—global survey suggests that the later a child accesses a smart phone, the better their mental health as adults, especially their self-confidence and social life. Another study shows that lower media use increases teens’ prosocial behavior and self-regulation. Some research blames social media for the mental health crisis, while other research documents individual variation—i.e., some kids feel better using it, and some feel worse.

Regardless, there’s a growing skepticism about smart-phone access and social media use. Therapist Glucoft Wong said she’s seeing more families grappling with recalibrating screen time in their households.

WHAT HELPS?

For parents:

Some kids are fine. The impact of the pandemic was not universally adverse. At scale, the mental health crisis—and shortage of professional help—is alarming. Still, depending on the measure used, statistically one quarter, one third, or half of kids may be alright. Some kids even benefitted. Shy and socially anxious teens, and teens who were experiencing low-grade trauma at school, were relieved by the break. Extra care needs to be taken to reintegrate and support them.

Remember the basics. Sleep, nutrition, exercise and friendships are foundational to all other functioning. One Stanford neuroscientist emphasizes sleep and deep rest above all for wellbeing, and teens are notoriously short on it. Studies show more sleep for teens improves many measures of wellbeing and achievement. Challengesuccess.org offers simple tools to help make conscious choices about time use around the clock.

Focus on psychological wellbeing and emotional skills. All the professionals I spoke with for this article agreed that support for healthy psychological skills is as important as—and perhaps more important than—academic skills. Focus on relationships and emotional health, they advise. This guidance echoes 75 years of research on resilience. Lisa Damour’s book, The Emotional Lives of Teenagers is an excellent place to learn more about how to do that.

Frost and François recommend sharing with teens what you’re learning about wellbeing. Leave materials out for them to read, finish the podcast you’re listening to while you get in the car together, etc. Casual and adjacent sharing helps support teens in a way that’s not didactic or face-to-face.

Make yourself prepared and available to have conversations about things that really matter, about topics that are relevant to your teen. “Teens are meaning-making machines,” Frost quips. “They care about how the world works and their place in it and they want to have conversations about important things.”

Have relationships, don’t just worry about them. “Being in the relationship is more important than the status check-ins of ‘How are you doing?’” Frost and François say. Have supportive family routines, a monthly café date, and be in the world together. “You’re planting seeds for their future and for the future of your relationship. It’s not one big thing, really, it’s how all the small actions day-to-day add up. Even if they balk at your suggestion, it’s worth persisting,” Frost says.

Gunnar concurs: “If I were the parent of a teenager right now, I would be working hard to have that child and the whole family have time when we’re just being a family and not in the media, on screens. Dinnertime, playing games, quieter, simpler things that provide that sense of grounding. And I would do a lot of listening and less talking.”

Clarify emotion language. Frost and François observe that since mental-health language has become more prevalent in our culture, more teens are using terms like “anxiety,” “panic attack,” or “dissociation.” It can be startling at first. Sometimes teens “front” with hyperbolic language; they’re trying it on, but it doesn’t always serve them. Have a growth mindset and see it as an opening for more learning, more talking. Ask gentle questions like, “What do you mean by that?” Tone is everything, says Frost.

In The Emotional Life of Teenagers, Damour reminds us that teens have big emotions in the best of times, and we can often help them understand and manage their feelings. It is when emotions become unmanageable or overwhelming that some professional help may be advised.

Help teens connect to something bigger than themselves. “Young people have a deep longing to feel connected to something bigger than themselves,” François said. “This includes nature, civic engagement, social justice, and volunteering. Getting to be part of a meaningful experience is so key.” Frost adds, “The impact on this generation of being the ‘turning point’ in the climate crisis is underestimated. Their relationship to nature is huge on many levels. And there’s a positive impact of spending time there, experiencing the mystery, the universe, and forces much greater than themselves.”

Reclaim exploration as a part of adolescence. In the 1960s, adolescence was seen as a period of exploration necessary to achieve a healthy identity. We seem to have lost that as we pressure teens to foreclose into decisions, identities, and careers, and as we reduce teens’ free time to be bored and mess around which is critical to developing their unique talents. “Allow kids to not know who they are and still feel valid,” Frost and François advise. Teens interpret even well-intentioned queries as pressure to have answers, and they feel they’re disappointing parents by not knowing.

Take care of yourselves. Teens can be encouraged to be kind and considerate, but they should not be their parents’ emotional caregivers. “Find your communities, find your regulation, your check points,” Frost advises parents, “so you don’t put so much on the teen to reassure you or to give you answers. Teens need to be free of their low-level anxiety about how you’re really doing.”

Connecting with other parents can also help set norms among peer groups, e.g., social media use.

Remember that you’re modeling self-care as well as becoming a better partner inside the relationship for your child to experience.

Resume collaboration with teachers. The three-way relationship among kids, parents, and teachers that has long been proven to support students broke down during the pandemic, Glucoft Wong observes. Parents, kids, and teachers missed out on the benefits of collaborative relationships and friendships and the seamless sharing of information that happens when campuses are open and people interact in person. Reach out to teachers—and other parents—to resume that communication and learn how to best support your students.

Set social media guidelines. A young teen’s brain is very different from that of an older adolescent. In The Emotional Lives of Teenagers, Damour recommends keeping phones out of bedrooms at night and putting age-appropriate brakes on tech access, for example, starting with a phone that can send and receive texts but not access social media. Common Sense Media also has helpful guidelines. But make this a partnership; one study found that excessive restrictions in the absence of communication made teens more secretive and more relationally aggressive.

For educators:

Set later start times and minimize homework. A later school start time for teens is linked to better mental health, and many teens are pressured for time due to too much homework (which isn’t linked positive outcomes).

Acknowledge emotions wisely. Most educators know the importance of a social and emotional education; the challenge is making time for it and embedding it in the school ecology. When emotions are normalized and the school community becomes more skillful, relationships will be deepened and people more skillfully authentic. For ten years now, meta-analyses [DD1] have consistently demonstrated the widespread positive impact of social and emotional learning on adults and students alike.

Create the culture you want. Create social norms for the culture and climate to encourage desired behaviors that become the norm. There are numerous surveys available to schools that let students give feedback about their school culture and assess school climate. Students can also contribute: Research on InspirEd, student-led social and emotional initiatives, showed improvements in school climate, school pride, student relationships and emotional safety.

Provide resources to students. Normalize conversations about mental health and psychological services. Learn what resources are available for your students and communicate those to them. Students need to know who to talk to, how to disclose, and find care in hard moments, like following a sexual assault, when a friend is in trouble, or when they’re invited to participate in harmful behaviors.

Facilitate safe, supportive student relationships across ages. Mentors come in all ages and locations.

Convey hope and inspiration. Students need more than information about problems; they need models and stories that give them hope about their future and their ability to navigate and shape it, without feeling overwhelmed by their responsibility for it. “Teens need honesty, but hopeful honesty,” Frost and François add. “They need to be held in a process of making meaning of what they’re experiencing. Otherwise, where will they get the perspective to face inevitable adversity?”

Model wellbeing. Model how to be an adult and how to achieve the future you want.

* * * * *

Unfortunately, all of the above advice is given in a particularly challenging context. Currently on overall measures of child well-being, the U.S. ranks 36th among 38 nations with comparable high-income economies.

“The nation is getting riled up about the wrong things,” Gunnar says. “We need to be very riled up about how to keep the world a safe place, about critical things like the climate and gun violence. That’s not for the kids to do. It’s for the adults to do.”

In the meanwhile, we can still all have a role in making things better for teens. Growing up in a stressful and unpredictable world will be part of this generation’s story, but in the safety of our patient gaze, warm regard, and reliable support, they may even develop hidden talents—gifts and abilities that we cannot imagine and that only emerge in difficult circumstances. As the author and artist Chanel Miller writes in Know My Name, “You have to hold out to see how your life unfolds, because it is most likely beyond what you can imagine. It is not a question of if you will survive this, but what beautiful things await you when you do….Wait for the good to come.”

[1] a group convened by the federal government to solve complex national problems and inform public policy

It's Time for the U.S. to Take Developmental Justice Seriously

February 3, 2021

The U.S. ranks among the worst in developed nations in which to raise children. Its poor performance is both alarming and consistent. But as the new U.S. administration goes to work, there are flickering signs that America’s children may start to get the care and respect they deserve. The Biden-Harris Administration is proposing a combination of emergency relief and permanent policies that are long overdue, albeit a drop in the bucket. But they’re significant and evidence-based, and they may begin to help us catch up with the more supportive ways other countries treat their children.

Policies and the beliefs and values they telegraph comprise a systemic approach to children, just as they do for any demographic, e.g. gender, ethnicity, ability, etc. And historically, children are late to the justice table. For most of human history, children were not seen as fully human until they could work, and even then, it was legal to abuse, enslave, and even kill them. They were considered objects—property to do with as one pleased. Some children were targeted more than others, including girls, the poor, immigrants, indigenous, and black children. In the U.S., child labor wasn’t outlawed until 1938; child abuse became illegal in 1974. Surgeries on babies were routinely performed without analgesics as late as the 1980s, as babies were deemed insufficiently evolved to feel pain—a belief refuted with data only in 1986.

The U.S. is progressing, but we lag far behind the rest of developed countries in elevating our children to the status and protection they deserve.

The most glaring example is our singular refusal among all UN member nations to sign the UN Convention on the Rights of the Child (UNCRC). The UNCRC is a legally binding international agreement that acknowledges the basic human civil, political, economic, social, and cultural rights of children. The UNCRC maintains that children are “entitled to special care and assistance” because of their developmental status and decrees that governments should hold “the best interests of the child” central to all of their decision-making. The Convention includes 54 articles detailing the following children’s rights: to survive, develop, be educated, and cared for; to be protected from violence, war, abuse or neglect; and to have a voice in matters that affect them. Why has the U.S. refused to ratify the document? Largely because Republican senators have consistently blocked it, claiming that it will undermine the sovereignty of the American family. I think we can safely conclude that this is not an actual problem, as 196 countries have successfully governed by the UNCRC for decades.

How do U.S. children fare compared to children in other countries?

Spending on families. According to The Organization for Economic Cooperation and Development (OECD), the U.S. ranks 34th out of 38 OECD countries in the percentage of GDP spent on family benefits. The OECD average is 2.4%, and while some Western and Northern European countries spend 3.5%, the U.S. spends less than 1.5%.

Caregivers’ paid leave from work to take care of newborns or newly adopted children is critical for children’s good start in life, and it’s an important way governments support child development. Newborns literally need consistent access to their caregivers’ bodies to establish healthy regulatory systems for the rest of their lives. The U.S. is the only country among 41 OECD nations that does not provide paid leave (although five states and D.C. have enacted their own paid leave policies). By contrast, many other countries offer a full year, Estonia offers one and a half, and the smallest length of time offered by any OECD nation other than the U.S. is two months.

Source: Pew Research Center based on OECD data

Child poverty. The U.S. has the 10th highest child poverty rate of 42 OECD countries; nearly one third of our country’s citizens in poverty are children. Research shows that poverty in childhood undermines cognitive, social, and emotional development as well as educational and occupational achievement. Lyndon B. Johnson’s Great War on Poverty saw child poverty rates decline, but beginning with the Reagan administration, that trend reversed—for children much more than for other age groups—as the graph below shows. This disproportionate data should raise questions about why the U.S. has chosen to hold poverty rates down for adults but not for children.

