Teens In Balance

Getting to Michelle Obama

I have to say I’m excited about Michelle Obama’s initiatve, Let’s Move! and the new foundation, Partners for a Healthier America.  This is great timing for BodiMojo, the online teen health destination we are building, with help from a Small Business Innovative Research grant from the National Institutes of Health. But here’s the question: if the initiative is truly about developing  “a strong network of members across the business, government, academic, and nonprofit sectors who will commit to accelerating efforts to address childhood obesity,” how does one actually get in front of Michelle or her group???

We’ve got a terrific online program built with the help of teens and being testing by about 250 Massachusetts high schoolers: BodiMojo. We’ve got a story to tell and we need to get the word out as we launch later this spring. I’m writing this on my personal blog so I can be brazen about my calling on friends and colleagues to help me lead the way to be part of this important national initiative. Really, I can’t afford a lobbyist.

So why teens, you ask?  Because they are the toughest and savviest group out there and they get short shrift on obesity prevention in lieu of the “risky” stuff, like sex and drugs.  Most obesity prevention programs target youngsters/tweens and families, but really teens are a key group.  (Brands and marketers know this: capture brand loyalty among teens and you have a customer for life.)

I hear it all time, “Teens don’t care about health!”  I honestly wonder if these people actually talk to teens.  Prevention messages may fall on deaf ears, but ask any teen if they care about their own health, and they’ll say yes. It’s just that they see it as part of who they are, not as some separate silo in their life they have to attend to – which is how grown-ups think (The life checklist: job, car, gym, kids, vacation, bills, etc.). 

Here’s the thing: Teens are making their own decisions and solidifying health habits that will transfer to young adulthood. They want to fit in, personalize their stuff, create an identity, and be part of civic life. They have strong opinions – and for the most part – make pretty wise decisions in spite of brain blips here and there. They care deeply about what they look like and just about all of them have body image concerns. In my estimation, we need to re-position “obesity prevention.” It’s time to brand healthy decision making as part of style – your personal charm. You know… your “mojo.”

So, help me get to Michelle.

Teen brains: Pumped by the power of peers

Just as I find myself seeped in adolescent psychology and health prevention efforts, it seems like the issue of  teen risk taking is perpetual in its concern and wonder.

Slate posted a two part series on adolescent risk taking by Alan E. Kazdin and Carlo Rotella. The first part of No Brakes! discusses the teen brain and why prevention messages don’t work – whether it is rational reasoning by parents, health 101 in schools, or pledges (as in virginity pledges  – like, no kidding).  On the other hand, they also explain that adolescent impulsivity is really no different than the grown up versions so give these teens a break.  However, the interesting aspect of the article is the influence of friends on decision-making and the brain’s internal reward system being pumped by the power of peers.  Kids make fairly good decisions when alone but when moved by the sprit of the group, they can land themselves in some pretty tricky situations.

Part 2 takes a pragmatic angle on the social-emotional brain systems of teens by providing some parenting tips.  “Now, if you're expecting modern science to produce a magic-bullet gimmick—or a pill—to contain teen risk, you're going to be disappointed,” the authors write. And indeed, their recommendations are pretty basic and commonsensical:  Monitor your kids, stay connected and engaged, keep them distracted, and help them to build skills and talents. This is all very practical but most parents know that even the best of efforts and even keel parenting might not work.  

Perhaps most interesting are the comments to the articles, which show just how darn hard it is to be a teen or a parent.  I think back on my teen years and I truly wonder how I survived it – not that I has a high risk taker, but I was in enough social situations and a few car accidents that could have gone the other way.  Of course, my parents had no idea – and I still won’t tell.

