Technology and social media now occupy a central place in the lives of our children and adolescents. According to data from the Pew Research Center in 2012, 75% of U.S. adolescents text. Texting has far outpaced phone calls and e-mail among adolescents as the primary means of (electronic) communication with family and friends. The number of texts they send has grown dramatically over the last few years, with a median of 100 texts sent daily among older adolescent girls in 2012. And it is increasingly challenging to distinguish texting from communication via other social media platforms: Flickr, Tumblr, Snapchat, Instagram, and Twitter. The new technology has augmented the local park or hangout as an essential aspect of adolescents developing their identity through intense interaction with peers.
We physicians who orbit the lives of adolescents may have difficulty keeping up with these developments, but we have a responsibility to be curious with our patients and their parents about the use of social media. We appreciate the developmental forces in adolescence that lead to new independence, heightened impulsivity, the intense importance of friendships, and sexual curiosity. When these developmental forces play out online rather than in high school hallways, there are new risks of unexpected consequences, serious psychological and even legal complications. In the same way that we speak with our patients and their parents about other risky behaviors, we should be curious about patients’ online behaviors and be prepared to offer them guidance as to how to lower risk and offer their parents guidance in establishing and enforcing reasonable rules and boundaries.
Texting is an increasingly commonplace means of communication. Many families will provide a new sixth grader with a cell phone to help the child manage a new bus route or a solo walk home, and texting can be an efficient way to stay connected.
But texting can pose a particular problem when it includes sexual material, or "sexting." Definitions vary, but sexting is most consistently defined as the taking of an explicit photograph of oneself and sending it to another via text or e-mail. There have been few controlled studies, but smaller surveys have suggested that between 20% and 30% of older adolescents have sent a sext, and a higher percentage have received them. Most of those sending these explicit photos are girls, and more than half of them report having been pressured to do so by a boy. While the likelihood of sending and receiving sexts is greatest among older adolescents, it can be a red flag for low self-esteem or social insecurity if a school-age or young teen is sending sexts.
More trouble can arise if these explicit photographs are shared with a wider audience, as can sometimes happen. This can lead to intense shame and psychological distress, bullying, and isolation; the subsequent stress can cause depression, anxiety, or even suicidality. Even without the shame of wide distribution, several studies have found a correlation between sexting and impulsivity and substance use in adolescents. Then there are child pornography statutes that can find 18-year-olds charged with a felony for sharing a photo of someone under 18. Beyond sexting, the circulating of other personal photos or posts (about drinking at a party, for example) can seem a harmless impulse, but these are often permanent and might haunt adolescents as they apply to college or for jobs. The consequences of an impulsive photo shared online can be unexpected, enduring, and occasionally devastating, and, like other teenage behavior, long-term consequences are rarely a top priority.
Although the value of staying connected so easily and frequently is enormous, these platforms also bring the possibility of predators who are looking to make more than a virtual connection with children and teens. The potential anonymity of these platforms also can make for group exchanges that can become mean spirited or abusive, and quickly deteriorate into cyberbullying. It can be difficult to find actual adults to supervise or manage these situations, and the risks for depression, anxiety, school avoidance, and suicidality among bullied adolescents (and among the bulliers) is well established.
Among other risks associated with extensive amounts of time spent virtually connected is the difficulty some adolescents have in shutting off or even silencing their phone; what precious little sleep they are getting is further squeezed by texts throughout the night. For those adolescents who have difficulty getting off of their phone or the computer, they can fall behind in school work or spend less time in the wide range of physical, intellectual, and creative activities that should be a part of a healthy adolescence. When too many relationships are managed virtually, teens can struggle with the nuances of communication and emotional understanding that happen in live exchanges. The abilities to be patient, to tolerate frustration or uncertainty, and to defer gratification are essential life skills, and are not cultivated in time spent tending virtual connections. These subtler risks of online activity may be especially pronounced for young people with problems with attention, impulsivity, mood, or developmental issues.