Overall well-being. UNICEF ranks the U.S. 36th out of 38 rich countries on the overall well-being of children. This includes their mental health, physical health, and academic and social skills—where America ranks 32nd, 38th, and 32nd respectively out of 38 countries.

(If you’re interested in how children are faring in your state, Kids Count ranks individual U.S. states on various measures of well-being. In overall well-being, Massachusetts ranks first, New Mexico last, and California 34th.)

Child mortality rates. Globally, children under five have the highest mortality rates of anyone under the age of 75:

And the U.S., one of the most medically advanced countries in the world, ranks 34 out of 44 OECD countries on infant mortality. Black babies in the U.S. are more than twice as likely to die than white babies.

Source: OECD infant mortality rates 2019, deaths/1,000 live births

Corporal punishment. A worldwide movement is gaining traction to prohibit the corporal punishment of children in any setting. (Corporal punishment is the intentional use of physical force to cause pain or discomfort, or non-physical force that is cruel or degrading.) As of this writing, 61 countries have legally prohibited it in all settings, e.g., family, daycare, school, prisons, etc. In the U.S., though outright child abuse is unlawful, corporal punishment just shy of that mark is legal in all families and in schools in 19 states. (See here for the difference between corporal punishment and child abuse.) Hitting an adult is considered assault, but the legal use of corporal punishment with children is just one example of the ways that they are denied the relationship rights and protections afforded to grownups. Five decades of research on the spanking of children shows that it leads to poor outcomes, but as of 2016, two thirds of U.S. parents agree with the statement “Sometimes a child just needs a good, hard spanking.”
Gun violence. Children in the U.S. are 15 times more likely to die from gun violence than children in 31 other rich countries combined. Gunshot wounds are the second leading cause of death for children and teens in the U.S.; more children under five years of age died from gun violence in 2017 than law enforcement officers in the line of duty. Since 1963, more children and teens have died by gun than all the soldiers killed together in the Vietnam, Persian Gulf, Afghanistan, and Iraq wars.

There are numerous other deeply disturbing statistics, but you can see the clear trend: The U.S. does not invest in its children like other developed nations. In his 2005 book Making Human Beings Human, influential developmental scientist Urie Bronfenbrenner writes:

America’s families, and their children, are in trouble, trouble so deep and pervasive as to threaten the future of our nation. The source of the trouble is nothing less than national neglect of children and…their parents (p. 211).

Laurence Steinberg a developmental scientist who studies teens, sounds a similar alarm in his 2015 book Age of Opportunity, Lessons from the New Science of Adolescence:

When a country’s adolescents trail much of the world on measures of school achievement, but are among the world’s leaders in violence, unwanted pregnancy, STDs,…binge drinking, marijuana use,…and unhappiness, it is time to admit that something is wrong with the way that country is raising its young people. That country is the United States (p. 1).

It’s time to rethink our rosy attitude about “American exceptionalism” and get real. America’s children are systematically undermined. We are only exceptional among nations in our ill treatment of them.

The political climate during the past four years was particularly hostile for children.

The last four years were brutal for children. Beginning with the 2016 presidential campaign, youth bullying spiked to around 70%—directly attributable to Donald Trump’s racist, sexist, and violent rhetoric, according to the Human Rights Campaign and the Southern Poverty Law Center.

The parent-child attachment relationship was targeted and weaponized by the anti-immigrant child separation policy. At least 5,400 children were systematically separated from their parents at the southern border, and at least 545 remain “lost” in the system, unable to be reunited with their families. This kind of separation is clearly known to cause toxic stress in children and alter the structure of their developing brains; it’s recognized by human rights organizations like Amnesty International, Physicians for Human Rights, and many more as a form of torture.

The Covid-19 pandemic layered on additional stress for the vulnerable: 700,000 children became uninsured, food insecurity spiked, and academic achievement disparities widened.

In her book Childism (a term for systematic prejudice against children), therapist Elisabeth Young-Bruehl writes that one of the clearest signs of a systematic bias against children is the “widespread acquiescence in policies that require future generations to shoulder responsibility for present prosperity.” She writes:

The young have been saddled with a world filled with violence, riddled with economic inequality, and endangered by a disastrous lack of environmental oversight; they must assume a gigantic burden of peacekeeping, legislating fairness, and halting environmental degradation (p. 14).

The last election has shown us that young people are increasingly politically active, expressing concerns over racial injustice, gun violence, climate change, and more. Yet in the 2020 election in California, a proposition that would have extended the vote to 17-year-olds was rejected.

Insulting language and micro-aggressions

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Derogatory language about children is normalized in contemporary society. As Donald Trump increasingly went off the rails, the media often referred to him as a child or—especially damning—a toddler. Surely, if any other demographic were targeted with such an insult, it would be seen as biased and prejudicial.

Even loving caregivers use labels like a “difficult baby” (to whom?), or “the terrible twos” (as if humans shouldn’t strive for autonomy). Teenagers (or iGens) are routinely maligned, as are the prior generation, the millennials. They are talked over, excluded, ignored, and insulted, despite data showing that they are generally inclusive, creative, diverse, accepting, and politically active.

Derogatory language reveals underlying attitudes about children and is especially harmful because of the way human development works. Young children are wired to identify with adults and absorb the discourse around them as normal, as the benchmark of the society they’re learning to enter. Only in adolescence, when they start to individuate, do they have a chance to separate the wheat from the chaff. We place an additional burden on their development when they have to work to shed harmful stereotypes of any kind.

Can we turn a corner?

The Biden-Harris Administration is proposing an overarching “care economy” that recognizes the critical importance of supporting families in caring for their children. A few of their proposals are:

A $1.9 trillion American Rescue Plan that could reduce child poverty by 45%, according to an analysis by the Columbia University Center on Poverty and Social Policy.
A commitment to emergency paid sick leave and family and medical leave, which research shows are critical to flattening the curve of Covid-19. The administration has also committed to a permanent 12-week paid family and medical leave policy, allowing families to care for newborns and other family members, and a national paid-sick-days law that makes it easier for people to care for themselves and others when illness strikes.
Shoring up childcare by reducing costs to families through tax credits and subsidies, and building more childcare centers, including in workplaces. Unpaid caregivers will also receive a tax credit. Importantly, the current administration plans to build up the childcare workforce with better pay, benefits, training, worker protections and career opportunities.
Free, high-quality universal early childhood education for pre-kindergarten three- and four-year-olds. Economists have long recognized that this investment is the best way to improve the economy over the long term.
Making schools hubs for parent and child support by providing more mental health professionals and community resources to families right in school buildings. This is an idea long supported by developmental scientists and educators.
Creating a task force to reunite separated children with their parents, which First Lady Jill Biden will oversee.

There is so much more to do, but these initiatives are hopeful signs that America, at long last, may finally begin to leave harmful approaches to children in the dust bin of history.

In the meantime, adults who raise, guide, and educate children have a powerful role, too. Historian Lloyd deMause documents the history of childhood in his book The Emotional Life of Nations, and he writes that when leaders don’t lead, caregivers can. “Changes in childrearing precede social change,” he reminds us (p. vi). Adult citizen voices are critical to persuading politicians to support families. Informed by developmental science and policy research, Americans can lift up our children, recognize their full humanity, and offer a more stable, successful, and hopeful future for all of us.

(Thumbnail image: Amy Humphries)

Pandemic 2020: Will the Kids Be All Right? Lessons on Parenting from 100 Years of Crises

April 16, 2020

Massive unemployment. Loss of life. Disrupted education. And an economy in free-fall. These are the ingredients for the kinds of tectonic social shifts that alter the arcs of human lives. And parents, as always, are at the fulcrum of the pressures, protecting their families while trying to hold together a semblance of normalcy for their children.

For 100 years, developmental scientists have studied how families and children respond to disasters, manmade and natural. From the Great Depression to Hurricane Katrina, from 9/11 to wars and historic migrations, we’ve learned a few things. Studies of resilience have shown us that certain conditions enable children to adapt well amidst adversity, and other conditions lead to unfavorable outcomes.

The most critical element, according to the research, is the presence of at least one stable, caring adult, someone who provides a secure psychological container and a scaffold for growth—and I’ll explain that more fully below. But there are other levers at play, too.

In times of societal crisis, the following qualities are important to a child’s psychological resilience. I share these with you in the hope that whatever your situation in caring for children during the pandemic, you can focus on what really matters to your family’s long-term psychological well-being and let go of the more minor concerns.

Dosage

Research on children’s resilience began with developmental psychologist Emmy Werner, who was a child during the horrors of World War II in Europe. Many of the 39 million civilians who died because of the war were children, and 20 million children were orphaned. Werner managed to survive with her cousins by “foraging in the ruins of bombed-out houses and in abandoned beet, potato, and turnip fields” when all of the adult males in her extended family perished on the battlefield or in prisoner camps.[1]

In order to explore how children survived, she studied the letters, diaries, and journals of 200 child eyewitnesses on all sides of the war across 12 countries. In addition, Werner conducted in-depth interviews with 12 adult survivors when they were in their 50s and 60s.

In her book, Through the Eyes of Children, Werner writes that many of the children who survived became adults with “an extraordinary affirmation of life.” However, children were affected differently depending on a number of variables. The most important was their level of direct exposure to violence, bombing, and combat. For example, in a study of 1200 British school children targeted in air raids, 18 percent had symptoms of post-traumatic stress disorder (PTSD), e.g., intrusive fears; nightmares; sleep disturbances; and heightened reactivity to loud noises, like sirens and explosions. These symptoms were present five years later at a rate comparable to those found in combat veterans of WWII and, later, the Vietnam War. When Werner interviewed her adult subjects more than 50 years later, they still reported frighteningly vivid memories of the sounds of air raid sirens, machine gun fire, and low-flying planes.

(Getty Images: Hulton Deutsch, Fred Ramage, Fox Photos)

Studies of children worldwide in other wars and conflicts, from South Central Asia to Rwanda to Ireland, corroborate that the dose is the poison. In other words, the degree or length of exposure to danger is strongly predictive of later disturbance.

This was true, too, for children who were alive at the time of the collapse of the Twin Towers in New York City on Sept 11, 2001. Representative studies of children and adolescents following the attacks showed that the greater the degree of direct or indirect exposure, the greater the symptoms of PTSD, anxiety, and separation anxiety, and of course children who experienced the loss of a family member suffered most. The proximity of children to the event when tragedy struck mattered. A study of 844 children showed that those who were below Canal Street when the towers collapsed, and witnessed the event or were out in the dust soon after, had more psychiatric and physical health disorders at ages 17-30. Those same children had four times the rates of both disorders co-occurring, compared to a control group of children who were across the bridge in Queens and only saw media coverage of the event.

But media coverage, too, is a kind of chronic exposure, albeit indirect. A study of middle school children who watched repeating loops of television coverage of the Oklahoma City bombings showed that they were more likely to have symptoms of PTSD seven weeks later (even though none of their families were harmed), compared to children who watched less television coverage.

