Ask the Mediatrician

Should I use the movie "Bully" to talk about bullying with my 10 year old?

Q: My 10-year-old son will be starting middle school in the fall. So far, he has had a pretty sheltered, drama-free experience at a great elementary school. I want him to be aware that bullying goes on and that he needs to tell someone if anything like that ever happens to him. I have thought about taking him to see the movie “Bully,” but am afraid that it will make him fear going to middle school. What do you think?
-Bothered about bullying, in Minneapolis, MN

A: Dear Bully Bothered,

Your concerns echo those of many parents who have children transitioning from one school to another. You are doing the right thing by trying to start a conversation about bullying with your son. However, your instincts on using “Bully” to introduce the subject are right on track. It may be too intense, since it includes a lot of physical and emotional child-on-child violence, as well as the suicides of bullying victims. Try opening the topic in another way.

One way approach could be to take your son for a drive and start the conversation in the car—that way, you won’t have to face each other as you talk, and his attention will be focused on the conversation (provided that he doesn’t have a book, DVD player, radio, or cell phone). Chances are your son isn’t so sheltered that he hasn’t heard about bullying, and he probably has some concerns of his own. Begin the conversation by allowing him to vocalize his thoughts:

1. Start with open-ended questions: “How are you feeling about starting middle school? What are you excited about? Worried about?”
2. It may help him talk if you depersonalize the topic, ask: “What worries do your friends have about school?”
3. If bullying hasn’t come up yet, you can present the issue from your own perspective, saying, “One thing I’m worried about is bullying, which we know can be an issue in some schools. Have you heard about that happening?" And "Please talk to me if you see anything that makes you uncomfortable. Together we can figure out a way to deal with it, and you’ll be helping to keep your school safe.”

When children and their schools see bullying as a community issue, they solve the problem by focusing on the needs of the bullies, victims, and the school community to make a positive change. This approach helps heal the community as a whole and is more effective than using a system of punishment, which often doesn’t address the core of the problem. Presenting the issue this way can help give your son a sense of shared responsibility for his school environment and will not only make him aware of bullying, but also empower him and his schoolmates against it.

For more information and resources check out:

• http://www.stopbullying.gov/
• http://www.ncpc.org/topics/bullying/what-parents-can-do

Enjoy your media and use them wisely,
The Mediatrician®

What can I do for my 15-year-old son, who has Asperger's and ADHD and seems addicted to video games?

Q: My son is 15 and displays symptoms of video game addiction, including lying and sneaking to try to gain access. He has Asperger’s and ADHD, and regardless of what medication regimen we try, the gaming obsession remains. I recently asked the psychiatrist to hospitalize him and treat him as they would other addicts, but they just changed his meds. Anyway, even if he were treated, he needs the computer for school. Do you have any advice for me?
-Dealing with Addiction, Orlando, FL

A: Dear Dealing with Addiction,

Unfortunately, more and more families share your story. Whether through sleep deprivation, anxiety, or social isolation, teens struggling with problematic video game or internet use are suffering, and their families are disrupted. And research shows that young people with ADHD may actually be more susceptible to problematic video game or internet use.

Part of why it’s so hard to find good treatment is that these symptoms have yet to be recognized as a formal psychiatric diagnosis in the U.S. (unlike in South Korea and China, where clinics, hospitals, and “detox” centers treat Internet Addiction Disorder). Still, there are steps you can take to help your son:

1. Keep working with mental health professionals. Make sure that his providers recognize and respect these particular problems.
2. Optimize his treatment. Just as youth with ADHD learn more effectively in the controlled computer environment than in the chaos of a classroom, they are also at higher risk for problematic internet behaviors. Similarly, the social awkwardness of Asperger’s syndrome feels more manageable online. That may be why there’s some evidence that problematic behaviors may decrease or disappear underlying issues are addressed in therapy and any medication is optimized.
3. Move his computer and internet access into common space. Your presence will help you help him regulate his computer behaviors. Be aware that smartphones and many portable digital players are wireless internet-capable, so treat them similarly.
4. Find diverse activities that fill his needs. Look for pursuits that have clear rules, and achievable goals, and that allow him to move at his own pace. Rock climbing or a martial art like tae kwan do or karate would build his mindfulness and self-discipline, while also providing exercise and positive social interaction.
5. Get him outside. Being immersed in nature has a calming and focusing effect. It can also be an effective context for treatment—wilderness therapy has worked wonders for some of my patients and could be a good option for your son.

