Evidence-Based Parenting

April 3, 2021 Leonard Sax MD PhD www.leonardsax.com

You can reach me at [email protected] (scroll to the bottom of the document for complete contact information).

The established consensus in 1964: encourage immigrant children to assimilate as soon as possible. For the scholarship underlying this consensus, see Milton Gordon’s monograph Assimilation in American Life: the role of race, religion, and national origins, New York: Oxford University Press, 1964. Because of this long-held consensus, the more recent finding that immigrant children now do better than American-born children is regarded as evidence of a “paradox.” Scroll to the bottom of this document for citations documenting the immigrant paradox. Disclaimers: I am not endorsing Dr. Gordon’s recommendations. 1964 was not the good old days; that era was much more racist and sexist than our own. Every era has its challenges.

The first two graphs I showed – demonstrating a marked in the proportion of people reporting either a major depressive episode, or serious psychological distress, 2009 to 2017 – with that rise seen among adolescents age 12 to 17, and young adults age 18 to 25, but not in older age groups – is taken from the paper by Jean Twenge and colleagues, “Age, period, and cohort trends in mood disorder indicators and suicide-related outcomes in a nationally representative dataset, 2005 – 2017,” Journal of Abnormal Psychology, April 2019, full text online at https://psycnet.apa.org/record/2019-12578-001. A comprehensive review of current scholarly literature documenting a recent rise in adolescent mood disorders, co-edited by Professor Twenge, is online at https://tinyurl.com/TeenMentalHealthReview.

Suggestion: If your first language was not English at home, speak your native language at home and ensure that your kids are fluent. Nurture connections with other families who share that language and that culture.

Leonard Sax MD PhD Page 2 of 16

The prioritizing of peer relationships over the parent-child relationship. In the 1960s, James Coleman found that the majority of American teens valued their parents’ opinion more than the combined opinion of all their friends. (He reported his findings in his monograph The Adolescent Society.) That’s no longer the case today. But peer relations are contingent and ephemeral. When peers matter more than parents, kids become anxious and fragile.

The culture of disrespect. The opening chapter of my book The Collapse of Parenting is titled “The Culture of Disrespect” – which is a fair summary of contemporary American popular culture, as experienced by children and teenagers. The Disney Channel exemplifies the culture of disrespect, with shows such as Dog with a Blog and Jessie and Liv and Maddie.

American popular culture now has toxic elements. Cardi B’s August 2020 video “WAP” broke records for the most streams in one week (93 million streams) and reached #1 on the Billboard Top 100. See my article “Why WAP Matters” https://www.thepublicdiscourse.com/2020/08/70643/.

Bruno Mars won six Grammys, including the Grammy for Best Song, for his song “That’s What I Like.” The song begins with these lyrics:

I got a condo in Manhattan Baby girl, what's hatnin'? You and your a-- invited So gon' and get to clappin' Go pop it for a player, pop-pop it for me Turn around and drop it for a player, drop-drop it for me

For more about Bruno Mars and his Grammy for Best Song, please see my essay “You and Your [Expletive] Invited,” online at https://www.psychologytoday.com/blog/sax- sex/201802/you-and-your-expletive-invited.

There is good and bad in contemporary American culture. The analogy to the big city. A big city has many great things: a beautiful art museum, a great science museum, a museum of history. But a big city also has dangerous, high-crime neighborhoods. You wouldn’t let your kid loose in a big city without adult guidance. By the same token, you shouldn’t let your kid loose on the Internet without setting some limits. Leonard Sax MD PhD Page 3 of 16

In my book Boys Adrift I ask: why are so many boys now disengaged from achievement, both in school and in the workplace?

The five factors which I believe are driving this phenomenon:

1) Changes in education over the past 30 years 2) Video games 3) Stimulant medications for ADHD such as Adderall, Vyvanse, Concerta 4) Endocrine disruptors (DEHP, BPA, PET) 5) “The revenge of the forsaken gods”

Video games Video games tend to shift motivation away from the real world, to the virtual world. In a large, prospective, longitudinal cohort study, Professors Craig Anderson and Doug Gentile found that boys playing violent games – particularly games which deployed a moral inversion – exhibited changes in personality over a period of 3 or more years. They become more selfish, less honest, more hostile, and less patient. Douglas Gentile, Craig Anderson, and colleagues, “Mediators and moderators of long-term effects of violent video games on aggressive behavior,” JAMA Pediatrics, volume 168, pp. 450 – 457, 2014.