Takeaway: Children with the most direct exposure to the pandemic—e.g., who lose a loved one or whose family is struggling with the disease, food shortages, or other deprivations—may be most at risk for psychological disturbances and should be prioritized for services and resources.
If possible, shield children, especially the youngest, from media exposure so that caregivers stay in control of the messages. Four- to six-year-olds can handle minimal, manageable facts about why their lives have changed. Teenagers can take in more information and are interested in understanding how the world works and their place in it. But even then, caution is warranted. It’s helpful to have a wise adult in the wings to talk about events and emotional responses, and extra care should be taken with sensitive or empathic teens, as they can become overwhelmed and anxious more easily. Staying constructive and action-oriented helps to mitigate the chances of depression and overwhelm.

Availability of loving caregivers

When uncertainty or danger strikes, children are “wired” to look to their caregivers to determine how safe they should feel. If their primary adult is calm, a child feels reassured. But if their adult is upset, the child feels unsafe, and their body and brain go into threat mode. And when the threat system is on too long without relief, physical and mental health problems can result.

The first documentation of the protective effect of a caring adult also came from observations of children during WWII. Anna Freud, daughter of Sigmund Freud, founded the Hampstead War Nurseries in England to care for children during the Blitz, the Nazi bombing campaign of the United Kingdom from 1940-41. Freud and her colleague Dorothy Burlingham documented their observations of children in their care in their book War and Children.

Though the children were not exposed to direct combat, they lived through repeated, unpredictable air raids throughout the day and night. Some children saw death up close, some were buried in debris, and many were injured. Freud and Burlingham found that, remarkably, when children were with their family members during these events, they rarely showed “traumatic shock.” They showed “little excitement and no undue disturbance. They slept and ate normally and played with whatever toys they had rescued.” The children seemed to equate their experience with just another childhood “accident,” like falling out of a tree or getting thrown off their bike. That the war “threatened their lives, disturbed their material comfort or cut their food rations” mattered little, according to Freud and Burlingham, as long as the children were with a trusted adult.[2]

But it became “a widely different matter” if a parent was killed or a child was separated from their parents. Children had a much harder time, for example, if they were evacuated for their safety to the countryside. Separation from parents was worse for children than enduring the bombings alongside their family, write Freud and Burlingham. This has been true in every war zone studied, from Rwanda to Bosnia and the West Bank to Syria. Studies show that if children lose the sense of safety anchored by a secure caregiver, the result is often an increase in PTSD, desensitization to violence, anxiety, depression, aggression, and/or antisocial behavior.

However, when the parent is present, their own emotional state matters. Freud and Burlingham write that most of the London population met the air raids with a “quiet manner,” so it was extremely rare to find children who were “shocked.” For example, they describe one Irish mother of eight whose windows were blown out in a bomb blast. When she showed up at the clinic, she said that they were “ever so lucky” because her husband was there and could fix the windows. Another mother brought her daughter in for a “cough and cold” but didn’t think to mention that they’d just escaped a bomb shelter destroyed in a fire. Due to the mother’s “lack of fear and excitement,” Freud and Burlingham write, the child “will not develop air-raid anxiety.” By contrast, they noticed that very anxious mothers had very anxious children. For example, one five year-old boy developed “extreme nervousness and bed wetting” when he had to get up in the night, get dressed, and hold his trembling mother’s hand.[3]

More recent research confirms that depression or anxiety in the primary caregiver is a significant risk factor for children’s psychological health. Anxious parents can overlook their children’s needs, and depressed parents usually under-respond to their children; either situation can lead to missed emotional cues and mental health problems in children.

Center on the Developing Child, Harvard University

On the other hand, when a supportive adult is present, the child can tolerate much more than if they were alone. Simply the presence of a calm adult can reduce the levels of cortisol, the stress hormone, in a child’s body. In fact, this supported exposure to manageable stress can even be “inoculating,” helping children to be more resilient, whereas complete avoidance of stress undermines the development of resilience.

The supportive adult figure doesn’t have to be a parent. Research shows that any non-parental figure in a caring capacity, including a neighbor, teacher, counselor coach, sibling, or cousin, etc., can be just as effective.

In addition to her study of children in WWII, Emmy Werner also conducted a 40-year longitudinal study on the Hawaiian island of Kauai to investigate the long-term effects of poverty and family dysfunction on children. She found that one of the strongest predictors of a child’s resilience was an emotional bond with an adult outside the immediate family.

This correlation was also found in a study of children in New Orleans who survived the flooding and aftermath of Hurricane Katrina. Children who fared the best seven years later were the ones who’d had the most supportive connections—family members, teachers, pastors, or shelter workers. By contrast, those who fared worst had lacked any constructive connections, and the ones who floundered marginally had had only one person as a solid anchor.

Werner also studied the records of pioneer families who travelled across deserts, mountains, and rivers in wagon parties. The Donner Party is perhaps the most tragic and well-known story of westward migration. A small band of 87 travelers took an ill-advised shortcut away from the Oregon Trail and onto a lesser known route around Salt Lake. The path eventually ended, and they had to cut through forests and brush to clear their way. The delay caused them to get trapped in the heavy Sierra snowfalls, unable to move for four months. As supplies dwindled, travelers resorted to eating their animal skin rugs and animals, and a few resorted to cannibalizing their deceased companions. Of the 41 children in the party, a third died, mostly infants and toddlers.

The ones who survived, according to Werner, had the strongest social supports from mothers, aunts, cousins, and a teacher who pooled what resources they had, maintaining whatever shreds of structure and normalcy they could muster. Werner details the particular significance of the sibling bond. Siblings shared food and drinks, nursed the sick and injured, and were confidants and supports to each other when the going got tough. The majority of children who survived went on to lead “long and productive lives,” becoming lawyers, ranchers, writers, prospectors, and heads of large families.[4]

Takeaway: Children are most resilient when they’re embedded in a network of social support: a parent, a caring parent figure, and/or siblings. Accounts like these suggest that the support that works for children doesn’t have to be overly-precious or hyper-conscious. Rather, practical, positive decency offered by ordinary people will suffice.
The message to parents who aren’t able to care for their own children because they’re essential workers—or are sick and quarantined away from their families—is that other committed adults can pinch-hit as caregivers just fine.
For stressed parents at home caring for children 24/7 and trying to work, too: Put on your oxygen mask first. Your self-care is essential. It’s a consuming challenge to bring your best self to this quarantine day after day, but your wellbeing is essential to you and your children. And rest assured, you don’t have to be perfect. Even in the healthiest relationships, parents are only “in-tune” with their children 30% of the time. What matters more is your flexibility to repair, to come back together, and perhaps to reunite at the end of a long day. Apologies, forgiveness, and self-compassion are key. Remember: the biggest lesson your children are learning from you is how to handle themselves in stressful situations.

Child characteristics

What about the characteristics of children? Do some kinds of children do better than others?

First, there is no “resiliency gene,” but difference in biological makeup does affect how children register and regulate stress. These foundations are created by genetic and epigenetic transmissions across generations and by childhood experiences, especially during sensitive periods. The physiology of the stress regulation system is established from the prenatal period, through the first three years of life, so the stress experienced during that time is very influential in shaping stress-sensitivity of a child’s system. However, research also shows that in puberty—a period of brain remodeling—a child’s stress physiology can be recalibrated for better or worse, depending on how much stress they’re experiencing.

About one in five children is more biologically “sensitive” to stress than others. Their “fight-or-flight” systems react more quickly, easily, and intensely to mild stressors. They can become more devastated in difficult conditions, even more susceptible to respiratory illnesses. But they bloom more brilliantly in favorable conditions—becoming the world’s artists, poets, inventors, and empaths.

The first wave of resiliency research presumed that children who were more easygoing and sociable (i.e., could enlist other people’s help), and “intelligent” did better. Newer research has refined those generalizations into more specific abilities.

Recent studies have pointed to certain kinds of cognitive and emotional skills related to resilience. Executive control involves the higher-order thought processes in the prefrontal cortex. These include self-management abilities like setting goals, devising a plan to accomplish the goal, problem-solving, flexibility, and monitoring progress along the way. Historical studies show that a family’s survival often depended on the contributions of children, and that the mastery and competence the children developed through these tasks served them well in their adult lives.

Emotion regulation is the process of monitoring feelings and using strategies to minimize unpleasant ones (down-regulation), increase pleasant ones (up-regulation), and maintain desirable ones in order to accomplish a goal. Positive strategies include reframing, acceptance, and finding a purpose. Drawing on children’s unique inner resources, like friendliness, musicality, humor, building, organizing, or creating can help keep their focus constructive. Unhelpful strategies include ruminating, numbing, escapism, venting, blaming, and disengaging; all of these lead to greater anxiety and poorer mental health outcomes in children.

Resiliency studies show that a combination of executive control and emotion regulation leads to the best outcomes and the lowest anxiety in children.

Takeaway: Some children may need a little more attention and support than others because of their age or their sensitivities. Pregnant women, infants, toddlers, preschoolers, and young teens need extra support and stress-buffering. It’s a good time to model, demonstrate, and teach executive control (e.g., through planning and completing projects) and emotional skills. Many professionals have suggested that during this time, traditional school lessons may be less important than social and emotional ones.

Prior vulnerability

Whatever the future effects of the pandemic on children and families, according to Jack Shonkoff, pediatrician and director of the Center for the Developing Child at Harvard, they will not be evenly distributed across families. Vulnerable families who already struggle with difficulties such as poverty, food insecurity, racism, immigration stress, and disabilities will experience more breakdowns like substance abuse, family violence, mental health problems, and later educational and employment challenges.

We’re already seeing news reports of faltering families. Divorce rates spiked in China following the peak of the pandemic, and early reports are signaling a similar trend in the U.S. The United Nations has reported a “horrifying” increase in domestic violence. As of this writing, calls to police and domestic violence hotlines are up 15-20% in New York; they’ve doubled in Lebanon and Malaysia, tripled in China, and increased 75% in Australia. Quarantined victims are trapped at home without access to teachers, counselors, or doctors who could support their emotional and physical safety. Part of the U.S. government relief package provides funding for shelters and hotlines. It seems that disasters that immediately threaten mortality like 9/11 or wars are less likely to spike family disturbance, but those that become chronic stressors like unemployment and the quarantine bring out the worst.

The disruption of education is a serious risk for vulnerable children. Educational consistency is a stabilizer for children in uncertain times, and teachers play critical roles in keeping disadvantaged children on track. Schools give structure and focus amidst disruption; many studies show that disasters interrupt children’s education, leading to unfulfilled lives, as well as a loss of human capital to society. UNESCO estimates that 91% of the world’s students are currently affected by school closures. While many schools are shifting to online education, the approaches are ad hoc and unstudied. Digital access is not available to everyone, though schools are struggling to provide students with internet hotspots. Some schools report that large numbers of students have “disappeared,” i.e., fewer than one half are engaging in online courses.

During the Great Depression, schools reduced their hours or closed. A million children lost access to school, and a quarter of a million children hit the road and rails, becoming “drifters” in search of work. For the first time, the federal government was spurred to take an interest in children’s well-being, because it was afraid that large numbers of disaffected youth could be susceptible to a rise of authoritarianism, similar to what was happening in Europe. The New Deal launched the first free school lunch program, free nursery schools, the first federally funded work-study programs, and the National Youth Administration and the Civilian Conservation Corps, which employed over seven million young people. The schools were funded to reopen, and Aid to Families with Dependent Children helped poor families. The government ended child labor and raised the mandatory school attendance age to 16 in order to eliminate having children compete with adults for jobs. The first safety net for children and families was cast, and the word “teenager” entered the vocabulary for the first time.