Where teen harassment and hope collide: The power of peers

Just as much as the childhood obesity crisis seems to be plaguing weekly headlines, so does the plight of childhood bullying. As recently as last month in my home state did a lovely young teen commit suicide after ongoing harassment by peers in her school. Commentary on the tragic event has been constant in terms of the failure that occurred in this school system, bullying legislation being pushed to the side, the problem of cyberbullying that magnifies the offline harassment, and what parents and schools can do to prevent it. NPR’s Here and Now, Robin Young discussed the issue today. Barbara Coloroso, a national expert and author of The Bully, the Bullied and the Bystander,  stated, “It’s a short walk from bullying to a hate crime.” She lives in Littleton, Colorado, the location of the Columbine school shootings.

Under this current atmosphere I picked up a book, Letters to a Bullied Girl, compiled by two teenage sisters, Emily and Sarah Buder, who in a concerted act of kindness, responded to a local news story about Olivia. Olivia had been targeted after she had an epileptic episode in school.  She changed school three times until finally home-schooled. Picked out as different or flawed by female peers, the length to which the harassment ensued was stunning in its cruelty. The girls created a webpage promoting hatred of Olivia, wore “I hate Olivia” bracelets and physically pushed her.  You get the idea. The forward of the book happens to be by Barbara Coloroso, who describes bullying as acts of contempt. She also spells out the characteristics of the bullying circle. It was on this latter note that I raised the subject with my middle schooler. In relaying Olivia’s story, she responded with shock, “That doesn’t happen in my school!”  But it could and it might.  Most bullying remains under the radar.  My level-headed tween could unwittingly ignor what might seem as typical kid joshing around and not realize that some kid might be getting that all the time -- relentlessly and without mercy.  It’s not ok to stand by.  I think she gets it.

The story of the Buber sisters as compassionate activists is instructive. Letters to a Bullied Girl is a selection of thousands of letters that poured in and is remarkable in its breadth.  It’s the kind of book you can only read in spurts as the stories and support in the letters are, at times, heart wrenching.  Of course, there are many historical stories of such cruelty and wars, current and past, based on power and contempt, and those that stood by. 

A famous case in psychology defined the phenomenon of the bystander effect.  Most college students learn about it in an intro psych course.  While not about bullying per se, the 1964 murder of Kitty Genovese brought to light a curious aspect of human behavior: the diffusion of responsibility. There were 38 people that either saw the attack on Kitty or heard her scream and no one did anything about it until it was too late (or so it has been told in the telling and retellings).  Since then numerous social psychology experiments have demonstrated the effect:  people think others are around; they assume some else will take some responsibility and figure “why bother?”

It’s the same with bullying, the expression of which has found a contemporary digital medium that keeps bullying alive, 24-7. A kid can’t hide in the comfort of home anymore. Bullying, online and off line, is a bother we all have to watch out for.  Thanks to two sisters who began a letter writing campaign that started with an email -- and the media that kept an inspiring news story alive -- hope and kindness prevailed.

Resource:  Stop Bullying Now

Teens and substance use: Do no harm or damage control?

The question whether brain research can be helpful in informing kids about drug use is nagging at me. I had the chance to ask a neurologist this question at a course at Harvard Medical School on school mental health. Luckily, it was the first session in the day and thereafter several other experts came around to it, more or less.  

My question centered around what kind of health information can be effective. Examples I offered were the scare tactics that The Meth Project uses in its video ad campaign in Montana, the standard health class that crams in all the bad things drugs and alcohol can do that wash over kids because they’ve heard it all before, telling or showing kids how cognitive function is impaired by substance use (e.g., “This is your brain on drugs and here are the consequences”), or having MADD come in or showing kids mangled up cars from drunk driving teens – or is there something else?  

And, how do you maintain a “do no harm” approach, if that even matters anymore since kids are exposed to the nasty effects of just about any risk behavior  – from unsafe sex, eating disorders, drug use, peer violence, and relationship abuse – in the movies, on the Internet, and in their community. 

What works?

Here were the answers:

Neurologist: Scare tactics may have immediate response but no real durable responses. I think: Yes, I know. That is the problem with PSAs intended to elicit fear and anxiety, so I push the question further.  What you do you do with teens at risk?  He says cognitive scripts and role-playing can be effective.  (If you can engage them to take the exercise seriously, that is.)