After hearing testimony from Anderson and Gentile, The California State Assembly passed a law prohibiting the sale of video games to minor children if the games depicted “killing, maiming, dismembering, or sexually assaulting an image of a human being, if those acts are depicted” in a manner that “[a] reasonable person, considering the game as a whole, would find appeals to a deviant or morbid interest.” The United States Supreme Court, in a decision written by Justice Antonin Scalia, ruled the statute unconstitutional, rendering it null and void. In his concurrence, Justice Alito shared his concerns about the implications of the research, but agreed with Justice Scalia that regulating what games a child may play is the job of the parent, not the job of the state. Justice Scalia’s opinion, and Justice Alito’s concurrence, are both online at http://www.supremecourt.gov/opinions/10pdf/08-1448.pdf.

Consequences of playing video games include:

• Attention problems • Rule-breaking • Obesity and overweight

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Attention deficit. The most popular video games such as Grand Theft Auto and Call of Duty offer constantly-changing challenges, scenes, and characters. Often there are multiple characters on the screen. The successful player must continually be scanning up, down, and sideways for new assailants. Sustained concentration on a single item is a recipe for defeat: you didn’t respond to that rustle on the right of the screen which was your only clue to an impending ambush. Distractibility is rewarded. Not surprisingly, researchers find that the more time you spend playing video games, the more likely you are to develop difficulties maintaining sustained concentration on a single item. Conversely, researchers find that boys who already have difficulty concentrating and focusing tend to gravitate to video games, where their distractibility is an asset rather than a liability.1

Breaking rules. The world of video games is unreal. You can jump off a 20-foot ledge onto the concrete pavement below and continue chasing your enemy: no sprained ankle, no broken bones. You can race your car at high speeds, crash into a wall, and walk away unharmed from the wreck of your car. You can hijack a car in Grand Theft Auto – in fact you have to hijack a car in order to play the game. Not only is risky behavior allowed in games such as Grand Theft Auto and Call of Duty, rule-breaking behavior is required and rewarded. If you jump off that high ledge to chase after your opponent, you are much more likely to succeed in killing your opponent than if you “waste” valuable time by running down the stairs instead. Not surprisingly, researchers have found that adolescents who play these games are more likely to engage in dangerous driving behaviors such as speeding, tailgating, and weaving in traffic; they are more likely to be pulled over by the police; more likely to be in automobile accidents; and more willing to drink and drive.2 In another study, teens who were playing risky racing video games at age 17 or 18 were more than three times as likely, 5 years later, to have been involved in an actual car crash, compared with teens who did not play such games.3

Obesity. Boys who spend lots of time playing video games are more likely to become fat compared with boys who spend less time playing video games.4 There seem to be two mechanisms operating here. First, playing video games burns less calories than many other activities, such as playing actual sports. Secondly, less intuitively, playing video games seems to have a direct appetite-stimulant effect, worse than watching TV.5 That may be why time spent playing video games is significantly more likely to be associated with obesity and other bad health outcomes, compared with time spent watching TV.6

The average boy spends 1 hour 19 minutes a day playing video games – that works out to 9 hours and 13 minutes a week – compared with 14 minutes a day for girls – that’s 1 hour and 38 minutes a week. These figures come from The Common Sense Census 2019: media use by tweens and teens, available at no charge at www.commonsensemedia.org.

For reliable reviews of video games, go to www.commonsensemedia.org.

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Guidelines for video games 1) No more than 40 minutes/night on school nights 2) No more than 1 hour/day on weekends / vacations 3) Your minutes do not roll over 4) No games in which the primary objective is killing other people 5) No games with a moral inversion (such as Grand Theft Auto)

For more about video games, see my essay for Psychology Today, https://www.psychologytoday.com/us/blog/sax-sex/201805/fortnite-boys-and-self- control. See also my essay for The New York Times, “But Mom, video games are my job!” at https://www.nytimes.com/2019/10/29/well/family/video-games-adolescents- screen-time.html. And of course please see chapter 3 of my book Boys Adrift, second edition, which is devoted entirely to video games.

Social media For an ongoing scholarly review of evidence linking social media use to adverse mental health outcomes such as anxiety and depression, see the paper coedited by Jean Twenge and Jonathan Haidt, online at tinyurl.com/SocialMediaMentalHealthReview.

