The Link Between August Birthdays and A.D.H.D.

A new study raises questions about age, maturity and overdiagnosis.

By Anupam B. JenaMichael Barnett and Timothy J. Layton

The authors are health policy researchers.

CreditJackie Ferrentino

The rate of diagnosis of attention deficit hyperactivity disorder among children has nearly doubled in the past two decades. Rates of A.D.H.D. diagnoses also vary considerably across states, with nearly three times as many children getting the diagnosis in Kentucky (where one in five children are said to have the condition) as in Nevada. More than 5 percent of all children in the United States now take an A.D.H.D. medication. All this raises the question of whether the disease is being overdiagnosed.

Diagnosing A.D.H.D. is difficult. Unlike other childhood diseases — such as asthma, obesity and diabetes — the diagnosis of A.D.H.D. is inherently subjective and depends on the assessment of parents, school personnel and health care providers. For a child who is easily distracted, an assessment of normal, inattentive behavior by one could be a formal diagnosis of A.D.H.D. by another.

It turns out that although diagnosing A.D.H.D. requires a subjective interpretation of facts, the month in which a child is born can be a strong, objective predictor.

Most states have arbitrary cutoffs for kindergarten entry, with children who do not reach a given age by a certain date required to wait a year. In 18 states, children who will turn 5 before Sept. 1 can enter kindergarten in the year that they turn 5; children who will turn 5 after Sept. 1 must wait until the next year. So in states with Sept. 1 cutoffs, in any given class, August-born children will usually be the youngest and September-born children the oldest.

These arbitrary cutoffs have important implications for the diagnosis of A.D.H.D. In a study published in The New England Journal of Medicine, we found that among several hundred thousand children who were born between 2007 and 2009 and followed until 2016, rates of A.D.H.D. diagnosis and treatment were 34 percent higher among children born in August than among children born in September in states with a Sept. 1 school entry-age cutoff. No such difference was found among children in states with different cutoff dates. The effects were largest among boys.

We believe these findings reveal just how subjective the diagnosis of A.D.H.D. can be. In any given class, inattentive behavior among younger, August-born children may be perceived, in some instances, to reflect symptom of A.D.H.D., rather than the relative immaturity that is biologically determined and to be expected among children who are nearly one year younger than September-born classmates.

The stakes of additional, potentially inappropriate diagnoses are high, particularly when diagnoses are accompanied by medical treatment, which has side effects. In cases where A.D.H.D. is appropriately diagnosed, we know that behavioral and medical treatments can improve concentration and school performance and other outcomes. And in these instances, the harms of medical treatments are, on average, outweighed by the benefits. But when the disease is improperly diagnosed, the clinical harms and dollar costs of treatment may not be met with commensurate benefits.

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A second-grade classroom in Minneapolis.CreditTim Gruber for The New York Times

Unlike other diseases such as asthma and diabetes, whose diagnosis is more objective and is not based on peer-to-peer comparisons, the diagnosis of A.D.H.D. appears heavily influenced by how children behave in school relative to peers and how those differences in behavior are interpreted by school personnel, parents and ultimately, physicians. Indeed, some evidence suggests that teachers and other school personnel are more likely than physicians or parents to first suggest that a child may have A.D.H.D.

Our findings aren’t new, but they suggest a continuing problem. Several older studies, both within and outside the United States, analyze rates of A.D.H.D. diagnosis among children born just before versus just after school entry-age cutoffs, similar in design to our study. Nearly all of these studies suggest that younger children within a grade are more likely to be diagnosed with A.D.H.D. than older children in the same grade. One study found that the relative age of a child in a class strongly affects teachers’ assessments of whether a child demonstrates A.D.H.D. symptoms but does not affect parents’ assessments, which suggests that many diagnoses may stem from teachers’ perceptions of students that are based on a child’s age relative to peers.

Our study, which uses recent data, tells us that the problem still exists and that it’s not small. Despite growing awareness that A.D.H.D. may be overdiagnosed and the fact that the medications used to treat it have serious side effects, something as arbitrary as the month a child is born still has a meaningful impact on the likelihood that the child is determined to have the condition.

At a minimum, physicians who frequently diagnose A.D.H.D. in children should be aware of these findings. A simple mental “adjustment” for whether a child is born in August may be sufficient to help physicians reduce overdiagnosis.

School personnel and parents should also be aware of how simple cognitive biases can creep into how important clinical decisions are made. Both our and previous findings suggest that parents of children who are young for their grade could reasonably question whether the initiation of medical treatment for A.D.H.D. should be delayed.

