Ask the Mediatrician

Making ‘friends’ with your children’s media—and how it can help you parent

The Mediatrician® contributed to the following post on A Platform for Good, the Family Online Safety Institute's resource page and blog.

Last winter, a father read an angry letter his 15-year-old daughter had posted on Facebook. In response, he put nine bullets into her laptop and posted the video online. Within weeks, it had garnered millions of hits and tens of thousands of comments.

Why so much attention? Certainly the shock value of his rage drew people’s attention. But he also verbalized some very common frustrations of parenting digital natives, and graphically played out a response to the powerlessness that parents often feel. Communicating feelings and finding ways to feel empowered are both important processes--but parents need ways to do so that support children’s healthy development, rather than terrifying and humiliating them.

Parents need a new way to relate to their children’s use of technology. They need information and skills that can help them see, understand, and feel welcomed to engage with the positive capabilities of these powerful tools. Here are some research-based ways to develop a friendly relationship with your children’s media use, teach your children to avoid possible pitfalls, and even use media to help you parent. Continue reading here.

My 15-year-old daughter is having pornographic conversations online--what do I do?

Q: I found out that my 15-year-old daughter has a profile on a social network site where she has pornographic conversations with boys. I am beside myself and don't quite know how to react or approach this. She has been acting differently and disrespectful recently and is extremely boy crazy! I am not sure if this is normal teenage behavior or if I need to get her into therapy. We live in a small community, but even here we know of instances where kids have been victims of Internet stalking and abduction. And last year, a classmate of my son’s was abducted, brutally raped, and murdered. I just can't understand why my daughter is getting involved with this kind of behavior. I have blocked access to our computers and wireless devices, but I don't want to totally block her phone access. I am just so upset, angry, and scared—how can I get through to her without driving her further into secrecy?
-Scared for my daughter, in Upstate New York

A: Dear Scared,

You’re right to be concerned about your daughter’s online behavior. Although it is normal for her to be ‘boy-crazy’, there is a difference between liking boys and making oneself vulnerable to exploitation and objectification. Your instinct to communicate with her about it rather than simply prohibiting all media use is a good one. 

Starting with your concerns about the behavior itself may lead to a direct conflict over issues that don’t get at the real problem (like your daughter saying that you “just don’t get the online world”). Focus on the real issue by considering what is driving her bahavior. Your daughter may be attempting to make sense of the abduction, rape, and murder that happened in your community by trying to regain control over her environment. You may want to discuss both the concerning behaviors and underlying influences on the behaviors with a pediatrician, or therapist. Your daughter may need professional assistance work through whatever is going on, especially if she won’t open up to you easily. For all of her bravado and disrespect, your daughter may actually be as frightened as you are--what you need to find are the feelings you share, and then use them to build an alliance.

Try talking with her by asking first about what other kids are saying: “How do your friends feel about it? Are they afraid this might happen to them?” Ask how her friends keep themselves physically and psychologically safe—both offline and online—and whether she does the same things or has different strategies. 

When she describes her feelings and coping strategies to you, try to listen without judging. If you can hear her views and explanations in a respectful way, no matter how outrageous they may seem, she will respond positively, open up more, and allow you to be on her side. Hopefully, your daughter will have the drive to take control of her life as a young woman--and the insight to come to her own conclusion that she needs to curb provocative and unsafe online behaviors.

If she is not developmentally ready to do this, then let her know, gently and with respect, that you do get the online world and that these behaviors are as dangerous as texting while driving or not putting on her seatbelt. Explain that, just as you would take away the car keys if she were to use poor judgment while driving, you will need to restrict her online access while she learns to care for herself and others in that environment. Explain that you know she can care for herself, and then set clear guidelines about what she needs to do to show you that she's ready to be a good--and much less restricted--digital citizen.

Enjoy your media and use them wisely,
The Mediatrician®

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My teen loves a role-playing game involving torture, what should I do?

Q: My 16-year-old son loves playing role-play games on the Internet. We recently became concerned, though, when we found out that the plots often involve torture. We are wondering why he is attracted to this kind of play and if there are any long or short term risks we should know about. We wonder if we should totally restrict his Internet access, but realize that this is not truly a realistic option. We do our best to keep the lines of communication open, but we need some guidance as to how to talk about our concerns with him.
-Tongue-tied, in Beverly, MA

A: Dear Tongue-tied,

Seeing your child engaged in this kind of play can certainly be alarming, and your impulse to talk to him about it is right on—but your discussion needs to be driven by reason rather than emotion, or it can backfire. Understanding what might be going on can help.