For the companion scholarly review of evidence demonstrating a rise in anxiety and depression among American adolescents since 2010, see the paper coedited by Jean Twenge and Jonathan Haidt, online at https://tinyurl.com/TeenMentalHealthReview.

Mike Stefanone: girls post more photos on their social media page than boys do; and the girls are more likely to point the camera at themselves. Michael A. Stefanone, Derek Lackaff, and Devan Rosen, “Contingencies of self-worth and social- networking-site behavior,” Cyberpsychology, Behavior, and Social Networking, 14:41-49, 2011. Stefanone and colleagues concluded that “Females tended to spend more time managing their profiles and shared more photos online. This was the case regardless of which dimension of self-worth influenced their behavior, and regardless of the size of their offline social support network. Females also identified more strongly with the appearance CSW” (p. 48; CSW = “contingency of self-worth”) The statement that “Females also identified more strongly with the appearance contingency of self-worth” is a scholarly way of saying that physical appearance determined self-worth for females more so than for males, and that the effect was significant (p < 0.01). See also my article for the New York Times, “Why do girls tend to have more anxiety than boys?” Leonard Sax MD PhD Page 6 of 16

April 21 2016, http://well.blogs.nytimes.com/2016/04/21/why-do-girls-have-more- anxiety-than-boys/.

Other scholars have extended this finding to note that girls are more likely than boys to post sexually-appealing or sexually-provocative photos of themselves. See Teens, gender, and self-presentation in social media” by Susan Herring and Sanja Kapidzic: this review is available at no cost at http://info.ils.indiana.edu/~herring/teens.gender.pdf. These scholars conclude that “in their visual presentations girls most often choose pictures that indicate a desire to appear attractive and sexually appealing” while that was less true, or not at all true, for boys. Jessica Ringrose and her colleagues have documented the emerging sexual double standard in social media, where girls feel pressure to present themselves sexually, and boys don’t. See their paper “Teen girls, sexual double standards, and sexting: gendered value in digital image exchange, Feminist Theory, volume 14, pp. 305 – 323, 2013.

Nicola Doring and her colleagues published a study of Instagram selfies, showing that teenage girls are much more likely to post sexualized poses, lying on their backs, etc. while the boys are much more likely to post selfies of themselves lifting something heavy, showing off their muscles etc. Their paper is titled “How gender-stereotypical are selfies?” Computers in Human Behavior, volume 55, pp. 955 – 962, 2016. See also the scholarly paper by Izaskun Sarabia and Ana Estevez, “Sexualized behaviors on Facebook,” Computers in Human Behavior, volume 61, pp 219 – 226, 2016, which reinforces many of these same points.

Jacqueline Nesi and Mitchell Prinstein, Journal of Abnormal Child Psychology, 2015, found that the more time kids spend on social media, looking to see how many likes they got on their own posts, and looking to see what other kids were doing online, the more likely those kids were to become depressed.

Sara Thomas found that many girls agree to send provocative selfies to their boyfriends because 1) all the other girls are doing it, and 2) they don’t know how or why to say no. See her paper “’What Should I do?’: young women’s reported dilemmas with nude photographs,” Sexual Research and Social Policy, volume 15, pages 192 – 207, 2018.

Inflexion point at 40 minutes: how come? Kids using social media less than 40 minutes a day are using social media to FACILITATE their social life. Kids who are spending much more than 40 minutes are often PRODUCING photos and/or videos for social media. (For the inflexion point at 40 minutes, see Twenge and Leonard Sax MD PhD Page 7 of 16

Campbell, “Media Use is Linked to Lower Psychological Well-Being,” Psychiatric Quarterly, June 2019, https://pubmed.ncbi.nlm.nih.gov/30859387/.)

Julie Jargon’s suggestion: get your daughter off social media and on to video games, where she can be master of the universe! https://www.wsj.com/articles/why-boys- might-be-weathering-the-pandemic-better-than-girls-11598360400. Julie Jargon’s suggestion is NOT wise.

Guidelines for social media 1) No more than 40 minutes in any 24-hour period 2) Your minutes do not roll over 3) No expectation of privacy: parents have access to everything

Sara Thomas of Northwestern found that many girls agree to send provocative selfies to their boyfriends because 1) all the other girls are doing it, and 2) they don’t know how or why to say no. See her paper “’What Should I do?’: young women’s reported dilemmas with nude photographs,” Sexual Research and Social Policy, volume 15, pages 192 – 207, 2018.