In his 2008 book “Outliers,” Malcolm Gladwell describes the now well-known phenomenon that a disproportionate number of Canadian professional hockey players have birth dates in the beginning of the calendar year. This is explained by the Jan. 1 age eligibility cutoff for hockey programs in Canada, which leads to the oldest hockey players within an age-based division exceeding the age of the youngest players by nearly a year, conferring them a performance advantage. A similar phenomenon is true for A.D.H.D., where a child’s age relative to peers confers a markedly different rate of diagnosis and treatment, but the stakes are higher.

Anupam B. Jena is an associate professor at Harvard Medical School. Michael Barnett is an assistant professor at Harvard School of Public Health. Timothy J. Layton is an assistant professor at Harvard Medical School.

7 ways parents can teach girls to build one another up, instead of tearing one another down


(Kara Somberg/for The Washington Post)

October 30, 2018

When Ashley Eckstein, an actress and entrepreneur, started performing professionally in fifth grade, the other girls in her class taunted her relentlessly. Now 37, Eckstein recently brought her 13-year-old niece to a girls leadership summit to show her a different dynamic — hundreds of girls celebrating one another’s accomplishments in fields including writing and social activism.

“The cheers, hugs and high-fives literally gave me goose bumps,” said Eckstein, author of “It’s Your Universe: You Have the Power to Make it Happen.” “Something very right was happening in that room full of confident girls all doing their own thing.”

The girls may not have realized it, but they were pushing back against a powerful tendency for girls and women to view one another as threats, rather than allies or part of a support system.

“Scarcity theory might lead young girls to believe that there are limits around how many good things can happen to any one person, which could also lead them to believe that their own success will be limited,” said Caroline Adams Miller, a positive psychology expert and the author of “Getting Grit.”

When Miller speaks to groups of female professionals, she often asks: Does anyone feel like one of the biggest challenges isn’t just how men have treated other women, but also women shooting one another from inside the tent?

“It’s not half the room raising their hands — it’s 100 percent of the women,” she said.

“Unfortunately, it’s been communicated to us over the years that there are fewer spots for women — a limited inventory,” added Donna Orender, the author of “Wowsdom! The Girls Guide to the Positive and the Possible.” And teens have their own concerns. A recent survey by Plan International USA, an organization fighting child poverty, and PerryUndem, a public opinion research firm, found that 30 percent of girls ages 10 to 19 see fewer opportunities at school for them than for boys, particularly in sports.

Girls who perceive that it’s a zero-sum game are less likely to support one another, but experts say that if girls band together, they can expand their options. Here are seven ways parents can raise empowered girls who support and encourage each other.

Urge them to use social media for good

Expectations and options for girls are rapidly expanding, but the PerryUndem survey found that girls still believe society most values their physical appearance. Girls also reported feeling tremendous pressure to avoid bragging or seeming overly confident.

Miller started an initiative, “#Share222,” to change that, by encouraging women to share one another’s substantive achievements on at least two social media outlets. This is something teen girls can do, too, replacing selfies and party pictures with shout-outs for friends who have reached personal goals. This kicks off a positive cycle. Girls want to reciprocate kind gestures, and they learn that true friendship and tenacity matter more than popularity or appearance.

Help them use expansive body language

When girls feel strong, they see one another as allies rather than predators, said Amy Cuddy, a social psychologist and the author of “Presence.” Even simple changes in posture can build their sense of empowerment. Cuddy notes that when girls are young, they stand with their feet apart and their chests out, but by the time they hit middle school, they start to display shrinking behavior.

Cuddy recommends that parents tell their daughters that they deserve to take up space, and that poor posture will affect their mood and sense of self-efficacy. Ask, “How do you feel when you’re ­sitting like that?”

“Feeling powerful activates what we call the behavioral approach system and makes us more optimistic, generally happier, and more confident and willing to take risks,” she said. On the flip side, “Powerlessness can be really dangerous and make it hard to know who to trust.”

Parents also can show girls images such as the Fearless Girl sculpture, which depicts a girl facing down the Wall Street Bull. “I get pictures from parents of girls all the time who want to be photographed with their chins up and chests out just like the fearless girl,” Cuddy said. “When I went to see it, there were probably 60 girls there. That’s what they want to see, and what we need to be showing them.”

Normalize giving and seeking help

Teach your daughter the importance of identifying sources of support. Orender regularly organizes formal mentor walks to pair tween and teen girls with women working in their fields of interest.

One time, Orender paired all the girls with women who were 65 and older. After the walk, the older women read letters to their younger selves, and the girls read letters to their older selves. “It was such a powerful way to show the girls that they’re not alone, and that intergenerational connection is a two-way street,” she said. At the end of every walk, Orender urges the girls to continue reaching out to their mentors for help and advice, stressing that girls can continue to build one another up throughout their lives.