Psychologist: Ok, says another panelist, scripts won’t work when the teen is under the influence, so…

Use a “damage control model”, she offered. In other words, help the teen come up with strategies for self care when at a party, like having a friend keep tabs, designate a driver, call home, etc.  This assumes that friends have the wear-with-all, or that one has the courage to call a parent (even a cool parent who claims to be there under any circumstance if in trouble), or you know when you’ve had too much and can stop. Most of us grew up with this crisis-based friends and family model. I get the pragmatics of it. Kids will experiment so give them the tools to deal in the moment.

Behaviorist:  Well, says another expert later in the day: Don’t let a kid get to the point they are using [street] drugs.  This would assume that other substances have been tried that lead up to the hard stuff, but that’s not always the case.  (We all hear about that one episode that killed a kid.) This approach suggests that you intervene with kids before any problems show up or persist, and teach the kids the skills to manage problems that arise – problems that usually are deficits in skills (flexibility/adaptation, emotional regulation, communication, and so on). You know, use PREVENTION.  That means parents, teachers and doctors know when to intervene early enough. Sadly, that is hardly the norm.

Many of the problems that can lead to substance use or abuse can be subtle and persist under the radar. It seems to me the brain research is key to our understanding of the teen brain and addiction, but our tactics for prevention and intervention come down to some basic things with all experts basically in agreement:

• Stay connected to kids at all levels
• Check in with them, care about what is going on, stand by them in finding a solution together
• Collaborate (with student, teachers, parent, peers, community)
• Know about the strategies that work and don’t work in the classroom and out of school (recent research on bullying shows that some of the tactics we teach kids like “walk away”, “stand up for yourself”, “know it’s not your fault”, may be counterproductive), and
• Punishment doesn’t’ work.

If a kid is persistently in trouble or lagging behind, there is a reason – it most likely it has to do with developmental immaturity or lacking a skill/cognitive ability, communication skills, or is a survival reaction from traumatic experience. Pushing kids away with punishment will – on the whole – back fire. This message became loud and clear from a principal at a recovery high school.  Her motto, “Don’t suspend, amend.”  On the other hand, many kids fall through the cracks because they aren’t noticed or move with a crowd and get caught up in unsafe scenarios. So how to reach out and prevent at-risk behaviors?

Bottom line: Be engaged.

Relevant Resources:

Greene, Ross W. (2008).  Lost at School: Why Our Kids with Behavioral Challenges Are Falling Through the Cracks and How We Can Help Them.

Youth Voice Project

Helping Traumatized Children Learn

Bringing joy into schools?

Last week my hero was a 7-year old boy who raised $240,000 for Haiti by riding his bike around London. 

This week I have a new hero. His name is Steve Gross, founder of Project Joy (see opening video on website). He brings the radical notion of playfulness back into the lives of children, especially children who have been traumatized or live in traumatizing conditions.

A charismatic guy, clearly a motivational speaker whether he’d consider that label or not, he got a room full of teachers, principals, counselors, nurses and psychologists to stand up and play a game – a game that got at least 75% of the audience to get up and dance.

What I loved about his presentation however, was not getting the middle-aged grownups to have a little fun. He was demonstrating the concept of JOY by felt experience – Bringing joy back into teaching, into therapy, into childhood, and into the present moment.

At a presentation at a Harvard Medical School course on School Mental Health, he put on the screen this quote from the American Journal of Preventive Medicine:

“The most threatening health crisis facing children in America is exposure to adverse childhood experiences.”

That’s a wake up call. We worry about acting out behaviors, substance use, precocious sexuality, high school drop out rates, and youth violence. These are the issues that make the headlines in newspapers and the media and are of utmost concern.  What does not catch anyone’s attention is the antidote to these problems in childhood and who is doing this subversive work.  This is the mission of Project Joy:

“Our mission is to ensure that nothing destroys the playfulness of children.  Nothing.”

Mr. Gross defines playfulness as:  “The motivation to freely and joyfully engage with, connect with, and explore the surrounding world.”