Remember, too, that when used in moderation, computers and video games can help young people with ADHD and Asperger’s learn, grow, and thrive in ways that they cannot in more traditional educational and social contexts. For more information and resources, take a look at this website.

Enjoy your media and use them wisely,
The Mediatrician®

My 17-year-old is having serious anxiety since he started playing Call of Duty--is there a connection?

Q: My 17-year-old son started playing Call of Duty a few months ago. Since that time, he has had more trouble than usual falling asleep and has been waking up in the middle of the night. Last night, he woke me saying he felt like he was having a panic attack—racing heart and hyperventilation. I hadn’t associated it with his Call of Duty play, but when we talked about it last night, I realized that the timing lined up. Is there any evidence of violent video games bringing on stress or anxiety in young players?
     —Shoot or Scare, in Vancouver, British Columbia, Canada

A: Dear Shoot or Scare,

The key question is this: Did your son realize the association between the time when he started playing Call of Duty and his increased general anxiety punctuated by panic attacks?

The research shows that at his level of brain development, your son is more likely than an adult to have increased fear/anxiety after playing violent video games, but less likely to have the insight necessary to make the connections. He will be address this problem more effectively if he “discovers” the relationship himself and devises a solution. If he has not made the association, it will work better if you explore with him what might be stressing him at the moment, gently steering him toward his own observations rather than telling him yours.

The reason that kids get so involved with Call of Duty (the biggest selling video game to date) and other action games is that they are designed to put players on high alert—to get their adrenaline flowing and their hearts racing, ready for unexpected turns of events. Adolescents seek new experiences and sensations—it is an integral developmental task at your son’s age. Video games are one way in which they can vicariously experience fear and mastery of that fear in a situation that is not life-threatening.

Gently encourage your son to stop playing for two weeks or so and see whether his anxiety lessens. If it does, he may want to decide whether playing the game is worth living with the symptoms. If it doesn’t, the adrenaline rush of gaming may have unmasked an underlying anxiety—he may want to take a closer look at what else is happening in his life, and consider seeking help from a talk therapist to develop effective coping strategies. See this related post for more information.

Enjoy your media and use them wisely,
The Mediatrician®

How can I block sexual content in Web searches from my 15-year-old's iPad?

Q: What is the best way I can block websites with sexual content that appear through Web searches on my 15 year old’s iPad and still let him use the Internet for safe sites? The built-in controls are a blunt instrument and block too much or all content.
-Seeking Better Blocking, in Nashville, TN

A: Dear Seeking,

As you’re finding, software controls aren’t very effective at blocking sexual content. They may allow sites that are creatively named while blocking innocuous sites on, say, breast cancer awareness. Also, if your son wants to get around them, he will. That’s why the best software for protecting your son is the knowledge in his head.

First, know that it’s natural and healthy for him to be curious about sex. But as you imply, the world of sex online is a minefield: The images he sees there are likely to be unrealistic, dehumanizing, and treating sex as a commodity—as something to buy and sell rather than an intimate expression of love and trust. That can affect his understanding of sex.

That’s where you come in. As a parent, you can direct him toward online information that will support him in developing positive sexuality (take a look at Scarleteen and GoAskAlice). You can also help him interpret the negative portrayals he sees online by having a candid conversation with him. Ask questions like, “What is really going on there?”, “How do you think that makes her feel?” and “Is that the kind of relationship you want to have?”

The more that his sexual education can occur out in the open and in contact with you, the less of an impact the schoolyard or Internet “sex ed” will have.

Enjoy your media and use them wisely,
The Mediatrician®

My 10-year-old son is miserable since I took away Call of Duty--what do I do?