On the other end of the economic spectrum, affluent families that tend toward “overparenting” can be at risk for fostering anxiety, as they strive to perfectly recreate the school learning environment at home in order to keep up with standardized testing and the college admissions cycle. These families might benefit from broadening their definition of learning to focus on simply reading, problem-solving, communication, and social and emotional skills.

“When children are involved in things they’re really interested in, a project or an exploration, they will be learning. Everything around them is a learning experience. Parents should think about how to take advantage of that,” advises Linda Darling-Hammond, professor at Stanford University Graduate School of Education and CEO of the Learning Policy Institute.

Takeaway: Vulnerable and disadvantaged families, especially with multiple stressors, should have access to and seek help from mental health and legal services. Local schools and each states’ Department of Education list educational guidance and resources for students and families. Staying connected to education is especially critical for children with any kind of disadvantage, while families who tend toward overparenting may benefit from dialing down excessive traditional educational demands.

A higher calling

Many studies of resilience find that survivors who do well have philosophies or spiritual traditions through which they interpret events and derive hope and optimism. Ann Masten, professor at the Institute for Child Development at the University of Minnesota, is a noted theoretician in the study of children’s resilience. In her book, Ordinary Magic: Resilience in Development, she writes that many faith traditions—including Buddhism, Hinduism, Judaism, Christianity, and Islam—naturally incorporate all of the ingredients for resilience. They offer parenting guidance; identify moral conduct; provide role models, mentors, and community support; teach and practice self-regulation; and value the greater good. A connection to some definition of the divine and a philosophical framework help survivors make meaning of their experience and in the process, help them keep calm. Studies show that some homeless families in shelters persevere because of their faith. African American communities find connection, spiritual guidance and a coherent vision through their churches; and orphans in war-torn Sri Lanka find acceptance and peace through Buddhist and Christian practices of meditating, storytelling, and reading scripture.

Sometimes, cultural practices offer meaningful support. A study of 1000 Afghani adolescents showed that in prolonged periods of armed conflict, Afghani cultural values of faith, family unity, service, effort, morals, and honor shored up resilience. Werner’s longitudinal research in Kauai showed that many adults who eventually created happy lives drew from their cultural heritage, becoming involved in Hawaiian conservation efforts, going to the ocean in times of trouble, or caring for their elders.

Recent psychological work suggests that having a sense of purpose may be enough to get you through. Surviving, ensuring your child’s well-being, volunteering, keeping your job, or finding awe in the moment may just be enough for now.

Takeaway: A connection to something greater than ourselves—whether it’s a spiritual practice, cultural beliefs, or a sense of purpose—can help families and children orient their thoughts, feelings, and actions. Participating in a larger flow can feel supportive and calming. Children, even very young ones, enjoy and benefit from these kinds of feelings and experiences.

* * * * *

Children are neither inherently resilient nor vulnerable. Instead, their well-being arises out of who they are as individuals together with the cascades of experiences they have. Some children may luck into a combination of resources that set them on a good path early on. But even for children who don’t do well initially, studies of the life course show that many can still find happiness later in life from a new opportunity, education, a good relationship, or a fulfilling career.[5]

For now, the world is in a difficult state of uncertainty. We don’t know how long we’ll be sheltering in place, the course of the virus, or what kind of “normal” life we will return to. But the enduring lessons for our children will surely be the emotional ones. These are the lessons they will remember as adults when they inevitably experience upheaval again—only then, it may be without us. So let’s stay focused on, and grateful for, what really matters.

Our Teens Are More Stressed Than Ever: Why, and What Can You Do About It?

May 9, 2019

Every time a new disheartening statistic is released on teen mental health, I cringe. For the past seven years there’s been a downward trend in the state of their emotional well-being, and I’m waiting—hoping—for an upswing.

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American Psychological Association (2018)

The American Psychological Association (APA) periodically surveys for stress in the American public, and since 2013, teens have reported higher levels of stress than adults. In the 2018 APA survey, teens reported worse mental health and higher levels of anxiety and depression than all other age groups.

These finding are consistent with other surveys, and I have yet to see data that counters that trend. A 2019 analysis by Jean Twenge, author of iGen and psychology professor at San Diego State University, showed that between 2005 and 2017, teens and young adults experienced a significant rise in serious psychological distress, major depression, and suicide. And a 2018 American College Health Association survey of more than 26,000 college students found that approximately 40-60% reported significant episodes of anxiety or depression during the year—an increase of about 10% from the same survey conducted in 2013.

Why is there a steady increase in teen distress, when the period of adolescence (as developmental scientists have discovered) is not inherently characterized by “storm and stress?” Adolescence is a period of transformation, not mental illness. So what’s the problem—and what can we do about it?

The popular bogeyman

The most popular focus of blame for teen stress is social media. Is there a connection? On the one hand, it’s certainly obvious that teens (just like the rest of us) spend hours every day staring at screens. And, adolescents are especially sensitive to the social comparisons that result from seeing carefully curated, idealized bodies and lifestyles online. At a panel[i] I recently attended in Berkeley, CA, one eighteen-year-old woman said that she regretted losing so much time in her childhood to wishing that her body looked different. She had come to the conclusion that Instagram and Snapchat “encourage us to live from the outside in, instead of from the inside out.”

In the APA survey on teen stress, one third to one half of teen respondents reported that social media made them feel judged or bad about themselves. In her book iGen, Twenge analyzed large survey data sets and found a correlation between the rise of the smart phone in 2012 and the rise of mental health problems among teens. Her further analyses uncovered similar correlations, explicitly linking more time on new media with more mental health problems for teens in grades 8-12. Conversely, more time spent in in-person interactions (along with sports, homework, religious activity, or print media) correlated with fewer mental health problems.

So, yes, there’s some evidence to support that social media may harm kids. But the situation is complicated. Science and culture zig and zag while scientists test and correct each other’s conclusions, and the correlations between screen use and mental illness have been roundly criticized. One social scientist tweeted that data also shows that “teen pregnancy, drug use, and delinquency all declined significantly with the rise of smartphone and social media use.” In other words, correlation is not causation. It simply means that two things just co-occurred.

A prospective longitudinal study which assesses people over time, sorts out causality better. One such Canadian study surveyed nearly 1,700 teenagers at several points in time up to a six-year period. It showed that social media use did not lead to depression, either in girls or boys. However, the reverse was true: Depression in middle school girls (though not boys) at the beginning of the study predicted greater social media use two years later. In other words, heavy social media use may be a sign for concern, not because it causes distress in the first place, but because it may be a symptom pointing to underlying distress. And middle schoolers may be most at risk.

The longer social media is around, the better youth and families are becoming at managing it. The APA survey on teen stress showed that individual teens use social media in different ways, and it’s worth noting that 55% of teens consider it a source of social support. Parents and teens are also getting better at understanding how social media “hacks” the brain (how the reward algorithms are coded to be maximally addicting). This is especially true in a developing brain, when the reward circuitry and dopamine architecture that “lock in” responses to pleasure are remodeled. As a result, many parents are limiting teen social media use, and numerous guidelines[ii] for wise strategies are now available. Social media “hygiene” is something we should all practice.

Are teens the canaries in the coal mine?

Teens take in more of the outside world than children do. Neurological changes occur in puberty that draw their attention outward, beyond the family, and their cognition allows them to ponder big issues in more abstract and sophisticated ways. Because they take in more and more of the outside world, what teens absorb is increasingly stressful. And high schools reinforce that expanding view with curricula on current social events. Yet teenagers have no prior experience and few strategies for dealing with this new level of exposure.

More than two thirds of adults and teens surveyed by the APA said that the future of the country caused them significant stress and that the U.S. is on the “wrong path.” Teens had additional concerns: 75% of them were stressed about gun violence, mass shootings, and school shootings. This is not surprising given that 288 shootings have occurred in the U.S. since 2009, 57 times the rate of all other developed nations combined. More teens than adults feel stressed by societal issues like rising suicide rates, climate change, immigration separation and deportation issues, and sexual harassment and assault. More teens than adults worry about work, money, and health alongside more age-relevant issues like bullying, peer conflict, gender identity, and sexual orientation.

Stress and adolescence can make for a perfect storm. Until recently, scientists believed that an individual’s baseline for stress reactivity was more or less set in the first two years of life. However, new research suggests that puberty might open that window of sensitivity again for a second chance at recalibrating the stress system—for better or for worse depending on the context: If the environment is supportive in adolescence, this second opportunity might smooth out earlier problems and improve coping in the long run. However, if the context is harsh and stressful without relief or repair, the stress system can remodel for vulnerability and set the stage for later mental and physical health disease systems.

Policymakers should be worried about rising teen stress, not only for the sake of teens’ psychological health (which should be enough cause), but for the health of the country. Teen stress might be an important warning that the nation is off-course. As influential developmental scientist Urie Bronfenbrenner said, “There is no more critical indicator of the future of a society than the character, competence, and integrity of its youth.”[iii] Put more bluntly: If we squander our human capital now, we can’t expect a robust society in the future.

Much of the responsibility for decreasing the stressors listed above is in the hands of policymakers—and ultimately in our hands as voters and citizens. But political and social change take time, and teens and parents are still left to cope. So what might be helpful?

First, remember that every teen is different. Some may find relief, empowerment, and community by actively engaging in planning and organizing around social, political, and environmental issues. Other teens may need to modulate or decrease their exposure to stressful news for self-protection.

Photo by Andrew Lichtenstein:Corbis via Getty Images

Teens benefit from, and want, relationships in which their understanding of the world and their place in it can be co-constructed in a healthy way. A mentoring relationship or facilitated group can help teens process their growing awareness with like-minded people while balancing it with a focus on healthy development. In such a setting, the skills for mastery and sense of control can gradually emerge at a developmentally appropriate pace that teens can manage.

Parents might be mindful of buffering their own stress from their teens. True, the parental brain has evolved to scan the environment for threats. But if parents pass on their stress, children can become overly stress-reactive, vigilant, and stress-sensitive. On the other hand, passing on constructive coping strategies is helpful.
Building emotional intelligence skills is always important, too. Every teen will benefit from a) the ability to be aware of their feelings and b) having strategies for regulation. As one woman on the Berkeley teen panel said about meditation, “It’s real. You should try it.”
And finally, a warm family climate and what I like to call a “competing joy” is always a good antidote to stress.

Resurrecting an old theory: Healthy identity development

A third possibility is that society has forgotten about an important developmental task of adolescence.

In the 1960s, while the Baby Boomer generation was famously transforming society, the lifespan psychoanalyst Erik Erikson wrote his groundbreaking work, Identity, Youth, and Crisis, about identity in adolescence.[iv]

Identity is how you walk in the world. It’s a sense of knowing who you are, what you believe, where you fit, and where you’re going. It includes being at home in your body, having personal agency, and feeling a sameness through time, all of which contribute to a general sense of well-being. According to Erikson, and the major developmental scientists who followed, finding a healthy identity is the central task of adolescence.