And he’s talking from preschool on up… and I’d venture to guess his strategies work with adults, too, after getting this audience to loosen up.  He crafted the game with clear boundaries – you don’t have to play you don’t want to.  Here’s the message:

When children and teens have permission to play… they play!

Simple? Profound?

It’s necessary and it seems like too many professionals and educators have forgotten how to play. You can see it in grown-ups' contrained bodies, facial expressions, and attitudes. In my own child’s middle school, the sixth graders only get recess half the school year – it’s an “elective”. We lament about this modern reality of schools taking out PE and recess time. But play doesn’t just happen on the playground; it is a philosophy, an attitude, a commitment.

How does the Project Joy instill play in school settings?  Through games, choices, empowerment, co-creating rules, employing transitions for children who may be overwhelmed or over stimulated (use of breathing exercise or soft music), and role modeling and engagement by older kids with younger kids. In effect, playfulness can counteract the effects of trauma on the mind and body – it becomes a means for affect regulation, problem solving, and empowerment through connection with others.

Play changes physiology. Play = healing.

Bring it on.

Other Resources:

The ACE Project

Invisible Children – Kids At Risk Action

That’s not my brain (on drugs)!

Recently, I was in high school health class for the BodiMojo project and asked the teacher whether she was incorporating any of the cool adolescent brain research that is coming out. You know (or maybe not), the research that shows how the teen brain is exploding with growth, soaking up learning and experimentation, refining certain areas for executive functions… and how substance use can cause damage during this vulnerable time??

Yes, the school is referring to this latest research, she tells me. “Great!” I exclaim. “What do the kids think about it?” I ask this feeling excited by the prospect of an equally ebullient response.

 “It’s not my brain!”

WHAT? Yes, that’s the teen response she gets. Is it just cool to me, a geeky grown up who gets inspired easily with modern science? Oh, has nothing changed even with the advent of brain scans that SHOW what is going on?

If I knew what alcohol or drugs did to the intricate working of the brain when I was 15, I would have thought twice about some of the shenanigans I got involved in. But alas, I had a pretty level head like many other teens pushing the envelope.

Still, I left the high school deflated.

Then, as if the universe was feeling my lament, there have been a series NPR segments about the very topic of the teen brain after binge drinking and what meth addiction looks like (literally, the use of virtual tool that morphs your face – the intent is to appeal to teen vanity).  Worth a listen or a peek. I then came to some YPulse postings – my daily news on the happenings in teen market – to learn about Montana’s public health campaign to stop crystal meth use.  Ok, if brain scans won’t do it, these series of videos should make a kid stop and ponder, and hopefully not ever consider it (hence the campaign slogan: “Not Even Once.”)  I write this with a warning.  Watch before sharing with kids as the ads depict the extreme physical, emotional, and social consequences of being hooked on something as addicting as crystal meth. Not pretty. But that’s the point.

Fear tactics often fail. I’ll be curious to learn how The Meth Project does over the long haul. In the meantime, PBS's Frontline has a great website on the Teen Brain – a bit easier to digest.

 

The grey zone of eating disorders

I recently showed a group of graduate students what is now an outdated documentary by NOVA, Dying to Be Thin, narrated by Susan Sarandon. The program depicts the extreme forms of eating disorders among teens and young women: the anorexic ballet dancer, the bulimic adolescent trying to maintain a sense of control in a dysfunctional family, a marathon runner at risk for heart problems, and the recovered woman suffering in her 50s from osteoporosis. Clichés perhaps, but he program is still relevant. 

At one residential treatment center you see young girls in group therapy talk about how they learned to control their eating from a movie or a TV show about eating disorders – the very programs that try to bring awareness and foster prevention. All one has to do these days is look at an issue of People Magazine and wonder how teens interpret celebrities' plights with weight and body image. My class discussion, however, centered on what to do when a student comes to the health center for an unrelated reason, but discloses one or two eating symptoms or a weird exercise fetish. How do you intervene as a counselor or residential advisor? Or, even more common in the lives of these 20-somethings, what can you do as a friend?

