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When Social Media Is Really Problematic for Adolescents

Underlying problems may make some young people particularly vulnerable to what they find on social media, an expert says.

There has been a lot of worry about adolescents and social media over the past couple of weeks, with new studies and reports raising questions about mental health and vulnerability, sleep and suicide. I recently wrote about the question of whether the word “addiction” is helpful in understanding our worries about adolescents and their relationships to the devices that connect them to their friends and their world.

In mid-May, a report in JAMA looked at suicide rates among those aged 10 to 19 over the period from 1975 to 2016; boys have traditionally had higher suicide rates, but the gap has narrowed as rates rose among adolescent girls, with the largest percentage increases among girls aged 10 to 14. The study was accompanied by an editorial calling the role of social media use among adolescents “an urgent public health issue that merits further investigation.”

Another study, just published in JAMA Psychiatry, showed a suicide bump among 10- to 19-year-olds (both boys and girls, but a larger increase in girls) at the time of the release of the Netflix series “13 Reasons Why”; the study shows association, not causation, but raises the question of “media contagion” — that is, the possibility that the show and the intense discussion of it on social media may have led to some imitative behavior, and cites “the need for safer and more thoughtful portrayal of suicide in the media.”

Dr. Michael Rich, an associate professor of pediatrics at Harvard Medical School and the director of the Center on Media and Child Health at Boston Children’s Hospital, cautioned against the impulse to look for binary answers to complex problems by drawing too-simple connections between social media and suicide, or video games and violence.

“What we need to do is look at the whole picture around these young people; we need to look at how kids and how we all are using social media,” he said.

Children may use interactive media in problematic or dangerous ways because of underlying problems, or they may be particularly vulnerable to what they find on social media. And even while the specific links between social media use and mental health (in both directions) are debated, and researchers try to elucidate the connections and the risks, there is a general acknowledgment that the emotional landscape of the next generation is increasingly tied to those online connections, for better and for worse.

“The technology isn’t the problem, we’re the problem,” Dr. Rich said. “It’s the interactivity that draws some kids in.” At Boston Children’s Hospital’s Clinic for Interactive Media and Internet Disorders, he said, they are seeing four manifestations of what they call problematic interactive media use, including gaming (mostly boys), and social media (mostly girls). And then there is pornography, “which is touching kids younger and more profoundly than anyone imagines,” he said. And finally there is “information bingeing,” with kids “disappearing down a rabbit warren of hot links.”

What these different problematic behaviors have in common, Dr. Rich said, is that many of the children involved had underlying issues to start with, such as attention deficit hyperactivity disorder, social anxiety or depression. He and his colleagues are coming to believe, he said, that the problematic use of interactive media “is not a diagnosis at all, but is a syndrome of these other already established psychiatric disorders.”

And when kids get treatment for that underlying problem, he said, “We often find these behaviors disappear or get much more manageable.”

Dr. Ana Radovic, an assistant professor of pediatrics at UPMC Children’s Hospital of Pittsburgh, an adolescent medicine specialist who does research in mental health services, said that only about a third of teenagers with depression get treatment, and it can take a long time.

At a clinic that serves teenagers who are severely depressed or suicidal, she began doing interviews about how they were using social media, and found she was hearing both positive and negative stories. “For example, there was one teen who shared with me that she enjoyed following a band that she liked on Instagram, and it made her feel better,” Dr. Radovic said. “And then all of a sudden she saw a picture of the band member self-harming and cutting her arm.”

Other adolescents talked about finding help through online groups — perhaps they found support through L.G.B.T.Q. sites which they didn’t find at home with their families — or about being talked out of suicidal thoughts on Reddit. “It’s a balancing act for some of these teens, finding help and support online but not being able to filter out the negative things,” Dr. Radovic said.

And a great deal of that balancing act may have to do with how teenagers are feeling before they go on social media, which then affects what they do on their devices, as well as how they react. Kids who are already feeling depressed have a negative cognitive bias, which affects how they interpret what happens on social media, Dr. Radovic said: “It’s a complex relationship, where you start off, what happens to you online, how you interpret what happens to you.”

“Teens are really driven by their peers, really rewarded by peer interactions,” Dr. Radovic said. “They’re exploring their identity, being creative, and sharing things that they’ve done, but it’s difficult for them to filter out the negative,” she said, and even more so when they are already vulnerable.

There are changes that tech companies could make in how social media works, Dr. Radovic said, which might reduce some of those negatives and change the online experience. For example, Instagram is looking at doing away with “likes” in a pilot program in Canada, to reduce social pressure and comparisons. There are ways to make things safer, she said, and even helpful; social media could play a part in the “safety plans” that teenagers make to handle suicidal feelings, if they come.

On the other hand, Dr. Radovic said, “there’s more and more evidence about sleep and suicidality,” with poor sleep a risk factor. And a new report from Common Sense Media emphasizes the ways that mobile devices have invaded our bedrooms, with both teenagers and their parents reporting waking up to check their devices, and using them right before falling asleep — and first thing on waking up.

The ways we use our devices, and the ways our children use their devices reflect who we are and how we’re doing, but they also reflect the power of the technology. Dr. Radovic asked, “Can we change how people are using their social media so they’re not multitasking constantly, not having it keep them up?” Can we help teenagers filter their online experience to stay away from negative exposure? Or even help them figure out how to use social media to get help when they need it?

“We have sort of checked out of parenting in the digital domain and had them do their own thing both because we felt completely inept next to them, but also because they said, ‘this is my space, not yours,’” Dr. Rich said.

“They need us in that space — we draw an artificial distinction between online and offline, real world and virtual world,” while for them it is a seamless reality, he said. “We need to parent them in that space.”


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