Emphasize mastery instead of performance

Instead of focusing on whether your daughter ran more laps than everyone else, ask her to articulate a specific goal. The question can then be, “Did you run more laps today than yesterday?”

The organization Girls on the Run helps girls focus on doing their best rather than beating someone else, said Allie Riley, the organization’s senior vice president of programming and evaluation.

“You can be competitive without thriving on doing better than someone else,” she added. “Otherwise, it’s, ‘I can do well or you can do well, but we both can’t do well.’ ” At 5Ks, the members of the team pace themselves to run in with a girl who is struggling, or two girls will try to cross the finish line together. Girls can transfer these lessons about empathy and mutual support to other areas of their lives.

Identify fierce but kind female characters

Girls often struggle with healthy aggression, but competition helps people accomplish goals they otherwise wouldn’t complete. Being competitive and supporting others aren’t mutually exclusive ideas. “We’ve been so militant about getting girls to be nice, they don’t even know there’s such a thing as healthy competition,” says psychologist Lisa Damour, the author of “Untangled.”

When Marina Passalaris, the founder of Beautiful Minds in Australia, conducts confidence-building workshops for girls, she emphasizes that you can be a good person with goals without harming anyone. “Socially, we have this weird idea that a nice girl is quiet and submissive and doesn’t chase her dreams,” she said. You can bring fierceness to competitive situations, then return to being a good sport and friend. Damour points to Mulan as a good example. Eckstein, the voice of Ahsoka Tano in animated Star Wars shows, refers to Hera and Sabine, powerful female characters in that universe.

“They’re part of a crew who work together to overcome the empire,” Eckstein said. “They’re girls working together, overcoming, doing great things.”

Urge them to be loyal

Girls can commit to having one another’s backs even if they drift apart or develop different interests. As Cuddy pointed out, “We make romantic commitments, so why not make friendship commitments?”

That said, parents should help their daughters choose friends with care. “Focus on the people in your corner, and only bring new people into your life who cheer you on,” says psychologist Lea Waters, author of “The Strength Switch.” “It’s okay to befriend someone who’s willing to fight it out with you in the arena, but avoid the ones in the stands throwing things at you.”

Encourage them to join a team

When girls play sports, they learn to set their egos aside and invest in one another’s success. Sports also may buffer them against that deflating posture. “When you’re on a team and social status is based on your strength, power and ability to do well for the team, that becomes what’s valued,” Cuddy said.

Girls who aren’t interested in sports can join another group with a shared vision. Consultant Jon Gordon, author of “The Power of a Positive Team,” recommends activities such as drama club or marching band.

“In theater, you have to make it about what’s best for the performance, and in a marching band, you have to trust that the person next to you won’t hit or step on you,” he said. “It’s all about being better for each other — no one achieves greatness in isolation.”

Phyllis L. Fagell is the counselor at Sheridan School in the District and a therapist at the Chrysalis Group in Bethesda. She tweets @Pfagell and blogs at phyllisfagell.com.

New Federal Exercise Recommendations

The New York Times

Very Brief Workouts Count Toward 150-Minute Goal, New Guidelines Say

New federal exercise recommendations include the first-ever federal activity parameters for 3-year-olds, as well as a few surprising omissions.

CreditJeenah Moon for The New York Times

As of Monday, the United States has new federal physical-activity guidelines. The new guidelines, which represent a scientific consensus about how much and what types of physical activities we should complete for good health, bear a strong resemblance to the existing, 10-year-old governmental recommendations. But they also feature some important updates and expansions, including the first-ever federal activity parameters for 3-year-olds, as well as a few surprising omissions.

And they offer a subtle, admonitory reminder that a substantial majority of us are not moving nearly as much as we should.

The idea that the government might suggest how much we need to exercise is relatively new. The first federal exercise recommendations were released in 2008, after several years of scientific background study.

 

During that time, an advisory board of researchers, most of them from academia, scoured the available scientific literature for clues about the relationships between physical activity and health and how much and what types of exercise seemed best able to lengthen people’s life spans and reduce their risks for disease.

Using that information, they assembled and presented a scientific report to the Department of Health and Human Services, which used it as the basis for the original 2008 guidelines.

Most of us probably know what those guidelines suggested.

In essence, they called for adults who are not disabled to complete at least 150 minutes a week of moderate-intensity exercise, such as brisk walking or other activities that raise people’s heart rates and breathing to the point that they can talk to a companion but cannot, should they be so inclined, sing.

The guidelines also noted that 75 minutes of vigorous exercise, such as jogging, would be equally effective but that the exercise, whatever its intensity, should take place in nonstop bouts of at least 10 minutes at a time and preferably every day.

