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There is no shortage of possible causes: Overparenting, screens and social media, cutthroat academic and sports competition, political acrimony, social injustice, climate concerns, gun violence and virtual learning among others. What gets obscured when we lump all youths together, though, is that certain demographic groups are especially vulnerable to psychological problems and may disproportionately account for the overall trend.
In my practice and those of my colleagues, it is tween girls from ages about 10 to 14 who have struggled more than in the past. The belief has long been that middle school is the hardest period to get through, especially for girls, but a confluence of more recent societal and biological trends has led to a perfect storm for tween girls.
A recent study of 10- to 15-year-old British girls, for instance, found that behavioral difficulties and life dissatisfaction increased more among this group of girls than boys during the pandemic, compared to the pre-pandemic period. Another study, with Canadian and Australian girls, reported more anxiety and depression, relative to boys, during the same time.
Further back, the U.S. National Survey on Drug Use and Health found that the percentage of 12- to 17-year-old girls who experienced at least one major depressive episode in the past year rose from 12 percent to 25 percent between 2010 and 2020. For boys, the increase was from 5 to 9 percent during the same period.
And researchers at the Centers for Disease Control and Prevention found that emergency room admissions for self-harm doubled for girls ages 10 to 14 between 2010 and 2014, while they stayed mostly unchanged for other demographic groups.
Long-standing research shows that girls and boys do not initially differ much in their rates of anxiety and depression. But in the middle-school years, girls become much more depressed and somewhat more anxious, and these differences persist into adulthood. What happens during this critical period to make girls especially vulnerable?
“Puberty interacts with stress to make girls prone to depression, self-injury and other psychological problems” said Mitchell J. Prinstein, chief science officer of the American Psychological Association (APA) and the author of “Popular: Finding Happiness and Success in a World That Cares Too Much About the Wrong Kinds of Relationships.” “And the amount and variety of stress increases during tween years.”
The hormonal and neural changes of puberty occur just as stress related to appearance, family, school, social life and extracurriculars rises. During the middle-school years, research has found that girls generally start to care much more than boys about how they fit into the world and what their peers think of them. And that is an area in which they have only limited control.
“Girls’ brain areas involved in the sensitivity of social evaluation become more active during puberty,” said Jennifer S. Silk, professor of clinical and developmental psychology at the University of Pittsburgh. “And the more active this part of the brain is, the more at risk one is for depression, anxiety and even suicidality.”
At the same time, girls face the same pressure as boys that comes with more serious academics and, for example, sports demands in middle school. But research suggests that they often take to heart more the message that you must excel at everything. Between ages 12 and 13, the proportion of girls who said they were not allowed to fail increased from 18 to 45 percent.
“Tween girls work so hard at being perfect everywhere for everybody, that they inevitably fall short and are exhausted by the time they come home,” said Phyllis L. Fagell, clinical professional counselor, school counselor and the author of “Middle School Matters: The 10 Key Skills Kids Need to Thrive in Middle School and Beyond — and How Parents Can Help.” “Many would be surprised to hear how harshly they judge themselves and how self-critical their inner dialogue sounds.”
And girls often use less active coping strategies when dealing with difficulties. While boys engage more in distraction with, for example, physical activity and concrete problem-solving, past research has found that girls often dwell on the problems and on their negative emotions. This tendency to overthink and regurgitate negative content, either alone or with a friend, also surges with puberty.
Perfectionism, self-criticism and rumination are all, in turn, well-established risk factors for depression and related mental health issues.
Social shifts further hurt tween girls
Puberty has been starting earlier during the past three decades among girls; the trend for boys is much less pronounced. It’s not clear why this may be happening, but changes in nutrition, environmental toxins and stress have all been suggested. The pandemic seems to have accelerated the trend. Unfortunately, earlier onset of puberty has been linked with depression, anxiety, substance abuse and other psychological problems in girls.
The most frequently discussed contributor to the rise in youth mental health problems is technology use. Although overall research into this link has been inconclusive, some studies suggest that girls seem to be particularly negatively affected by social media.
After years of slow but steady increase in social media activity, tweens today use it 17 percent more than 2019. Unsurprisingly, girls are more engaged with social media, while boys play more video games. The problem is that the girls’ higher social media use affects them more strongly than boys. The more time they spend on Instagram, Snapchat, YouTube and TikTok, among others, the more they will probably experience depression, low self-esteem, poor body image, worse sleep and other mental health problems.
“In general, girls are more likely to engage in comparisons and to be affected by interpersonal feedback. And those tendencies predisposed them to depression,” said Prinstein. “Now those processes are hugely amplified with social media.”
A JAMA Network study published this year, with 84,011 participants between ages 10 and 80, found that the relationship between social media use and life satisfaction is most negative among young adolescent girls, compared with any other demographic group. This finding suggests the tween years might be a critical period during which girls should stay off social media as much as possible.
Besides being potentially toxic on its own, long hours of social media use prevent girls from engaging in behaviors that promote well-being, such as in-person interaction with friends, sleeping and physical activity.
For example, eighth-graders who meet up with their friends “almost every day” fell from more than 50 percent in the 1990s to about a quarter in 2015 — and is likely less now.
“What started before the pandemic just got worse with the restrictions on socializing and in-person school and activities,” said Deborah Roth Ledley, a clinical psychologist in Philadelphia and co-author of “The Worry Workbook for Kids.” “I’ve seen it affect girls badly because they shifted their social world online completely.”
Parents should be aware that, with the onset of puberty, their girls might need more support than before. A good place to start is to examine the amount of stress their daughters are feeling and, if needed, help them reduce the pressure or the number of scheduled obligations.
“Our study of tween girls early in the pandemic showed that, somewhat surprisingly, many were feeling more free, had more time to sleep and relax,” Silk said. “We can see it as a pandemic silver lining but also as a wake-up call that our girls are too stressed.”
We can counter girls’ perfectionism and self-criticism with self-compassion.
“Make sure that you model self-compassion by how your treat yourself, because tweens are watching us even when we think they’re only peer-focused,” said Karen Bluth, an assistant professor in psychiatry at the University of North Carolina at Chapel Hill and the author of the audiobook “Self-Compassion for Girls: A Guide for Parents, Teachers, and Coaches.” “And then help them question the validity of the self-critical voice by inquiring ‘Is that true all the time?’ ‘Is it really, really true?’ ‘Are you absolutely sure, without a doubt?’ ”
When it comes to social media and the smartphones on which it is most often accessed, try your best to delay both until high school. “Give them a flip phone until they are 14 and always collect screens by 9 p.m.,” Prinstein said. Online organization Wait Until 8th can provide helpful tips.
To get your tweens onboard, make screen policies together by creating a family media plan. Then commit to it, implementing consequences if needed. Be sure to model healthy technology-related behaviors, such as having off-screen times and spaces, not sleeping with a phone and discussing what you see online.
Talk to your daughters about their values and their goals in using social media.
“Appeal to their social justice beliefs, to not wanting to be manipulated by companies,” Fagell said. “And discuss empathy — thinking how their online involvement affects others. That will bolster their sense of agency and counter helplessness and hopelessness.”
Bluth suggested inviting tween girls to experiment with social media by varying the type of use (passive vs. active or interactive), the timing (first thing in the morning vs. later vs. late at night) and the duration, and checking how they feel afterward.
“Ask them if they feel good, connected, having a sense of purpose versus bad about themselves, sad, worried, lonely,” she said.
Finally, always keep the lines of communication open. Be curious about girls’ lives, but do not bombard them with questions and put pressure on them. Share your own middle-school hardships and mishaps. And more than anything, listen.
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