Q: My 10 year old used to be an avid skateboarder and baseball player—until Call of Duty on XBOX Live arrived. I didn’t in my wildest dreams think that he would become addicted to a video game. I have a 21 year old who played all of the games but was never ruled by them. Since my awakening, I have removed the game, but my son is miserable. How long does it take to deprogram him?
—Problem Gaming, in Kansas City, MO

A: Dear Problem Gaming,

More and more young people are being referred to me for Internet or video game behaviors that are causing real problems in their lives. It sounds like your 10-year-old son falls into that category. Unfortunately, time away from the game may not be enough to deprogram him—he probably needs professional help.

Even though our healthcare system that doesn’t recognize video game addiction as a formal problem, there are still steps you can take to help your son. You’ve already taken the first step: removing the game (though if he is indeed addicted, he will find other ways to keep playing). The next step is to find and make an action plan with a therapist who understands this kind of problem.

In the meantime, when talking about this with your son, frame this as a health issue, not as an issue of misbehaving. Your son's excessive game play could be a symptom of another issue—like social anxiety or depression—and it could be his way of taking refuge in a world he can control. Explain that you see how miserable he is, and that although he may not understand yet, the goal here is not to punish him but to make his life better.

For more information about signs, symptoms, and treatment, click here. Also check out this related post: My teen daughter's addiction to technology is ruining our family life--what should I do?

Enjoy your media and use them wisely,
The Mediatrician®

My 5 year old is afraid of TV—what do I do?

Q: My 5-year-old daughter does not like TV that involves conflict. She has no desire to see a Disney movie and even gets anxious when a kid gets lost on Veggie Tales. She'll watch Blues Clues, Yo Gabba Gabba, and Barney but has no desire to watch the shows for her own age. When a movie is shown in CCD or Kindergarten, she gets anxious and sometimes starts crying. Will her inability to distinguish reality from fantasy resolve with age? Or is she an overly anxious, sensitive child?
-Facing Fear, in Chicago, IL
 
A: Dear Facing Fear,

It’s wonderful that you’re observing so closely how your child responds to the media she’s using. Every child is different. Knowing your daughter and watching her as closely as you do will help you make the best decisions for her.

Because children younger than 7 or 8 can’t reliably tell what’s real and what’s not, things that don’t seem scary to you or to older siblings may terrify them. Even though cartoons are marketed for young children, most aren’t really designed with their developmental stage in mind. Conflict and suspense sell tickets to adults, whose brains understand that it’s not real, but children experience these things in a much more direct and primal way.

Many kids are encouraged or learn to cover the anxiety that these images provoke. Your daughter may simply be more transparent in her responses than others her age, and even if she does seem more sensitive than other children, that can be positive, too.

In any case, it’s likely that her fear will resolve with time, but don’t push her to achieve this developmental milestone earlier than she’s ready. That would simply encourage her pretend she is not feeling what she is feeling, which will make her more anxious in the long run. In the meantime, ask teachers and other caregivers to find alternative activities for her rather than forcing her—and peers who may be better at hiding their anxiety—to view TV or videos that trigger her very normal stress response to anxiety-provoking images.

Enjoy your media and use them wisely,
The Mediatrician®

Will my 7-year-old outgrow her fear of 3D movies like Puss in Boots?

Q: My seven-year-old daughter loves movies, and there are many 3D movies geared toward kids this holiday season—Arthur Christmas, Happy Feet 2, Hugo, Puss in Boots, and The Muppets. But when my friend took her to see Puss in Boots, which opens with snow falling, the 3-D snow really freaked my daughter out, and she refused to put the glasses back on the remainder of the film. Is this something she will grow out of? What should I do?
-Multidimensional in Atlanta, GA

A: Dear Multidimensional,

These movies can be exciting and fun—for some viewers. The 3D effect that is so engaging demands that our eyes and brains combine two artificially created 2D images into a single 3D image. This is much harder for the brain to do than it is to visually process objects that actually have three dimensions, like snow falling in real life. This processing uses parts of the brain that do not fully develop until the mid-20s (although even adults can develop eyestrain, headaches, and even nausea from watching 3D movies).

Because her brain is not fully mature, doing this work may be really uncomfortable for your daughter. It may also feel overwhelming to be “surrounded” by the movie, especially when it gets loud or scary. That’s part of what a lot of people like about 3D, but it isn’t enjoyable for everyone.