It’s not easy, as most people with disordered eating patterns will vehemently deny they have any problem. Plus, who knows how many live with eating problems that go undetected, unbeknownst to love ones, and suffer silently.

On the books, the prevalence of classic eating disorders remains relatively low – less than 5% in the US – and that may be due to the specific symptoms needed to meet the criteria of a medical diagnosis. The people numbers, however, are staggering with estimates ranging from 10-24 million individuals. Of course, 90% of them are girls and women. What there is no statistical data for are the millions of girls – and boys – who suffer with “sub clinical” eating issues. 

The medical establishment has tried to capture this grey zone with the diagnosis of “Eating Disorder not other wise specified” or Ednos. But the diagnosis is only handy if people seek help for their symptoms. Most don’t. For those who do? A mere 10% of people with eating disordered behavior receive treatment and often it is not covered by health insurance.

Now comes a New York Times article by Abby Ellin, who has previously written a book about her story: Teenage Waistland.  She recently interviewed national experts on the subject, and concludes:

Perhaps the most difficult part of treating Ednos is that “normal” eating is such an elusive concept. Thinness tends to be the ideal, no matter what lengths people go to get there. 

Juxtaposed to the obesity epidemic that may strangle our health care system in the near future, it really does leave one pondering just what can be done when there is no "normal" anymore.

Size 12 and the new normal. What have we really gained?

My tween daughter and I watched, A Girl’s Life, a PBS documentary tracking four teenaged girls and contemporary issues. Since I had seen a screening already, I had to quality for my daughter that some of the situations would seem extreme and the language shocking, but if she had any questions we’d pause the DVD. Why the caveats? Well, I was following my own mantra of “Do No Harm” and I did not want to introduce ideas or behaviors that could someday be modeled, like the cyber-bullying and female gang violence vividly portrayed in the program. 

But, alas, the part that her 12- year-old brain took in was feeling sorry for the 15-year-old Analuz – a large size girl, buying a dress in Macy’s.  She had hard time finding a gown that fit. That my daughter had empathy was one step, that she got it that the retailers and media make it difficult for girls to feel good about their bodies, was the other. Now if she can carry that sensibility as she grows taller and gains weight is a hope. (Girls sprout up to 8 more inches and up to 40 pounds during puberty.)

Any woman knows that the odds are stacked against girls.  But as we wizen up, research shows that body acceptance goes up over time, but body dissatisfaction pretty much stays in the trenches. 

Coincidentally, there had been a news story about the American ski champion, Lindsey Vonn, who had to deal with the press. The issue was over a European Alpine ski coach (who had never seen her) quip about her heaviness being her athletic advantage. Taken out of context, apparently, the remark on her weight (as in overweight) caused a media ruckus.  Lindsey Vonn is stealth 5'10, 160 pound athlete. When you look a photo of her, you think: she’s not fat, she’s fit! My daughter sees her as a role model.

Also across my screen was a New York Times fashion article, The Triumph of the Size 12s. Certainly worth the read. It may be welcomed news that the fashion world is now embracing the average sized women, but that these women are considered fat within the industry still is a cause for outrage. The fashion world seems to be exploiting the natural female curves on these normal size women as appealing (which they are) but sees this in response to a “fat fetish” trend (as in men prefer it).

So what’s the translation here? “Fat” is the new normal?

Are Teen Parents More or Less Connected?

There have been a number of surveys, research reports and polls that are confusing. Are today’s parents in tune, overbearing, or clueless about what’s going on with their kids? Do they coddle or give to much power? Check out some recent reports from CBS’s Health in America poll, or the America Psychological Association's Stress in America survey.

Who are these kids anyway?

Don Tapscott, in his recent book, Grown Up Digital writes how the Net Generation (born between Jan 1977 and Dec 1997) is the first generation to be immersed in digital technology.  His multimillion-dollar research shows that this generation gets along pretty well with their Baby Booming parents. In fact, he refers to a “generation lap” vs. any gap. “The implications are huge,” he writes.” In some families, members have begun to respect each other as the authorities they actually are. This has created an engaged dynamic within families. If managed well by the parents, this dynamic can create more a open, consensual, and effective family unit.” 