It takes time. Young children identify with their parents: they imitate them and believe that they’ll grow up to be like them. But with the onset of puberty, neurological and social forces propel teens to differentiate from their parents. (Differentiation is not a rejection of parents, but a reconfiguration of the relationship in order to accommodate a teen’s growing autonomy and independence of thought and action. It’s a necessary process that teens need to go through to become functioning, autonomous adults.)

But teens struggle with their identity and with the core question that adolescence invites them to answer: If I’m not my parent, who am I?

There are multiple paths by which teens find their identities. Whichever they take, Erikson believed that the establishment of a coherent sense of identity requires a period of moratorium—a timeout during which a teen is clearly not a child but the adult path has not been determined. It’s a time to discover and experiment with different roles, paths, ideas, and activities. When a teen quickly changes points of view, jobs, friend groups, pop culture preferences, hair color, and more, this process is likely at work.

The psychologist Jeffrey Arnett, who named the later period of emerging adulthood, said that the central themes to be settled in establishing a healthy identity are worldview, work, and love. The psychologist James Coté believes that identity rests on two things: first, the feeling of having matured into adulthood, and second, finding a permanent niche in community and lifestyle. But exploration can occur across many domains, including politics, religion, societal issues, relationships, recreation, appearance, competence, occupation, morality, ethnicity, sexuality, and intimacy. The process can last a decade or more—usually only one or two areas can be tackled at a time—but it culminates in commitments to those dimensions, a greater sense of purpose, a coherent system of values, and long-term plans. Identity formation—or coming of age—is a central theme of many classic and best-selling novels including The Catcher in the Rye, The Fault in Our Stars, The House on Mango Street, and Jane Eyre.

An authentic identity exploration is hard, intellectually and emotionally taxing. Uncertainty can be uncomfortable, and progress is not linear or orderly. There are anxious periods of not knowing where to fit. Dead ends are common. And progress feels unstable, sometimes sliding back after taking a step forward. It can be difficult for parents to stay supportive as their teens bang around in the mess of options. But identity exploration is most successful when it’s encouraged and accepted by an adult, where the teen feels seen, where their feelings and perceptions can be accurately mirrored back to them, and where they can borrow the confidence, optimism, insight—and sometimes limits—from a loving adult.

According to Erikson, teens should grow into an adult identity, not be forced into one prematurely. But not everyone has that privilege. Some teens are restricted by life circumstances, a lack of options, and/or economic necessity. Others are restricted by self-imposed constraints, or limits others place on them. Erikson said these forced choices do not necessarily lead to a failure of identity: young adults can still organize meaning and purpose out of the circumstance, while still exploring other areas. But he did believe that the lost potential was “regrettable.” Without an authentic search, a teen might not get the chance to discover their true capabilities.

When teens don’t get a chance to explore the central questions of their lives, there can be several problematic outcomes:

A foreclosed identity results from a premature commitment to a path without sufficient exploration or experimentation. This could be the child whose “tiger” mother decided for her in fourth grade that she would be a dancer; the son whose parents forced myriad activities on him in order to build a college resume; or, conversely the child who grew up without any mentor, guide, or exposure to opportunities.

For youth who lack a wide range of opportunities, middle and high schools can offer much-needed exploration and experimentation. In her book, When Grit Isn’t Enough, Linda Nathan argues that career exploration and support should be systematically incorporated into educational curricula from middle school through graduation and across the transition to college.

In their book, Talented Teenagers: The Roots of Success and Failure, authors Mihaly Csikszentmihalyi, Kevin Rathunde, and Samuel Whalen identify the qualities that sustain the development of talent across teen years. Along with a modicum of talent and wholistic support, free time was an important variable. Teens who were distracted with too many life hassles, family conflicts, excessive out-of-school employment, or over-scheduling, did not have the unencumbered time and space that was necessary to just “mess around” in the subject area, to dream, practice, and experiment. Exploring what you’re good at and what you enjoy takes sheer time.

Today, in the drive to raise their selectivity ratings and drive a vast lucrative network of feeder businesses, the college industrial complex colludes to torque teens’ developmental trajectory. Teens (and their parents) often sense a pressure to be a certain kind of idealized applicant, and they’re tempted to shape their high school experiences to fit someone else’s idea of who they ought to be in order to be accepted into college.

Psychologist Robert Sternberg is a forceful critic of college admissions practices. He argues that college acceptance criteria are not correlated with either college achievement or life success. Instead, the types of competencies that predict actual success are: 1) creativity and the ability to see things differently or defy a current trend; 2) wisdom and the application of knowledge and skills for the common good; and 3) practical intelligence and the ability to cope with a situation that’s not explicitly taught, along with more conventional and domain-specific kinds of intelligences.

A diffused identity is one that is never quite settled, in which exploration and experimentation never seem to end. The identity feels incoherent and disjointed, and the individual seems confused about, or just unaware of, who they really are. They’re often more neurotic, have difficulty making decisions, and suffer extreme self-consciousness.
A negative identity is an undesirable one, chosen in opposition to, or defiance of, surrounding pressure. This might be the “bad boy/girl,” the extremist, and the anything-my-father-isn’t person. Erikson observed that a negative identity often arises from a lack of recognition or acceptance from the important person in the teen’s life. In those cases, being somebody “bad” feels better than being nobody at all.

Based on J. Marcia (1980). Identity in adolescence. In J. Adelson (Ed.), Handbook of adolescent psychology. New York: Wiley. — Based on J. Marcia (1980). Identity in adolescence. In J. Adelson (Ed.), *Handbook of adolescent psychology.* New York: Wiley.

What else is protective against stress?

Some stress is good.

Some parents might overcorrect and try to protect their children from any stress at all. Scientists worry about this kind of experience, too! Parents who “snowplow” or “lawn-mow” away their children’s obstacles do them no favors, in fact, they may be undermining their children’s development. Stress in the right amount promotes neural growth, enhances task performance, and can be a motivation to stretch, reach, and strive.

When young people have a chance to master a new challenge, it can contribute to their resilience, i.e., their ability to withstand and recover from future stresses. Their challenges should be reasonably within their developmental competence; not overwhelming; and “scaffolded” if necessary, where they’re coached through the components. After the challenge has passed, rest and repair also help.

Mind the basics—sleep, exercise, nutrition.

Teens need more sleep than adults, and they need it later on the clock. A recent survey found that teens are shortchanged by an average of two hours of sleep per night, which adds up to a devastating deficit. Sleep is critical to all areas of functioning. It’s necessary for cognition and consolidating memories, especially in the adolescent period of rapid brain growth. When schools adopt later start times to accommodate teens’ unique sleep needs, the benefits are vast—better mood regulation; improved academic performance; and fewer incidents of conflicts, aggression, bullying, and accidents. Teens, like everyone, should follow good sleep hygiene, including screen-time management. Healthy nutrition and regular aerobic exercise also help keep an even keel.

An authoritative parenting style is extremely protective.

Authoritative parenting balances warmth and love with clear expectations and the support to meet those expectations. It’s flexible, respectful, and allows a teen’s growing autonomy. Of all parenting styles, authoritative parenting is the most predictive of positive outcomes for children and teens.

Other family qualities that help keep teens on track include a positive climate that creates a background sense of well-being, joyful ways of staying connected, and regular routines and rituals. In other words, a thriving family life is nourishing, provides a buffer, and supports resilience. Parents’ own development matters, too; how parents manage their own stress is extremely influential for teens. The template of family life gets imprinted on a teen and stays with them for a very long time.

Photo credits: D. Divecha, Unknown, D. Divecha, S. Burkhart, M. Divecha, R. Archibald

Keep growing the skills of emotional intelligence.

In the APA study of stress, three-quarters of the teens surveyed said they wanted more emotional support. One powerful strategy is to teach them to recognize feelings when they’re happening and help generate constructive strategies (not avoidance and distraction) to regulate them. The more families can name and normalize emotions and emotional competence, the more successfully teens develop.

Save time for friends and relationships.

Good relationships are essential to mental health and well-being. The presence of a caring person can buffer the cortisol response. In the presence of a friend, challenges feel easier to navigate. Unfortunately, teen boys are at risk for giving up their good friends, which can lead to sadness and grief, in addition to an absence of support.

Whatever the cause of adolescent stress, it falls to parents, educators, and mentors to help teens move through it. Developmental science, practical sense, and even traditional wisdom can all help.

When my own daughter (whose father is Indian-American) became a teenager, we marked the new road ahead with a Hindu coming-of-age ceremony. Sitting in the circle of our community and facing my daughter, the pundit reminded her of two things: first, to stay connected to her family, and second, to develop her powers of discernment.

Discernment, the pundit said, is the ability to parse what is true and right from what is not, and it’s one of the most important intellectual qualities. It requires recognizing the difference between what matters to you and what is coming toward you from the world. From that space, wisdom springs.

I’ve enjoyed watching my daughter develop discernment—and use it—as she has formed her identity, choosing a partner, a career, and a new city to live and thrive in. As other parents of grown children can attest, when our teenagers explore their way into the world and land comfortably in a solid identity, it’s a joy for everyone. Nowadays, though, they may just need some extra care doing that.

[i] Teen Wisdom Panel, April 26, 2019, David Brower Center, Berkeley, CA.

[ii] Common Sense Media; Cyberbullying Research Center

[iii] Bronfenbrenner, U. (1996). The State of Americans: This Generation and the Next. New York, NY: Simon and Schuster, p. 1.

Can a Pregnant Woman’s Experience Influence Her Baby’s Temperament?

October 8, 2018

Thirty years ago, when my Indian mother-in-law first learned that I was pregnant, she had some advice: Eat a lot of ghee (clarified butter), think pleasant thoughts, and gaze upon beauty.

Charming, I thought. I had a full time job with a two-hour commute. Where was there any time for meditative reflection? Still, she planted a thought in my mind, and I began to wonder. Was there a connection between my internal state and the development of the baby growing within me?

Folk wisdom and cultural beliefs throughout history have maintained that a woman’s emotions affect the fetus. Animal studies have shown that maternal stress, especially, can affect offspring—but it’s not been clear exactly how relevant those findings are for humans. In the last 15 years, though, research on human mothers and babies has caught up to show that my mother-in-law was at least partly correct: A pregnant woman’s emotional state—especially her stress, anxiety, and depression—can change her child’s development with long-lasting consequences.

Yerkes and Dodson, 1908, in Diamond, DM et al. (2007).

Some stress is good.

When it comes to stress, psychologists often affirm the Goldilocks approach: too little is not good, as it makes us passive. And too much is not good because it can overwhelm us and contribute to emotional upheaval and physical disease. Along the spectrum, there’s a “just-right” amount of stress that helps us to function optimally in most situations.

The Goldilocks principle (called the Yerkes-Dodson law, in psychology) seems to be true in pregnancy, too. “The human brain requires sufficient, but not overwhelming, stress to promote optimal neural development both before and after birth,” writes researcher Janet DiPietro of Johns Hopkins University.

Pietro and colleagues studied pregnant women who were mentally healthy, well-educated, and had low-risk pregnancies. Midway through the pregnancies, Pietro measured the level of the mothers’ psychological distress (stress, anxiety, or depression). After the babies were born, she tested their development at six weeks and then again at the two-year point. She found that babies whose mothers had mild-to-moderate distress were more advanced in their physical and mental development. Another study showed that the babies’ brain development benefitted from a little prenatal stress, maturing a bit faster, with quicker connectivity among neurons.