Adults were urged, too, to do some type of strength training twice a week, while children older than 6 and teenagers were told to exercise moderately for at least 60 minutes a day.

 

That was 10 years ago. Since then, exercise scientists have published a mountain’s worth of new research about the health effects of physical activity — and of sitting — and of how much time we really need to spend in motion.

So two years ago, the Department of Health and Human Services convened a new panel of scientific advisers to sift through this research and provide updated exercise recommendations.

Earlier this year, that group delivered a 779-page scientific report to H.H.S., from which the new recommendations were devised.

To the surprise of some scientists and other observers, these guidelines, which were published on Monday in JAMA, are broadly the same as the previous set.

Again, they call for adults to complete at least 150 minutes of moderate-intensity exercise or 75 minutes of vigorous activity every week, along with strength training twice a week.

They also suggest balance training for older people and, for the first time, urge kids between the ages of 3 and 5 to be active for at least three hours a day, an acknowledgment that even small children run the risk of being too sedentary these days.

 

The most substantive change in the new recommendations involves how long each bout of exercise should be. The new guidelines say they do not need to last for 10 minutes.

Any physical activity, no matter how brief, including walking up stairs or from the car to the office, provides health benefits, according to the new guidelines, and counts toward exercise goals.

Using these parameters, “it will be much easier” for people to accumulate the desired 150 weekly minutes of moderate activity, says Adm. Brett Giroir, the assistant secretary for health at H.H.S., who oversaw the development of the formal guidelines.

This idea is captured in a new H.H.S. website cheerfully titled “Move Your Way” that summarizes the latest guidelines.

But despite this expansiveness, the 2018 recommendations do not cover some types or aspects of exercise, including high-intensity interval training. Although these brief, intense workouts are popular and widely studied, the guidelines’ writers felt that more research was needed about their safety and effects.

For the same reason, the guidelines do not set a target for how much — or little — time people should spend sitting or how many steps they should take each day, instead reiterating that the best goal is 150 minutes a week of activity.

Helpfully, the new guidelines do include some practical proposals for increasing exercise, including having health care workers ask people about their exercise habits during every appointment and employers promote physical activity at work.

But such efforts are voluntary, of course, and may be unable to overcome the greatest challenge facing the implementation of the new guidelines, which is us.

Despite 10 years of hearing that we should be moving more, few of us are.

Only about 20 percent of American adults meet the existing recommendations, and a third never work out at all, statistics show.

But Admiral Giroir says he believes that the new guidelines can and should inspire large numbers of people to get moving.

“They are so simple,” he says. “You can walk, dance, mow your lawn, park your car a little farther away. It all counts and could really make an impact on people’s health.”

New Study Finds Positive Correlation Between Team Sports and Mental Health

Women’s Sports Foundation

Researchers, including the team at the Women’s Sports Foundation, have long underscored the positive physical benefits that come with playing sports. A recent study published in the Lancet Psychiatry Journal advanced the conversation by further analyzing the effects of sports on mental health.

Reviewing data from more than 1.2 million responses to a US Centers for Disease Control and Prevention (CDC) survey, the researchers concluded that “physical exercise was significantly and meaningfully associated with self-reported mental health burden.” The report asserts that exercise can ease the burden of a variety of mental health issues, including mild depression, anxiety, panic attacks and stress.

To conduct the research, the authors of the cross-sectional study looked at data from CDC surveys given to adults 18 or over in 2011, 2013 and 2015. The study, which concerns survey responses derived from a one-month period, compares the number of self-reported bad mental health days between individuals who exercised and those who didn’t.

The conclusion? All exercise is good for mental health, but some forms are more beneficial than others.

The report indicates that “individuals who exercised had 1.49 (43.2%) fewer days of poor mental health in the past month than individuals who did not exercise but were otherwise matched for several physical and sociodemographic characteristics.”

“Even just walking just three times a week seems to give people better mental health than not exercising at all,” Adam Shekroud, an author of the study and Yale University psychiatry professor, told CNN. “I think from a public health perspective, it’s pretty important because it shows that we can have the potential for having a pretty big impact on mental health for a lot of people.”

Not all exercise is created equal when it comes to mental health though, the study found. Team sports had the largest association with a lower mental health burden, with a 22.3% reduction. Cycling and aerobic and gym exercises were next, at 21.6% and 20.1%, respectively. The best amount of time to exercise in terms of mental health is approximately 45 minutes three to four times per week, according to the report.

The study was published in August 2018, but has seen the most traction in the media in the last two weeks. In a climate where mental health is becoming increasingly destigmatized — particularly in athletics, where athletes have begun speaking out about their battles with mental health issues — the research is more relevant than ever.