The fact that she took off the glasses and refused to put them back on actually sounds like a good thing: She’s taking care of herself. She’s determining for herself what feels good, and adjusting what she can to make herself comfortable. Those are good skills for a seven year old—or anyone—to have.

So even though your daughter may grow out of any physical discomfort with 3D, follow her lead. It’s not important for her to feel comfortable with or even like 3D. If you want to bring her to a movie, take a look at some reviews to make sure the content is right for her, and then watch it in 2D (which you can usually do in the same cineplex where it’s showing in 3D). After all, if she’s not enjoying the movie, her time—and yours—is definitely better spent elsewhere. 

Enjoy your media and use them wisely,
The Mediatrician®

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My teen daughter's addiction to technology is ruining our family life--what should I do?

Q: I am the mother of three daughters (15, 13, and 11). Although I try to set limits, technology is ruining my family life. My oldest daughter in particular is addicted to Facebook, Skype, texting, etc.—whenever I try to reduce or eliminate her access, she finds a way to be in touch with her friends. Plus, when she does interact with friends via technology, she gets anxious, which leads to increased use. What do you suggest?
-Anxious about Addiction, Metro West suburb, MA 

A: Dear Anxious,

As a teenager, your daughter is pursuing key developmental tasks through her media use—seeking experience, establishing individual identity, and connecting with peers. But the amount of time she is devoting to it, the exclusion of family, and the anxiety she is experiencing when interacting via technology—and the fact that she responds to it by increasing her use—are cause for concern and could be symptoms of addictive behavior. Although the formal diagnosis has not been established in this country, Internet Addiction Disorder is a recognized and serious problem in parts of Asia and Europe, and it is causing real problems for American adolescents and their families.

Address this issue quickly, directly, and with compassion. First, at a time when things are good and you are not in open conflict about your daughter’s media use, sit down and have a conversation with her. Ask how she feels about her media use. Listen to her. She may be unhappy or uncomfortable and may say so if she doesn’t feel criticized or attacked. Then, when the opportunity presents, tell her that she seems anxious when she communicates online, and that you are concerned for her. Ask her what she thinks might help.

It’s possible that she’s feeling lots of pressure to be constantly available. If she acknowledges that that’s the case, enlist her help in finding peace for herself and your family, but be prepared to help her with concrete guidance and boundaries. Offer to take the blame if her friends criticize her for not being available at all times—she can complain that mom takes the phone away to charge it between 9 pm to 6 am, or for even longer if she uses it too much. This way, she can save face while reducing her anxiety, as well as learning to manage her media use in the context of everything else she needs to do in a day.

It is possible, though, that she will resist any and all of your attempts to address the situation with her. If nothing you try works—if she really can’t stop and it continues to wreak havoc for her and your family—you may need to seek professional help.

Enjoy your media and use them wisely,
The Mediatrician®

The Mediatrician’s New Year’s Resolutions for 2011

Q: This year, I want to start making some better choices about media so I can better connect with my family. I usually hate resolutions—because who ever keeps them, really?—but am wondering what I might consider when deciding what and how to change.
- Determined for 2011 in Eden Prairie, MN

A: Dear Determined,

I’m with you. I don’t usually make New Year’s resolutions—they’re often idealistic and unrealistic and, thus, abandoned by mid-January. But this year, to create some that I could live with, I decided that my resolutions should adhere to three basic criteria: 

1) They cost basically nothing, so that there’s no financial barrier to achieving them.

2) They are worth keeping for their own sake, and because the process of keeping them is worthwhile. Perfection is not the goal—tweaking your family’s media use and enjoy the resulting time together is.

3) They’re fun!

The following are resolutions that I can and will try to follow throughout the year, and I welcome you to join me: 

Share media you love with your kids
What movies, songs, and books did you love at your child’s age? Share and talk about them with your kids. Then ask your kids to share their favorite media with you. Whether they teach you to play a video game or make a Facebook page, they’ll love getting to show their mastery, and you’ll get a window into their media worlds. Enjoying these shared experiences is also a fun way to bring media use into the realm of positive (as opposed to policing) parenting.