Does that mean that women should welcome stress in order to boost their fetus’ development?

Absolutely not. According to DiPietro, the normal stresses of modern life are enough already. “The last thing a new mom needs is to head into newborn baby care stressed and exhausted.” In other words, healthy women leading reasonably normal lives can “stop worrying about worrying.”

But too much stress can be harmful.

On the other hand, when women experience severe stress during pregnancy, their babies can be at risk for serious problems. What kinds of stresses are harmful?

In studies on pregnant women, intense stress has been defined to include the following: the loss of a loved one; war; a major catastrophe like an earthquake, flood, fire, or terrorist attack; and interpersonal violence. These stresses have been linked to subsequent miscarriage, prematurity, or low birth weight in infants.[1] Stress that is chronic—like poverty, homelessness, racism, and discrimination—can also lead to low birth weight, as well as later physical and psychological problems. Babies whose mothers experienced these kinds of toxic levels of stress while pregnant are statistically more likely to have respiratory and digestive problems, irritability, or sleep problems in the first three years of life. They are also more apt to experience developmental problems, with cognitive, behavioral, social-emotional, and health issues that suggest neurodevelopmental changes that ripple into adolescence and adulthood. Many of the studies were careful to rule out other potentially confounding environmental factors in order to isolate the effects to the prenatal environment.

A woman who experiences depression is also cause for concern. Newborns of mothers who were depressed during pregnancy are four times more likely to have a low birth weight than babies born to mothers who are not depressed. When women are depressed during pregnancy, there’s also a greater likelihood that they’ll suffer postpartum depression, which can become a major challenge for the whole family. Not only does the mother suffer, but research shows that depression in the primary caregiver is one of the strongest predictors of poor developmental outcomes in children. These children simply do not receive the normal interpersonal attunement and feedback they need in order to grow in emotionally healthy ways.

Even anxiety about being pregnant can be cause for concern. Research shows that “pregnancy-related fears”—worrying about an unplanned pregnancy, a specific medical risk, the fetus’ health, labor and delivery, or your ability to be a good parent—can be problematic in high doses. Excessive levels of anxiety (as opposed to what you worry about) are correlated with a greater likelihood of having a preterm birth. Also, pregnant women’s high levels of anxiety are correlated with later problems in children, including a difficult temperament, behavioral and emotional problems, anxiety, problems with attention regulation, impulsivity and hyperactivity, immune functioning and autoimmune disease, cognitive problems, and stress regulation.

Fetal stress and infant temperament

Psychologists have long known that babies enter the world with different temperaments. Some babies seem easy and sociable; others are more reactive, difficult to soothe, and are more sensitive to their environment. Until recently, scientists thought babies were “just born that way,” with temperaments that were “constitutional,” part of their makeup, or “inherited” from parents.

But the new research on fetal development changes that notion, and our understanding has progressed toward an interplay between biology and environmental influences—even before birth.

Catherine Monk, Professor of Medical Psychology in Psychiatry and Obstetrics and Gynecology at Columbia University Irving Medical Center, and her colleagues study the long reach of prenatal influences, especially among women who suffer from depression, stress, and anxiety. They found that some fetuses register mothers’ stress, and that fetal reactivity correlates with infant temperament at four months.

Monk and her colleagues brought 50 pregnant women into the lab and monitored the fetal heart rate while the women completed the Stroop Test, a mildly stressful mental task. Fetuses of women who were clinically depressed or anxious showed they registered the performance stress of their mothers, by the changes in their heart rates during the task. Later, when the babies were four months old, researchers assessed their temperaments by watching how reactive they were to a range of new stimuli (sounds, sights, smells), and some important patterns emerged. In particular, fetuses who had greater heart rate changes during their mothers’ task were more likely to be highly reactive at four months of age.

Subsequent studies have shown while the heart’s reaction to stress is important, the recovery from the stressor—how soon the heart returns to baseline—is also predictive. A quicker heart-rate recovery in the fetal period predicts an easier temperament and even more prosocial behavior later in childhood.

The fetus’ response to stress and the ability to return to baseline, may be the earliest sign of a fetus’ emerging stress regulation system, which in turn is the foundation of temperament (reactivity and regulation). The stress regulation system involves complex processes throughout the brain and body, and its effects cascade through complicated pathways into all the other areas of development. In infancy, the stress regulation system affects babies’ ability to form an attachment with others, to explore and learn about their world, and to receive feedback from others that helps them grow. It also affects their health and immune systems. Even for adults, scientists find that over the entire lifespan, the ability to manage the ups and downs of our interior worlds—stress, emotions, energetic “arousal,” and positivity—affects our physical and mental health, relationship quality, decision-making, and even creativity. Some studies assert that stress regulation has consequences for education, employment, and overall life satisfaction.

But a baby isn’t born with a thermostat set to some ideal of normal. In utero, the fetus is programmed to listen for cues about their future environment and start adapting accordingly.

“Theoretically, it’s an elegant evolutionary adaptation,” Monk told me in a recent interview. “The pregnant female communicates to her offspring cues about what the postnatal world is like, and the adaptation starts in utero.” But problems arise when the fit between the stone-age brain and the modern world is misaligned. “It could be advantageous to be reactive and vigilant if you’re in a dangerous postnatal environment,” Monk explains. “But we’re not facing bears in the woods now, so maybe the system for prenatal adaptations made to anticipate adverse environments (the environments that are eliciting stress and anxiety in pregnant women) aren’t adaptive for our modern world.”

The stress regulation system operates much like a thermostat that sets the room temperature, increasing the heat or turning it down to achieve a desired range. When we perceive a threat, the sympathetic nervous system activates a fight-flight-or-freeze response throughout the body and brain. When we judge that the threat has subsided, the parasympathetic system turns on to try to bring the whole system back to a resting state.

Because the biological “hardware” is just forming during the fetal period and early infancy, these are crucial times for setting the stress baseline in each fetus and young baby.

How do mother’s feelings get through to the fetus?

Scientists are curious about how stress reaches a developing fetus. This research is just in its early stages, and much more needs to be learned. But so far, scientists are focusing on a few mechanisms which may operate together or independently:

One is cortisol, a stress hormone that’s a downstream product of the body’s stress response. Women with anxiety and depression have higher levels of cortisol. And there is some evidence that when the placenta registers higher levels of cortisol from the mother, it creates an epigenetic change—a molecular modification to the gene that changes how it functions—that allows more cortisol through to the growing fetus, which in turn affects the stress regulation system.

“The placenta is highly susceptible to maternal distress and a target of epigenetic dysregulation,” Monk and colleagues write.

Inflammation is another focus of investigation. The pro-inflammatory cytokines—proteins that impact the behavior of cells and resulting immunity—may play a role, but the research on the exact pathways involved is still in the early stages.
Scientists are also looking at the role of infection and the microbiome, but there is no conclusive evidence at this time.

There are other complications, too. For example, one gestational period doesn’t seem more sensitive than another, but the impact of stress might vary depending on which areas of the brain are developing when the stress occurs. And while both sexes are affected, there are hints that male and female fetuses might react differently. For example, some research shows that female fetuses are more reactive to stress in utero, but other studies suggest males and females react similarly, but that males recover more quickly.

How much control do pregnant women have?

It should be obvious that almost every source of major stress—war, the loss of a loved one, violence, poverty, homelessness, a demanding workload, etc.—is outside the control of the woman experiencing it. But given that we live in a culture that frequently blames mothers for whatever happens to their children, I was concerned that this new research might be wielded against women.

“Could this research be used as a new form of mother-blaming?” I asked Monk.

“I think about this a lot,” she replied. “I don’t want my research to be adding stress to a woman’s life.”

Monk pointed out several caveats to the findings:

First, she cautioned that the research is just beginning, and we have to consider that these are correlations, not cause-and-effect. The associations have been shown repeatedly by different researchers, but it is not possible to complete a scientifically controlled study of intense stress on humans that would sort that out.

Second, Monk explained that a pregnant woman’s stress is just one of many “exposures.” There are numerous biological and environmental influences on development: The air a woman breathes, the water she drinks, the nutrition she ingests, and whether she exercises, gets sick, or is exposed to toxins. There are genetics. The father’s sperm quality matters, too, and is affected by his age, health and risk factors, and even frequency of physical exercise. Support from partners, families, and friends is important in mitigating stress.

Third, we should care for pregnant women more preventatively. “If we want to have a healthy population, a healthy workforce, then society is responsible,” Monk says. “So let’s take care of women and families early on with policies and programs that support them.”

Fourth, some stress is modifiable. “I see homeless women living in shelters, and I see busy medical doctors juggling family life with their practices,” says Monk. “One person can’t move the level of poverty in the country, but we can do something to help people cope with it. We really do know how to de-stress people and help them with depression and anxiety.”

And finally, stress hardware isn’t completely formed by birth. Once born, the quality of early caregiving continues to alter the epigenome that regulates stress, emotions, and behavior, dialing up or down the expression of genes that set the baseline for stress regulation. In many cases, good caregiving after birth can offset a rocky prenatal start.

How much stress is too much?

“How can women know if their stress levels are harmful or normal?” I asked Monk. “Are some kinds of stress worse than others?”

She replied, “Science is not at a place yet of saying that one kind of stress is worse than another. In our clinic, we see women in extreme stress, and what matters is how much, and what inner and outer resources they can bring to the experience.”

Monk listed some indicators of harmful stress:

When stressful feelings are chronic (symptoms might include an inability to get up in the morning, a continual low mood, not eating or sleeping)
When there’s prior exposure to trauma or abuse (which the anticipation of parenting might reactivate)
When a person’s life foundation is weakened by repetitive daily stresses (e.g., “Will I lose my job?” “Where’s my next meal coming from?” “Are we getting a divorce?”)
Or continual feelings of being overwhelmed

In addition, Monk and her colleagues use the Perceived Stress Scale to measure stress in their research subjects. They found that women in poorer mental health (comprising about 20% of their samples) score around a 26 or less on the scale. Items such as “I feel like I don’t have control,” “I often feel overwhelmed,” and “I feel like I can’t get things done,” are indicative.

Monk adds, though, that fewer psychologists are trying to measure a person’s amount of stress, and instead are looking at how they function across different areas of their lives. For example, a person might ask, “How am I functioning now compared to six months ago?” Or, “How am I functioning cognitively, physically, interpersonally, or emotionally?” This approach offers more useful information, Monk notes, allowing the person to leverage what is going well and to shore up what is not.

What helps?

Every person has unique vulnerabilities and strengths, and every situation is different. But research confirms that although we might not be able to control what happens to us, we have some control over how we react. And that matters. We can change our responses to stress through self-care (nutrition, sleep, and moderate physical activity); increasing our repertoire of emotion strategies for coping; having positive experiences; and seeking support from others. A strong support network of engaged partners, helpful family members, and good friends can buffer the ill effects of stress. Techniques like meditation and mindfulness have been shown to reduce stress and create better pregnancy outcomes and physical health.