Kids are often drawn to media violence because it scares, upsets, or alarms them—they are attempting to master the troubling experience. But children who repeatedly engage with it until it doesn’t bother them can become desensitized to not only virtual violence but to real violence as well. This is a big part of the problem with exposure to media violence; it makes violence seem more common than it actually is and changes our beliefs about what’s normal.  

Another contributing factor may be your teen's “big” feelings, which may include a good deal of anger. His interest in these games may be driven partly by a need to explore those feelings. However, engaging in simulated torture is not a therapeutic way to do that. Short-term effects could include signs that he is more on edge, such as increased anxiety, sleep disturbances, and irritability. In the long term, he may see violence as a more acceptable way of addressing conflict.

It sounds like you’ve already set the groundwork for open communication about media messages, and talking about the issue of torture need not be very different. Still, there are some particular approaches that may be helpful in addressing this issue:

• Help him find a way to explore the “big” feelings. Restricting internet access won't make the feelings go away. That's why it can be helpful to have him work with a therapist to find a different, more therapeutic outlet for them, like sports or martial arts.
• Keep computer in public space, like the dining room table. That way he can play in areas where you can see what he’s doing and discuss it with him.
• Open a conversation about this game by playing with him, or sitting beside him while he plays. Ask him to teach you about the game and to explain what’s going on in it, how he feels playing it, and what he finds enjoyable about it. Listening to him can help you learn what needs this game is filling, and can open the door to brainstorming other ways to meet those needs.
• Set limits on content. It may be difficult to be reasonable rather than emotional at this point, but try saying something like, “As your parent, just like I can’t feed you junk food, I can’t let you practice hurting others. I see that you find it exciting, and I know that your rational mind understands it’s only make-believe, but getting used to even simulated torture changes you. I don’t want you to change that way.” Then work with him to find games that excite him but don’t include torture.

Remember that his media interests can offer a window into what he's processing internally, so a combination of setting limits on the content and helping him find another way to explore and process the feelings should serve the whole family well.

Enjoy your media and use them wisely,
The Mediatrician®

How do I limit my child's media time if he's physically fit and gets good grades?

Q: My child is in third grade, and he’s already diagnosed with ADHD. He has a high IQ, is in honors classes, and is physically active—he’s a Gold-medal wrestler. He still uses media for too many hours each day, though. Given that he’s in good shape and gets good grades, how can I tell him not to use so much media?
—Looking for Limits, in Hyannis, MA

A: Dear Looking,

Try approaching this issue a little bit differently. Instead of focusing on what isn’t working due to his media use, talk with him about how to make sure he can fit in all the important parts of his day.

For example, he needs to get enough sleep, go to school, go to wrestling practice, have at least one sit-down meal with family, play outside, and whatever else is important in your family. Media can be added to the time that’s left over. For ideas of how to make a daily calendar with your son, see this previous post.

For yourself, it might be helpful to think about what you think is affected by how much time he spends using media. Is it that he’s not getting enough sleep, or not spending time with his friends? Is he not getting enough outdoor time or enough time for free play? Thinking through these questions may help you feel more comfortable approaching this conversation with your son and give you a sense of what you would like to see included in his schedule.

Enjoy your media and use them wisely,
The Mediatrician®

How do I stop my teen from sharing inappropriate Facebook posts?

Q: We have stopped our 17-year-old daughter from using Facebook a number of times due to angry and inappropriate postings. We put unrecognizable passwords in, but she keeps creating or restarting Facebook pages. I believe she has one now, and I can’t find it. She has probably blocked me. Is there any way of totally blocking Facebook from our home? She is unable to control her reactions and what she says. We are at a loss.

-          Facebook Frazzled in Acton, MA

A: Dear Frazzled,

Frankly, it is difficult, if not impossible, to block Facebook from her (remember, in the days of smartphones and free wifi sites, blocking from your home is not enough). However, it sounds as if keeping your daughter off of Facebook—even if you did manage it—wouldn’t solve the problem. Her angry posts probably reflect what she’s feeling in real life, and it sounds like she’s looking for an outlet for those feelings.

 It is important to remember where your daughter is developmentally as a teenager. At this stage, it is normal for your daughter to be exercising her independence and expressing how she feels. Social media sites serve these developmental needs well because they can be crafted by each user. The best way to address your daughter’s postings is by opening the doors of communication and engaging her in a conversation about them.

It may be helpful to start the conversation by asking her general questions or just having her share what’s going on in her life. This will help you understand your daughter’s point of view, and may even lead you to understanding the reasons behind her angry postings. As both a parent and pediatrician, I’ve seen many kids acting out because they have been victims of others’ hurtful actions or were exposed to inappropriate talk or behavior. Finding the source of your daughter’s anger can allow you to help her deal with her emotions and experiences in a developmentally healthy way.