Understanding Teenage Friendships In Middle Schoolers

Your Teen Mag

The author of the new book The Gift of Failure: How the Best Parents Learn to Let Go So Their Children Can Succeed offers her take on middle school friendships.

MIDDLE SCHOOL CHALLENGES: CHANGING FRIENDSHIPS

 By Jessica Lahey

Middle school is challenging for so many reasons. Academics become more difficult. Schedules fill up with activities. And, in what might be the most treacherous terrain for kids and parents alike, teenage friendships change.

The peers your tweens cling to as they enter the middle school may look a lot different from the ones they race out with on the other side. And that’s to be expected. Friendships change over time, not just because our children evolve, but because the very nature of friendship evolves with them.

Early in childhood, our children’s friendships arise out of proximity and habit. We toss our kids into the sandbox with our friends’ kids. And this arrangement works for everyone. As kids get older, however, they begin to build emotional connections with friends based on compatibility. Their shared interests, dreams, and goals begin to edge out mere convenience.

When they become tweens, middle school friendships become much more complex. And for good reason. Tweens use friendships as a way to try on an identity. Old friends offer sameness and comfort. But the pull of novel ideas of other kids begins to lure them in new directions. Tweens begin to build teenage friendships based on these new priorities. Some priorities, such as social status or fashion choices, may not make much sense to parents. But they are just as important to our children’s growth as shared history or values.

YOUR TWEEN’S FRIENDSHIPS INEVITABLY CHANGE.

All too often, the shifting sands of tween friendship result in broken hearts. Tweens feel dumped, shunned, abandoned, and betrayed. And friends move back and forth between comfortable old relationships and exciting new alliances. As any parent knows, our own personal heartache hurts. But the secondhand heartbreak we experience through our children is much more painful, mainly because it’s out of our control. The urge to intervene, to save and heal, is powerful, and while meddling around in tween social machinations may make us feel better, we must stay out of it.

Our children’s teenage friendships are not about us any more than their choice of what to wear to the middle school dance is about us. The tween years are for trying on fifteen different outfits—the blue shirt with the tan pants, the red skirt with the white top—to see what works best for a changing body, mind, and spirit on a given day.

Tweens move from relationship to relationship, adopting this detail of a friend’s personality, discarding that characteristic of another, until they have collected the essential elements of their identity. Some relationships will survive this process, and some will not, but every one is an important phase of the journey. We may not love every outfit our tweens try on, but it’s our job to be there when they emerge from the dressing room, when they do a little twirl and wait for us to tell them how grown up they have become.

Jessica Lahey

Jessica Lahey is a frequent contributor to The New York Times and The Atlantic and author of The Gift of Failure: How the Best Parents Learn to Let Go So Their Children Can Succeed. Find out more at jessicalahey.com.

Help Tweens Use Their Phones Less With These Tools

From screen limits to break reminders to Do Not Disturb, OS and app settings may help us break unhealthy digital habits and tune into what’s really important.
By Caroline Knorr 
Use Your Phone Less (with Tools from Apple, Google, Snapchat and More)

The internet invasion started slowly. But then it came all at once. Suddenly, we’re checking email at 3 a.m., fighting with our kids to make them shut down their devices, and staring at screens instead of making eye contact. No one asked for this life, but here we are: wasting time online, getting distracted (even when our phones are off!), and playing catch-up on all the latest stuff our kids are doing on SnapchatInstagramYouTube, and who knows what else.

It doesn’t have to be this way. A new wave of so-called “digital wellness” features designed to prevent screen overload is taking hold in some of the most popular tech tools. From operating systems including Apple’s iOS 12 and Google’s upcoming Android Pie update to social media like Snapchat and Instagram, you can see exactly how much time you’re spending online, set limits for yourself and your kids, and reduce distractions and interruptions from notifications.

You have the right to remain skeptical. The idea of tech companies trying to help us stay off their products — after using every trick in the book to keep us hooked — is pretty ironic. And there’s no proof that digital wellness features work — much less help mental health issues associated with technology use, such as anxiety, depression, and addiction. But if you’re concerned about your tech use, as well as about your kid’s, they’re certainly worth trying. Whether they help depends a lot on your family’s needs, your kids’ willingness to be on board, and the kinds of conversations you have around self-regulation. Take a look at some of the most popular platforms’ efforts to protect your digital well-being.

iOS 12

Screenshot of iOS screentimeScreen TimeYou can enable Screen Time on your kid’s phone and password-protect the settings so they can’t change them. Or, you can also manage the settings remotely by setting up Family Sharing. We recommend using the features together with your kid. Work on using screens intentionally and mindfully, and help your kid learn to regulate their own use when you’re not around to do it for them. Key features:

  • Usage report. A daily and weekly readout of the time you’re spending on your device. You can see exactly how much attention you and your kids pay to app categories such as social networking versus, say, reading and reference.
  • Downtime. Turns the phone off during a specific period of time — for example, 9 p.m. to 8 a.m.
  • App Limits. Sets daily time limits for app categories such as games and entertainment as well as for individual apps.
  • Always Allowed. Lets you choose which apps (for example, music apps) that never turn off — even during downtime.
  • Content & Privacy Restrictions. Controls what your kids can see (such as mature content) and do (such as download and delete apps). Also puts limits on how much information third parties can access about your kid.