Make mindful choices
How many times do you find yourself or your kids turning on the TV, computer, or video game console out of habit? Or because you or they can’t think of anything else to do? As a New Year’s Resolution, transform media use into a purposeful choice. Watch a certain show or play a certain game, and then switch to another activity you enjoy. This will help your family use technology as the powerful tool it can be for learning, connecting, and entertaining rather than simply as a diversion.

Move screens into common rooms
When media use is confined to a shared space, it becomes a social rather than a solo act and must compete with the other demands of family life. This makes it easier to engage with media only when there is a focused reason to do so. It also gives parents greater access to what children are doing with media, and it gives children a way to understand (and accept) their parents’ responsibilities in overseeing their media use.

Create media together
Shoot video of your family, edit it, upload it to YouTube, and share the link with friends and family. Or build a website or blog about a favorite cause. Such activities emphasize that kids can not only receive but also create media. They also model how media can be used in public dialogue and true participatory democracy—concepts that kids may not understand now but can learn about over time. Instead of worrying that media are making us less individually and socially responsible, model ways in which media can make us more involved in life, each other, and our society.

Upgrade your interactions with others
Social media can be a wonderful addition to the host of ways you connect with people who live far away or with whom you’ve lost touch. They can help you locate folks and provide a way to connect as frequently as you’d like at your convenience (e.g., if you’re around the world from each other, you can be in regular communication despite the time difference). However, if communication with a given person remains exclusively virtual, you miss out on nuance and warmth that a voice provides. To regain some of these other aspects of human connection between in-person visits (or when visiting isn’t feasible), call a faraway friend on the phone. Or use email or texting as ways of arranging in-person gatherings. In this way, media can serve as tools for developing and nurturing true relationships. 

Share media-free family meals
Research shows that sitting down and sharing food protects kids against becoming overweight, as well as from a host of health risk behaviors, from anxiety and depression to early sexual activity to violence. The mealtime opportunity to share experiences and thoughts with those you love and trust is powerful prevention. But remember to keep the tube off: Having the TV on during that meal distracts you from each other and from your body’s signals of hunger and satiety, thus neutralizing the potential positive effects

Touch nature and let it touch you
Research shows that spending time with nature reduces anxiety, improves attention deficits, and contributes to free play and imagination. So turn off the TV, computer, and video games and take a family walk. Or grow a plant from a seed, and let everyone get dirt under their fingernails. Just be together, outside and unwired.

Unplug to bring back daydreaming
We parents so often focus on giving our children the best advantages we can: schools, lessons, sports, and media, all intended to help them learn and expand their minds. But no directed activity can take the place of daydreaming, free play, and even boredom, which is when we can let our thoughts wander and then be regrouped in new and unexpected configurations. This is when kids engage their creativity, develop a sense of self, and learn to reflect on what is important to them. All the knowledge in the world cannot compare with the ability to think deeply about it, and then imagine and create something better. Let’s give kids this crucial space.

Enjoy your media and use them wisely—and happy new year!
The Mediatrician®

The Good News about Children and Media in 2010

Q: It seems like all we ever hear about are the negative effects of media. What research has been done on using media in positive ways?
- Feeling Bleak in Boston, MA

A: Dear Bleak,

We’re so glad you asked! Indeed, studies in the past year indicate just how positive media can be for children and families when it is used in a controlled way, paying particular attention to its content and the context in which it is used. 

Here are some 2010 good-news highlights and the scientific studies they are based on:

1) Technology is aiding schools, providing educators with more interactive tools for teaching and giving students more opportunities to engage with classroom learning at home and beyond.

2) Children’s TV programming can have profound positive effects on child literacy, identity, and overall well-being, here and abroad.

3) While violent video games have been shown to incite viewers’ aggression, prosocial video games can have positive effects on children’s social behaviors. 

4) Active video games can increase physical activity in children—though these shouldn’t exceed time spent playing sports, playing actively outdoors, etc.

5) Community-based initiatives can have significant positive effects on educating kids about the importance of physical activity and how it contributes to fighting childhood obesity.

6) Media literacy programs for kids can work to educate them about making healthy lifelong decisions—about media and so much more.

Learn more about the studies behind these findings in the CMCH blog.

Enjoy your media and use them wisely,
The Mediatrician®