Once you’ve talked it through and are both in a calm state, you may also want to remind your daughter that what she puts online reflects back on her and that inappropriate or angry content may have negative and long-lasting repercussions. Suggest some alternative means of expressing herself, such as talking with her friends, keeping a private journal or blog, or confiding in another trusted adult (or even a therapist) whom she feels respects her. Be sure to let her know that you are always there as a resource and that you support her in her efforts to deal with whatever she may be going through.

For more information on internet safety, please see:

• CMCH Internet Safety
• Facebook Safety Center

Enjoy your media and use them wisely,
The Mediatrician®

How can parents make the internet a safe place to play?

Q: With kids of all ages using the internet for everything from socializing to finding information to playing games, how can we keep them as safe as they can be in that world?

-Net Nervous

A: Dear Net Nervous,

You're right--just like the school playground, the internet is a place where children play, learn, and connect with others. But unlike slides and tire swings, the online world changes with each passing day. How can busy parents keep their children safe?

Fortunately, you don’t need to know all the ins and outs of the internet in order to parent well there. You can simply bring your offline parenting techniques to the online world, and we have a new Internet Safety Toolkit that can help you do that. Based on research and full of practical tips, these four tools offer age-specific guidance to help you parent in an ever-changing online world:

• Tool #1: The Basics
• Tool #2: For Content They See
• Tool #3: For Content They Make
• Tool #4: For How They Interact

You can also find these tools here. 

Enjoy your media and use them wisely,
The Mediatrician®

How can I stop my son from texting while driving?

Q: I’ve been begging my teen son not to text while driving, but I know he does it anyway. What can I do to get him to stop?
--Texting and Driving in Beverly, MA

A: Dear Texting and Driving,

You’re right to be concerned--according to a new study from the CDC, one third of U.S. teens report texting while driving. The issue has come front and center this past week, when an 18 year old became the first person in Massachusetts to be convicted of causing a fatal car crash while texting.

But stories like this and state prohibitions on texting and driving may not get the reaction you're looking for from your son. Research shows that knowing it's dangerous doesn't necessarily deter some young adults from texting while driving. And because his brain won't be able to fully process long-term consequences until he's in his 20s, the idea that an accident like this could happen to him may just not feel real.

To get the message across, try approaching the issue in a way:

1. Make sure to touch on consequences that he can grasp. Although it's important to talk about the very real dangers of texting while driving, it might help to also discuss those that are closer to what he has experienced--like not being allowed to drive. The young man who was convicted this week had his license revoked by a judge for 15 years.
2. Work with him to establish clear rules for cell phone use. He'll want to have his cell phone with him when he's in the car, but it doesn't have to be a distraction. Ask him what would help him keep his eyes on the road--turning the phone off completely? Leaving it in the glove compartment or the trunk? If he owns the solution, he is more likely to feel ownership of it and to abide by it.
3. Together, create real consequences for not abiding by the rules. Agree ahead of time on what happens if he does text while driving. Maybe for a period of time he loses the privilege of driving the car--or of having a phone.
4. Praise what he does well, and follow through on the consequences when he slips up. Both will reinforce how important this issue is.
5. Model the behavior you'd like to see--and put your phone away while you're driving, too. He will listen far more closely to what you do than to what you say.

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®

Ratings Reality: Who rates our media and what that means for children

CMCH staff member Kristelle Lavallee contributed the following post to Thriving, Boston Children's Hospital's pediatric health blog.

Are you looking to take the family to a movie but aren’t sure whether your child should see The Hunger Games (PG-13) or Bully (unrated)? If you base the decision on the Motion Picture Association of American (MPAA) ratings, the answer seems pretty cut and dry—“maybe” to Hunger Games, and “no” to Bully. But are the movie ratings the best guide to making healthy media choices for your children?

Based on the best-selling novel, The Hunger Games is a fantasy story where teenagers are pitted against each other in a battle to the death broadcast on live TV. In contrast, Bully is a “slice of life” documentary about peer-on-peer bullying in American schools.

Both movies center on children and teenagers, but the fictional Hunger Games, portraying “intense violent thematic material and disturbing images” (MPAA’s description) was given a PG-13 rating, while the documentary Bully with “some language” (MPAA again) was rated R. The producers of Bully knew that accepting an R rating would greatly limit the film’s impact as an educational tool for young viewers, so they chose to release it unrated. But when a film is released without an MPAA rating, it comes at a price: Fewer theaters are willing to show it, and those that do will treat it the same way they treat films unrated for extreme violence or sex. Continue reading here.