 In our household, my husband is a Baby Boomer, I was born in the first year of Gen X (the baby bust generation) and my old daughter is was born in at the end Net Gen (aka Gen Y). Her 9-year-old sister falls in Gen Z (1998 to present). Four generations in one nuclear family.  We certainly experience a “generation lap.”  Like Tapscott describes in his book, our family enjoys and shares in certain cultural and social experiences that has spanned 40+ years.  The Beatles come to mind, as do living in this season’s “All you need is love” t-shirts from American Eagle.

Tapscott finds Gen Y (and  presumably Gen Z) is smarter (brains are wired differently), more civic minded, more creative, and, lo and behold, family matters. (Warning: These kids tend to stick around after college).

Yet, standing back and looking at the reports that seems to come across news headlines and twitter feeds it seems like parents are as clueless as ever about their kids behaviors: Sex, drugs and rock-and roll still prevail.  And to today’s parents seem to think their kids aren’t doing it as if total amnesia has occurred about their own coming of age in the late 60s, 70s and 80s.  

Like my 9 year old might blurt out, “What the?” 

Mostly, I take comfort in what Tapscott has to say about our digitally-marinated kids and he cites the trend data to show declines in unplanned teen pregnancies, lower rates of drug use, less violence, lower rates of smoking (not cool anymore), and higher IQs (cool to be smart), On the other hand, today’s teen behavior is also the by-product of the digital era:  They are more stressed, distracted, impulsive (think “sexting”), more exposed (You Tube and social nets), and have transferred school yard bullying to cyberland.

Seems like parents (I include myself, here ) might be missing the forest through the trees. Our brain neurons are too busy trying to keep up that we’re at risk for missing the obvious.

Teens In Balance: Hope for 2010

After reading a number of end of year reviews, end of decade reflections, top ten lists, about how the technology revolution has forever changed being in the world, the best and the worst, and all the great lives that have passed, I am left with one feeling. 

Astonishment.

What a decade in the scheme of the four I can look back upon.  I have to say this was the most challenging and I’m not sure if it is indeed because of all the cataclysmic events that have occurred (not to mention raising children) and the adult maturity to reflect on their impact, or the simple fact that it was filled with really difficult moments on a humanitarian scale.

I was a teen in the 80s and looking back it was not all that bad.  My mother might feel entirely different with all the things she was paying attention to in her world.

But I’m an optimist at heart – and my tendency is always to look toward the future for hope.  The fact of the matter is we received an NIH grant to build an online teen health destination (a lot of work, good timing -- and luck of course.).  I say to people “This was a gift.” And most say: “No, you worked hard for it.” Both are true.

We plan to launch BodiMojo in 2010.  One thing the project has done for me personally is to be connected with today’s teens and up to date on how they experience and see their unique challenges. (See our BodiMojo year in review on the compilation of teen health surveys and initiatives).  My twelve year old is a year shy for being allowed on the site (kids must be 13) but peeks over my shoulder as I work on it, plays some of the games to help us find glitches, and recently had me set up positive affirmations to go to her cell phone (“Daily Mojos”). 

“This IS cool, Mom!” Who could ask for more?

But I do. My personal motto is “Live with intention.” I believe in setting intention and then follow a chosen path, no matter how big or small.  Can we help this generation make better choices, live healthy lifestyles, make commonsense decisions, be kind to others?

So I take a measure of hope from a recent survey, Good Intentions: The Beliefs and Values of Teens and Tweens. Leave it to the Girls Scouts to boost the spirits with their nationwide survey among scouters and non-scouters. This 10-year follow up finds that today’s kids have level heads and  are making a shift toward more civic engagement and hold more responsible beliefs and values. Teens are more likely to vote when old enough, give to charity, and volunteer in their own community.

Cheers to that!