Android Pie (available now on Pixel devices; rolling out to other users)

Screenshot of Android's Digital Wellbeing toolsDigital WellbeingUnlike the Screen Time features in iOS 12, you can’t enable Digital Wellbeing settings on your kid’s phone and password-protect them. Instead, Digital Wellbeing is designed for individual users to customize their devices to their own needs. If you’re an Android family, you can discuss and try various features to make the phone work for you — instead of the other way around. (If you want to have more control over your kid’s Android phone, check out Google’s Family Link parental-control app, which allows remote monitoring.) Key features:

  • Dashboard. Graphs the time you’ve spent in individual apps and lets you set daily time limits for apps that keep you hooked longer than you’d like (for example, 15 minutes tops on Snapchat).
  • Do Not Disturb. Silences your device entirely or allows you to specify which alerts you want to see (or not).
  • Notifications. Personalizes your alerts, so you can snooze them and schedule them at a convenient time.
  • Wind Down. Automatically turns your phone grayscale and enables Do Not Disturb at a time you specify.

YouTube

Screenshot of YouTube's Time Watched featureAccount Settings. One of the most popular platforms for kids and adults, YouTube is easy to get lost in — or it used to be, anyway. Now you can see a full rundown of how much time you and your kids spend scrolling through videos, and if you think you’re overdoing it, you can enable settings to curb your use. You can’t password-protect the settings, though, so they’re mostly helpful for you if you let your kids use your phone or if you help your kid set them so they can regulate their own use. Key features:

  • Time Watched. Available only on the app, these stats show how much time you’ve spent watching videos for the present day, the day before, and the past week. Within this feature, you can also set a reminder to take a break after a certain amount of time and disable autoplay so you won’t get sucked in to watching endless videos.
  • Scheduled digest. Instead of random notifications about the latest video that distracts you at all hours, you can get all your alerts bundled together at one time.
  • Disable sounds & vibrations. If you can’t see or hear your alerts, you’ll stay blissfully engaged in important stuff (such as talking with your kids) until you check your phone.
  • Restricted Mode. Though it’s been around for a while, Restricted Mode can be a helpful additional setting to give you some peace of mind. It limits mature content from showing up in your kid’s feed (it’s not perfect, though).

Instagram (available soon)

Screenshot of Instagram's Digital Wellbeing toolsDigital WellbeingRunning neck and neck with Snapchat as the most popular social media app among teens, Instagram is a key social lifeline. Its parent company (Facebook) has made an effort to help users manage their time and reduce exposure to cyberbullying by adding settings such as Comment Controls, which allow you to micromanage your friends’ replies, and All Caught Up, which lets you know you’ve seen every post since the last time you scrolled through your feed. Digital Wellbeing, which will roll out soon, will add even more functionality. You can check back for updates after the new version is released. Key features:

  • Activity Dashboard. Displays a daily average of the time you’ve spent on the app for the week.
  • Daily Reminder. Allows you to set a time limit and receive a notification when you’ve hit your limit.
  • Mute Push Notifications. Silences push notifications (you can also turn them off entirely in the app’s settings or on your phone’s settings).

Snapchat

Screenshot of Snapchat's Do Not Disturb featureDo Not DisturbThe pioneer of the disappearing message, Snapchat is now a full-fledged portal to friends, videos from around the world, current events, and much more. Needless to say, it can take up a lot of time. But you can cut down on the noise — a little bit. Key features:

  • Do Not Disturb. Instead of disabling the phone or the app altogether, Snapchat lets you mute notifications from individual people. If you have a chronic oversharer on your friends list, you don’t have to block or remove them. Just “shush” them for a while and you won’t be alerted to their posts.
  • Mute story. Muting a story pushes the friend down your contacts list, effectively making their posts the last in line.

TikTok – Real Short Videos

Screenshot of TikTok's Digital Wellbeing featureDigital WellbeingTikTok serves up endlessly scrollable 15-second videos from people all over the world. Averaging 13 million video uploads per day, the app could certainly eat up a lot of your kid’s time. You can password-protect the Digital Wellbeing features on your kid’s phone so they can’t change them. Key features:

  • Screen Time Management. Sets a two-hour daily viewing time limit. (The time limit isn’t customizable.)
  • Restricted Mode. Filters out videos that may not be age-appropriate.