As an example, Monk and her colleague Elizabeth Werner developed a four-session intervention that reduces the risk of depression in pregnant women by half. The PREPP program (Practical Resources for Effective Postpartum Parenting) reaches out to women through OB-GYN offices, and offers them education on three topics:

Parenting skills (e.g., How to help babies sort out day-night cues; encouragement for carrying the baby when he’s not crying, etc.)
Psychoeducation (e.g., What to expect about babies’ crying); and
Mindfulness and self-reflection (e.g., Examining how you were parented)

This intervention reduced depression and anxiety in mothers, and their babies became better self-regulated as well.

“By learning more about handling their baby, a mother may literally be facilitating their baby’s regulation along with their own. Mothers and babies get onto a bidirectional, more positive cycle,” Monk says.

As for me, since this knowledge wasn’t around to confirm my mother-in-law’s advice during my pregnancies, I hedged my bets. I knew I carried high levels of stress from a turbulent childhood, so I took some extra care. I exercised, was thoughtful about my food, and took a prenatal yoga and meditation course. But by the second pregnancy, I was frequently overwhelmed with panic attacks at the prospect of managing work and two children. Already my energy was low, and I filled in with chocolate milkshakes when I should have rested. Fortunately, both daughters did fine in the long run and are well-adjusted adults. But many women face graver challenges, and as a society, it’s our responsibility to protect and support them. Many countries have made children a collective investment, but in America, tragically, we haven’t. It’s a big problem—and a big topic, which I’ll save for a future blog entry.

More Resources

How pregnant women’s emotions affect prenatal and child development:

Origins: How the Nine Months Before Birth Shape the Rest of Our Lives, by Annie Murphy Paul.
Catherine Monk’s videos on prenatal stress here.
Newsletter from Janet DiPietro’s lab.

Stress reduction in pregnancy:

Newman, K. M. (2016, August 17). “Four Reasons to Practice Mindfulness During Pregnancy,” Greater Good Magazine. Retrieved from https://greatergood.berkeley.edu/article/item/four_reasons_to_practice_mindfulness_during_pregnancy.
Bardacke, N. (2012). Mindful Birthing: Training the Mind, Body, and Heart for Childbirth and Beyond. New York, NY: HarperOne.
Mindful Birthing Network: Mindful birthing. (n.d.). Retrieved from http://www.mindfulbirthing.org/.
Hardwiring happiness: Zimmer, E. (2015, June 24). 082: Dr. Rick Hanson. The one you feed. Retrieved from http://www.oneyoufeed.net/rick-hanson/.
Introduction to mindfulness-based stress reduction:
- Palouse Mindfulness. (2015, August 28). Mindfulness-Based Stress Reduction (UMass Medical School, Center for Mindfulness). Retrieved from https://www.youtube.com/watch?v=0TA7P-iCCcY.
- Sega, A. (2016, August 22). Jon Kabat Zinn: Practical Stress Reduction. Retrieved from https://www.youtube.com/watch?v=3fjNPbErciU.
- Kabat-Zinn, J. (2016). Mindfulness for Beginners: Reclaiming the Present Moment and Your Life. Boulder, CO: Sound True.
This is one of my favorite resources for self-development:
- Hanson, R. (n.d.). Rick Hanson. Retrieved from http://www.rickhanson.net/rick-hanson/

How to find out about, and advocate for paid leave from work:

Find out if your state has paid family and medical leave protection here:
- National Partnership for Women and Families. (n.d.). Paid leave means a stronger nation. Retrieved from http://www.nationalpartnership.org/issues/work-family/paid-leave-means-map.html.
Quick economic statistics re: the costs to both employers and employees of NOT having paid leave: https://drive.google.com/file/d/1geQNdDBd2MDBvzvOMJg_YKdfVqSsduWZ/view.
Companies that offer paid leave, and their rationales for doing it:
- National Partnership for Women and Families (2018, January). Companies with new or expanded paid leave policies (2015-2018). Retrieved from http://www.nationalpartnership.org/research-library/work-family/paid-leave/new-and-expanded-employer-paid-family-leave-policies.pdf
An article on how businesses can adopt paid leave:
- Williams, J. C., & Massinger, K. (2015, November 23). “Need a Good Parental Leave Policy? Here It Is.” Harvard Business Review. https://hbr.org/2015/11/need-a-good-parental-leave-policy-here-it-is.
How to negotiate a leave, from the Harvard Business Review:
- Gallo, A. (2012, October 25). “How to Negotiate Your Parental Leave,” Harvard Business Review. Retrieved from https://hbr.org/2012/10/how-to-negotiate-your-parental-leave.html.
The effects of paid leave on child health and employee retention:
- National Partnership for Women and Families. (n.d.). Studies on the Effects of Paid Leave. Retrieved from http://go.nationalpartnership.org/site/PageServer?pagename=issues_work_library_paidleave_research#effect

Reference

Yerkes and Dodson, 1908, in Diamond, D.M., Campbell, A.M., Park, C.R., Halonen, J., & Zoladz, P.R. (2007). The temporal dynamics model of emotional memory processing: A synthesis on the Neurobiological basis of stress-induced amnesia, flashbulb and traumatic memories, and the Yerkes-Dodson law. Neural Plasticity, article ID 60803, 33pgs. doi:10.1155/2007/60803

Footnote

[1] Low birth weight, sometimes referred to as “small for gestational age,” occurs when the weight at birth is lower than expected for the length of the pregnancy. It is a risk factor for subsequent development. The U.S. has the one of the highest rates of babies born with low birth weight—about 1 in 13. Babies who are born very small for their gestational age are more likely to go on to develop problems, but most low-birth-weight babies who receive good nutrition and sensitive, affectionate care and stimulation, catch up and do just fine.

Additional Photo Credits

Top panel, left to right: MaxRiesgo, RapidEye, vm, DragonImages

Middle panel, left to right: FatCamera, photominus, Dean Mitchell, martinedoucet

The Transition to Parenthood: What Happened to Me?

November 30, 2015

"Tell me about the joys of being a new parent," I prompted my niece, whose little baby is five months old. She is 34, works full-time, and is married to my nephew.

The transition to parenthood is profound, as many parents already know. Developmental scientists consider it to be one of the most massive reorganizations in the lifespan, changing the brains, endocrine systems, behaviors, identities, relationships, and more, of everyone involved.

Kelly's answers had a quiet and whimsical grace.

"There is nothing more beautiful in this world than his smile," she said. "Or watching him discover something new. Last night he found the upper register of his voice, so he spent five minutes shrieking at a high pitch, playing around with the newfound note."

Kelly is a beautiful person, so I wasn't surprised to hear her speak appreciatively about her young son. And, in recent and evolving research, scientists are charting a "global parental caregiving network" that gets shaped in a new parent's brain to bring about some of the very thoughts, feelings, and behaviors that Kelly and other new parents experience.

In 2014, Ruth Feldman, a researcher in Israel and at the Yale School of Medicine, conducted an experiment with her colleagues. They went into the homes of 89 new parents, collected samples of oxytocin (the bonding hormone), and videotaped the parents interacting with their newborns. Later, the researchers put the parents in a functional-MRI machine and replayed their videos back to them, observing which parts of parents' brains "lit up" when they saw their own infants (versus videos of unrelated babies) .

The researchers found two main regions of the brain particularly active in new parents. The first is the "emotion-processing network." This is located centrally and developed earlier in evolution than the neocortex (see below). It involves the limbic, or feeling, circuitry and includes:

The amygdala, which makes us vigilant and highly focused on survival
The oxytocin-producing hypothalamus, which bonds us to our newborns
The dopamine system, which rewards us with a squirt of the feel-good hormone to make us motivated and enjoy parenting

All together, this network creates a heightened emotionality in parents in response to their babies. In fact, according to researchers Laura Glynn and Curt Sandman, the volume of gray matter (or number of neural cell bodies) increases in the above regions in new mothers and is associated with their positive feelings toward their infants. (See Glynn and Sandman's review article on brain changes in pregnant mothers.)

The second region is the "mentalizing network" that involves the higher cortex, or the more thinking regions of the brain. This area, along with additional superhighways that develop between the emotion and mentalizing systems, focuses attention and grounds in the present moment: Who couldn't stare at a new baby forever? It also facilitates the ability to "feel into" what a baby needs: Areas of the brain that involve cognitive empathy and the internal imaging of, or resonance with, a baby, light up. These regions help a parent read nonverbal signals, infer what a baby might be feeling and what he/she might need, and even plan for what might be needed later in the future (long-term goals). These regions are also associated with multitasking and better emotion regulation. In other words, parents' brains are remodeled to protect, attune with, and plan for their infants.

Other research has found that hormonal changes in pregnant women dampen their physical and psychological stress response, as if to make more space to tune in to their babies' needs.

But along with all these changes, there seems to be a collateral cognitive hit: In a meta-analysis of 17 studies, 80% of women reported impaired aspects of memory (recall and executive function) that began in pregnancy and persisted into the postpartum period.

Mothers aren't the only ones whose brains are remodeled. The brains of fathers, too, light up in ways that nonparents' brains don't. Feldman and her colleagues found that while the emotion processing network is most active in the biological mothers she studied, it is the mentalizing networks that are more active in the brains of fathers who are co-parenting alongside moms. The more fathers engage in caregiving tasks, the more oxytocin they produce, and the stronger the activation in the mentalizing areas of the brain.

Interestingly, in gay dads who are primary caregivers (half of Feldman's subjects), both emotion and mentalizing systems were highly activated by engaging in parenting. (For more on how parenting changes fathers' brains, I recommend the fun read, Do Fathers Matter? What Science is Telling Us about the Parent We've Overlooked, by Paul Raeburn.)

In other words, parenting is a very plastic and flexible process. While pregnancy prepares a mother's brain for parenting, the act of caregiving can produce upticks in oxytocin (the bonding hormone) and create neurological changes that support parenting in many adults--dads, adoptive parents, and other alloparents (any caregiving adults).

Kelly's husband Sahil is open about the new feelings he's having as a dad. "Winnie [short for Winter] is a curious, cheerful little person, and watching him develop and experience the world for the first time brings me endless amusement and joy. With Winnie, I've found new depths of love--it feels like a very biologically driven emotion."

While he is drinking in the sweet elixir of his baby, Sahil is also running his feelings through the thought circuitries. "Besides being afraid of the regular things--injury, illness, and such--I am also sad that his innocence will inevitably be eroded over time, and that he will inevitably experience all the various pains involved in growing into an adult."

Kelly admires her husband's changes and says that one of her greatest joys is "watching my husband develop into an incredibly loving, nurturing, and giving father."

Parents, naturally, continue to develop as individuals, and the arrival of a baby stimulates self-reflection. Observing Winnie moved Kelly to reflect on what must also have been the miracle of her own beginnings. "I'm fascinated by the fact that I, too, floated in a sack of amniotic fluid; that I, too, saw my hand for the first time and probably stared at it for 30 minutes straight, waving it in the air. Or that I, too, might have been startled by my own sneeze, or gas, or yawn."

Sahil says, "Having a child has given my life more meaning. For example, rather than working to earn money just for myself, to purchase various objects and experiences, I now have a great reason to do so. I'm more careful now, too. I have a child who depends on me, so I feel like I need to take better care of myself, so that I can be my best possible self to take care of Winnie."