Facebook (currently in development)

Screenshot of Your Time on Facebook featureYour Time on Facebook. Though research shows teens prefer Snapchat and Instagram to Facebook, you’re probably on it more than you would like. The company is rumored to be creating some options to help you keep track of the time you spend on the platform, which in theory should help you cut down. You can check back for updates after the new version is released. Key features:

  • Time on Facebook. Displays a daily average of the time you’ve spent on the app for the week.
  • Manage Your Time. Allows you to set a time limit and receive a notification when you’ve hit your limit.
  • Mute Push Notifications. Silences push notifications (you can also turn them off entirely in the app’s settings or on your phone’s settings) or choose which alerts you want to get.

How Puberty Kills Girls’ Confidence

The Atlantic

In their tween and teenage years, girls become dramatically less self-assured—a feeling that often lasts through adulthood.

CLAIRE SHIPMAN, KATTY KAY & JILLELLYN RILEY
SEP 20, 2018

The change can be baffling to many parents: Their young girls are masters of the universe, full of gutsy fire. But as puberty sets in, their confidence nose-dives, and those same daughters can transform into unrecognizably timid, cautious, risk-averse versions of their former self.

Over the course of writing our latest book, we spoke with hundreds of tween and teen girls who detailed a striking number of things they don’t feel confident about: “making new friends,” “the way I dress,” “speaking in a group.” In our research, we worked with Ypulse, a polling firm that focuses on tweens and teens, to survey more than 1,300 girls from the ages of 8 to 18 and their parents. (The sample was broadly representative of the country’s teen population in terms of race and geographic distribution.) The data is more dramatic than we’d imagined: The girls surveyed were asked to rate their confidence on a scale of 0 to 10, and from the ages of 8 to 14, the average of girls’ responses fell from approximately 8.5 to 6—a drop-off of 30 percent.

Until the age of 12, there was virtually no difference in confidence between boys and girls. But, because of the drop-off girls experienced during puberty, by the age of 14 the average girl was far less confident than the average boy. Many boys, the survey suggested, do experience some hits to their confidence entering their teens, but nothing like what girls experience. (The Ypulse survey did not break down its findings at a granular enough level to discern if there was any correlation between kids’ race or income level and their self-described confidence.)

The female tween and early-teen confidence plunge is especially striking because multiple measures suggest that girls in middle and high school are, generally speaking, outperforming boys academically, and many people mistake their success for confidence. But the girls we talked with and polled detailed, instead, a worrisome shift. From girls 12 and under, we heard things such as “I make friends really easily—I can go up to anyone and start a conversation” and “I love writing poetry and I don’t care if anyone else thinks it’s good or bad.” A year or more into their teens, it was “I feel like everybody is so smart and pretty and I’m just this ugly girl without friends,” and “I feel that if I acted like my true self that no one would like me.”

Confidence is an essential ingredient for turning thoughts into action, wishes into reality. Moreover, when deployed, confidence can perpetuate and multiply itself. As boys and girls (and men and women) take risks and see the payoffs, they gain the courage to take more risks in the future. Conversely, confidence’s absence can inhibit the very sorts of behaviors—risk taking, failure, and perseverance—that build it back up. So the cratering of confidence in girls is especially troubling because of long-term implications. It can mean that risks are avoided again and again, and confidence isn’t being stockpiled for the future. And indeed, the confidence gender gap that opens at puberty often remains throughout adulthood.

What makes confidence building so much more elusive for so many tween and teen girls? A few things stand out. The habit of what psychologists call rumination—essentially, dwelling extensively on negative feelings—is more prevalent in women than in men, and often starts at puberty. This can make girls more cautious, and less inclined toward risk taking. Additionally, at an early age, parents and teachers frequently encourage and reward girls’ people-pleasing, perfectionistic behavior, without understanding the consequences. Often, this is because it just makes parents’ and teachers’ lives easier: In a busy household or noisy classroom, who doesn’t want kids who color within the lines, follow directions, and don’t cause problems? But perfectionism, of course, inhibits risk taking, a willingness to fail, and valuable psychological growth. “If life were one long grade school,” Carol Dweck, the Stanford University psychologist who wrote The Growth Mindset, explained to us in an interview for our first book, women “would be the undisputed rulers of the world. But life isn’t one long grade school.”