Challenges

The joys of parenting are often felt more deeply than almost any other feeling humans are capable of having. But the challenges are great, too. "Every mom I knew was surprised by the impact of becoming a parent and wished she knew more about coping with it," writes Jan Hanson in Mother Nurture: A Mother's Guide to Health in Body, Mind, and Intimate Relationships. Hanson is a nutritionist who co-authored the book with her husband, the neuropsychologist Rick Hanson, as well as OB/GYN Ricki Pollycove.

There are challenges to parents' physical health: recovery from pregnancy and delivery, the adjustment to breastfeeding, disturbed nutrition, fatigue, and insufficient sleep. As you would expect, Kelly reports that trying to stay rational, keep conflicts down, and drive safely are difficult on three hours' sleep and/or when she's been up, exhausted, since 4 A.M. She is experiencing what researchers know: That proper sleep is critical to health and well-being, including mood, decision-making, performance, and safety.

There are psychological adjustments to the new parenting role, too. Some parents need time to recover from a difficult or complicated birth process. For some, parenting demands can trigger strong unresolved feelings from childhood, especially if it was traumatic or troubled. Hormonal changes, along with sleeplessness and the constant demands of a new baby, can create surprising new feelings, too: anger, sadness, feeling trapped or isolated--even guilt, fear, and inadequacy. Some parents have to wrestle with having lost a previous child, or perhaps they are parenting a difficult or differently abled child. Kathleen Kendall-Tackett writes about these psychological challenges, and more, in The Hidden Feelings of Motherhood: Coping with Stress, Depression, and Burnout.

Having a new child introduces new challenges to the parents as a couple. Conflicts often increase in a relationship after the birth of a child, in part due to the "roommate hassles" of who will do what in the household as well as disagreements about parenting styles. Sometimes the sense of intimacy, closeness, and sexuality in a relationship can get derailed with the arrival of a little one. Couples are challenged to re-synchronize their relationship and develop a new sense of teamwork.

The couples who are most at risk for serious problems after the birth of a child, write parenting scholars Carolyn Pape Cowan and Philip Cowan in their book When Partners Become Parents, are those who were on the rocks before the child came along. Becoming a parent amplifies any pre-existing fissures in the relationship. Especially problematic are poor communication patterns--where one stonewalls, digs in, and/or refuses to budge, while the other escalates. In contrast, couples who have productive ways of working out new difficulties and challenges do the best adjusting.

After the arrival of a child, there are new logistics to deal with: new strains in managing a household, financial and legal concerns, when and how to go back to work, and figuring out childcare. Like many contemporary mothers, Kelly experiences the challenges as coming from both sides: the struggle to feel okay going back to work after three months versus the struggle to feel okay staying home without being criticized as a poor worker or an anti-feminist.

New parents also undergo a rearrangement of their social life, including how they interact with extended family and friends. Some friendship networks get reconfigured (not all childless people want to hang out with new parents). Kelly noticed that other people changed in their relationship to her as she became a parent. Many people offered unsolicited opinions, especially on the topics of sleep and clothing: "At times it felt that anyone who had once been a mother felt the need to say that my baby should put on more clothing. Even in 90-degree weather when he was sweating! And I was quite happy to be co-sleeping with Winter, but I was made to feel guilty about this on many occasions. Sleep is such a touchy topic, and many people tried to convince us to get Winter into a crib if we wanted what was best for him." Kelly found support from her sister who encouraged her to be firm about her internal compass in the face of many differing opinions: "Your only option is to learn to listen to yourself and know that you know your situation, and what works for your family, better than anyone else." Kelly adds that the most helpful exchanges are ones where she is encouraged to share how things are going, and in return hear a similar story and outcome. "Not only does it feel good to know I'm not alone in this, it educates me about what works much better than direct advice."

Rick and Jan Hanson and Ricki Polycove have seen so many thoroughly exhausted mothers in their practices that they identified a "depeleted mother syndrome," a condition where the mother's "outpouring, stresses, vulnerabilities, and low resources" are so overwhelming as to "drain and dysregulate her body."

The solution they recommend is threefold, focusing on lowering parenting demands, increasing supportive resources, and building resilience. Rick Hanson is a thorough, compassionate, skilled, and practical therapist, and Mother Nurture is therapy in a book: From one-minute soothers, to resolving childhood issues, there is much help in the way of cognitive, neurological, and commonsense approaches. Among other things, he provides suggestions for :

taking care of your body
small daily practices to improve outlook
reframing circumstances
concrete problem solving approaches
transforming painful emotions from the past
problem-solving sleep
vitamins to help with the nervous system
assessing neurotransmitters
staying connected to your partner with empathy
sharing the load
maintaining intimacy
healing hurt feelings

Kelly noticed that just as her identity started changing as a parent, there was a tendency for people to converse with her exclusively about motherhood. She was naturally thrilled that her loved ones were excited about Winnie, yet she longed for relationships that also nurtured her individual identity as a painter, a counselor, yoga enthusiast, and traveller.

As an American, Kelly is not alone in this experience. Kathleen Kendall-Tackett writes that in many non-industrialized countries, the postpartum period is a special time of "mothering the mother." New mothers are considered especially vulnerable so their activities are limited, they're relieved of normal work, and they stay relatively secluded with their babies while other relatives take care of them. Along with that extra care, there are special rituals and gifts that mark this as an important period. American mothers, in contrast, are quickly released from the hospital and are often even expected to entertain guests who come to visit the new baby. That difference in support, Kendall-Tackett says, is why in industrialized countries about 50-80% of new mothers experience the "baby blues," and another 15-25% have full-blown postpartum depression. In more traditional cultures where new mothers are exclusively nurtured, postpartum depression is "virtually non-existent."

Kelly agrees: "A mother needs to be nurtured and cared for because she is doing nothing for herself at this point. Everything is being given to the baby and I find little time to do things like even wash my hair or take a bath. Or connect with a friend. Even getting a hug from my husband can be hard in those times when a baby is especially demanding. When I do get that hug, I need it more than ever before."

The transition to parenthood is a huge transformation. And America, with no comprehensive child-family policy and no federal paid family leave policy--is a particularly unsupportive place to have a child. But the accumulating research is pointing to just how sensitive and important this period is for families. With a little knowledge and some foresight, parents-to-be, and their loved ones, can better plan for the transition. The rise in popularity of the postpartum doula (a person, usually a woman, who is trained to help new families in the home) is a step in the right direction.

Rick Hanson encourages new mothers--and fathers--to insist that others take their needs seriously. "Treat yourself like you matter," he says.

* * * * *

Further reading (some of these are oldies but still goodies):

On coping with the challenging feelings of becoming a new parent:

The Hidden Feelings of Motherhood: Coping with Stress, Depression, and Burnout (2001) by Kathleen Kendall-Tackett
*Mother Nurture: A Mother’s Guide to Health in Body, Mind, and Intimate Relationships (2002) by Rick Hanson, Jan Hanson, and Ricki Pollycove
When Partners Become Parents: The Big Life Change for Couples (1992) by Carolyn Pape Cowan and Philip Cowan
The Gentle Art of Newborn Family Care: A Guide for Postpartum Doulas and Caregivers (2012) by Salle Webber

On becoming a father:

Do Fathers Matter? What Science is Telling Us about the Parent We’ve Overlooked (2014) By Paul Raeburn
All In: How Our Work-First Culture Fails Dads, Families, and Businesses—and How We Can Fix It Together (2015) by Josh Levs
Home Game: An Accidental Guide to Fatherhood (2009) by Michael Lewis

Family Stress: It's Not All in Your Head

December 11, 2014

For most of my kids' childhoods, I felt that my ability to guide my family faced direct competition from school, and many forces beyond.

In elementary school, heavy backpacks bent my kids' soft little backs. Homework intruded into playtime, even though research has shown that play is important for cognitive and social development. In middle school, more homework and big projects hijacked precious family weekends--just when my kids needed more sleep, more time to adjust to their rapidly changing brains, and more healthy time with friends, and when my husband and I needed some rest. By high school, the downward pressure from looming college applications threatened to torque my kids' developmental arc.

"Don't do anything for a college resume," I warned. "Make choices because they make sense to you."

As the tsunami of outside competition flooded toward us, I felt like a little mushroom field trying to filter toxins out of a roaring river. The competition over messaging added even more pressure: media was saturated with hypersexualized images, dysfunctional interactions, unrealistic problem-solving, violence, and more. It was hard to stay on top of it all, to teach my kids the difference between our values inside our family versus values in the outside world. This on top of our own adult pressures to manage childcare, two jobs, meals, paychecks, health care and sick days, quality time, extended family, and maybe a few friends.

Adults are stressed, but our kids are stressed, too. A recent survey found that in the United States, teens' stress has now surpassed that of adults. Many young people say that they are overwhelmed, depressed, and sad because of the stress that they, themselves, gauge to be unhealthy. And the mental health of teenagers in this country is declining over time. Many parents are frantic, reaching for whatever levers they can put their hands on: hiring therapists, looking to medications, and trying ancient practices to calm everyone down. If only we could find the right key, we parents think, we can unlock the stress, and our child will thrive.

But when the number of kids and families struggling is so large, we have to start asking questions about the systems beyond ourselves. We parents love our children wildly, and ultimately, they're our responsibility. But our ability to care for them successfully also depends in large part on how the wider culture, policies, and values support childrearing. And on that score, America is not doing very well, especially compared to other countries. Last week I published an op-ed in The Washington Post exploring that theme. One of the comments was provocative: "America hates children," it read.

"Just because you're paranoid doesn't mean they're not out to get you," goes the saying. And I'm here to affirm: The stress that you and your kids feel is not all manufactured inside your family. Self-help goes only so far, and sometimes it even deludes us into accommodating to a maladaptive situation. A new election cycle will roll around soon, and it's time to start asking when America will put children first.

How Can Parents Help Prevent Bullying in Middle School?

November 6, 2013

Bullying Prevention Awareness Month is over, and unfortunately it had a horrific run of high-profile tragedies: two teacher fatalities at the hands of students, several bullying-related suicides and attempted suicides, two Florida bullies charged with felonies, and a 14-year-old shooter charged as an adult. Once again, we’re left to face the grim reality that bullying is alive and well in our culture.

But there’s something that all of these cases had in common—and that the news media didn’t notice. All of the kids involved in these events were 12-14 years old.

No surprise, from a developmental perspective. The onset of puberty remodels the developing brain—both for humans and for many animal species—in a way that makes young adolescents especially sensitive to their social world. The reason for this can be understood through an evolutionary lens: Reproduction requires social skills—mating, parenting, fitting in to the social niche, coordinating to secure resources, taking care of the community, etc. So it would make sense that while bodies are being reshaped to produce offspring, brains would also simultaneously change to make us more socially receptive and active at that time.

How does puberty make teens more susceptible to bullying?

Recent research on the teen brain shows that adolescents, compared to both children and adults, are exceptionally sensitive to social dynamics. In brain-imaging studies, teen brains show more activation in regions that process rewards, motivations and emotions (the socioaffective circuitry in the subcortical, limbic regions) compared to children and adults. As a result, teens can feel more intensely, especially about social interactions. They more easily feel judged, threatened, and evaluated by others.

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— Urie Bronfenbrenner

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Yale Center for Emotional Intelligence

The Yale Center for Emotional Intelligence uses the power of emotions to create a more effective and compassionate society. The Center conducts research and teaches people of all ages how to develop their emotional intelligence. Learn more here.