In fact, later in life, the goalposts shift considerably. “It rewards people who take risks and rebound,” Dweck added. And the boys in our survey seemed to have a greater appetite for risk taking: Our poll shows that from ages 8 to 14 boys are more likely than girls to describe themselves as confident, strong, adventurous, and fearless.

Teen and tween girls are focused instead, according to our polling data, on setting impossibly high standards for themselves: Our polling data shows that the proportion of girls who say they are not allowed to fail rises from 18 to 45 percent from the ages of 12 to 13. In their efforts to please everyone, achieve more, and follow rules, many girls are actually nurturing traits in themselves that set them up to struggle in the long run. Adding to this, many girls are also wise enough by the age of 12 to see that the world still treats men and women differently—that dings their confidence, too.

Social media doesn’t help either, and its ill effects might hit girls harder than boys. The internet can multiply social stresses astronomically. In the past, girls could have an overwhelming day at school, fight with a friend, and get a “bad” grade, but go home and get some distance. There’s no distance anymore—only constant, instant, and public condemnation or praise.

There’s evidence that tweaking the status quo, and acclimating girls at this critical age to more risk taking and failure, makes a difference. Some of the most compelling data links participation in sports to professional success. A study from the accounting firm EY and espnW, ESPN’s women’s site, found that 94 percent of the women currently with C-suite jobs in the U.S. played competitive sports. It’s not only through athletics that young girls can gain confidence; sport is simply an organized and easily available opportunity to experience loss, failure, and resilience. But the same skills can be acquired by participating on a debate team, learning to cook, or speaking up on behalf of a cause like animal welfare—as long as there is a move outside of her comfort zone, and a process of struggle and mastery, confidence will usually be the result.

It’s essential to close the gap, and to do so early, because the long-term effects of these dynamics hurt not only girls, but the women they become, many of whom, within a few years of entering the workforce, experience another confidence drop, and a drop in aspirations. Their rule-following, good-girl methods have been celebrated, rewarded by a structured educational and societal system. It’s a shock to arrive in the adult world and discover a dramatically new playing field: Failure is okay. Risk is worth it. No wonder they struggle: Their whole life, to date, they’ve internalized just the opposite, a societal bait and switch that should be recognized. Girls are adept at learning—they just need the right study guide.

5 Strategies for Getting Kids off Devices

Ever try to pry a tablet from sticky fingers? Check out these tips to avoid the tantrum. By Christine Elgersma 
5 Strategies for Getting Kids off Devices

“Just a sec,” say nine out of 10 parents answering an email when their kid asks them for something. If it’s hard for us to jump out of the digital world, just imagine you’re 3 and the lines between fantasy and reality are already blurred — then throw in a super-engaging, colorful, fun, immersive experience. Or you’re 5 and each episode of Mutt &  Stuff on the Nick Jr. app is better than the last. Or you’re 8 and you’re almost finished building something amazing in Minecraft. Why would you ever want to stop?

This is why getting kids off their devices is so tough. And when threatening doesn’t work, and you discover the research that two-minute warnings aren’t the best option either, what can you do? Thankfully, the American Academy of Pediatrics (AAP) has some new guidelinesaround screen use that ease some parental guilt, but you still need to get your kid off the iPad at some point. Aside from being a strong role model, try these tips to minimize conflict and find the balance we’re all seeking.

  • Have another activity lined up (bonus points for making it seem fun). For the youngest device users, transitions are hard — period.  Even if the next “to do” is a “must do” (such as eating lunch), tell your kid what’s coming next. You can rehearse the process: “When I say stop, it’s time for the iPad to go night-night. Let’s see how fast you can flip it shut! As soon as it’s asleep, we can sneak into the other room and paint.”
  • Use visual and sound cues to help kids keep track of time limits. For kids who don’t yet know how to tell time, try a timer that can help put them in charge of the process: “When the time is up, it’ll look and sound like this.”
  • Find apps with built-in timers. Video streamers like Cakey and Huvi throw parents a bone and have internal timers so the app stops on its own. Then it’s up to the parent to make sure kiddo doesn’t just jump into another app.
  • Tell kids to stop at a natural break, such as the end of an episode, level, or activity. It’s hard for kids (and adults!) to stop in the middle of something. Before your kid gets on a device, talk about what they want to do or play, what will be a good place to stop, and how long they think it’ll take. Set the limit together and hold to it, though a little wiggle room (a couple of minutes so they can finish) is fine.
  • Discuss consequences and follow through when kids test the limits. When all else fails, it’s important to have discussed consequences for when your kid won’t give it up. For little kids, the line can be something like, “If it’s too hard to turn off, the tablet has to go away for a whole day.” For older kids it’s more about keeping devices in a public space, setting expectations, and enforcing them. If they show you they can be partners in moderating and regulating themselves, there can be more flexibility.