I recommend that parents deploy programs such as NetNanny, MyMobileWatchdog, TeenSafe, or mSpy. “mSpy” is a terrible name, because you are NOT spying: you TELL your child that it is your job to know what they are doing online. You explain that it is the parent’s job to be aware of how much time their kids are spending online, and which sites they are visiting.

2021 update: NetNanny and MyMobileWatchdog have significantly DECREASED the power of their apps. They no longer enable monitoring of photos taken with the phone, and they do not allow monitoring of SnapChat and similar apps where photos “vanish.” MSpy does allow monitoring of photos and “ephemeral” apps such as SnapChat. For more information, see https://www.mspy.com/.

Many of the apps listed below are NOT stable on the iPhone. They can be uninstalled without the parent knowing – then reinstalled, so the parent doesn’t know what happened while the app was off the phone. Some of the apps listed below say that they work on the iPhone. I hear different reports from parents: some say it works on the iPhone, others say it can be uninstalled without their knowledge. If you are concerned, switch from Apple (iPhone) to Android (most other phones). I have no affiliation with Apple or Android or Samsung or anybody else.

Here are apps which parents have found useful:

Bark: monitors text messages, YouTube, and other social networks. Works on Apple and Android. https://www.bark.us/. Leonard Sax MD PhD Page 8 of 16

Screentime: https://screentimelabs.com/. Works on Apple and Android.

Circle: manages connected devices wherever they are. Works on Apple and Android. https://meetcircle.com.

Eset parental control: monitors content and limits screen time. Works only on Android. https://www.eset.com/us/.

Qustodio: monitors content including YouTube, limits screen time, easy-to-use dashboard from your own laptop. This is one of the few apps which works both on smartphones and on tablets and laptops. https://www.qustodio.com/en/

Another excellent option, as discussed in the presentation, is to give your child a "basic phone" - a phone that can make and receive phone calls and texts, but not surf the Internet or take photos. Two leading basic phones are Pinwheel and Gabb.

No devices in the bedroom! – i.e. phones, and no UNSUPERVISED Internet access. Here is the American Academy of Pediatrics announcement of the guidelines: https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/pages/media-and- children.aspx. The full text of the AAP guidelines, as published in the journal Pediatrics, is available at no charge at this link: http://pediatrics.aappublications.org/content/pediatrics/138/5/e20162592.full.pdf. Here’s a link from the AAP to create a “family contract” for kids’ use of media: https://www.healthychildren.org/English/media/Pages/default.aspx.

No child under 13 years of age should have a smartphone. That doesn’t mean that all 13-year-olds should have smartphones. It depends.

Who is responsible when kids send pictures on their cell phone? My answer: PARENTS are responsible. See my op-ed October 25 2013 for the Wall Street Journal, http://on.wsj.com/1dp0OXO. See also my discussion of this topic on Fox News, October 29 2013, http://video.foxnews.com/v/2781648798001.

The most important thing parents must teach kids about online communication: there is no privacy.

Your job is to be a parent, not a best friend. A best friend can’t tell you what to eat, or forbid you to watch pornography, or take away your phone at 9 pm; but a parent can, and must.

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Transforming the relationship: once the fun is there, the relationship becomes loving. Once the relationship is loving, parenting is easy. You must prioritize time to have FUN with your kid. See the chapter titled “Enjoy” in The Collapse of Parenting.

Justin Bieber had a big hit with his song “Born to be Somebody”: “I’ll light up the sky like lightning / this world will belong to me / I was born to stand tall”

Do not confuse being humble with being timid. Do not confuse self-esteem with courage. Simplest strategy to teach humility: household chores.

UCLA study: the new cult of fame “Being famous” was not presented as a desirable life objective in the most popular shows on American television 1967 through 1997. But as of 2007, “being famous” and “being wealthy” are now the most important things. See “The Rise of Fame: An historical content analysis,” online at http://www.cyberpsychology.eu/view.php?cisloclanku=2011061601.

Bloated self-esteem leads to narcissism and to resentment. If I’m so great, how come I have to work so hard for not much money?

Enlightened humility – founded in a genuine interest in other people – is more likely leads to contentment and happiness. A better definition of humility? “Being as interested in other people as you are in yourself.” To be successful in life, you must be willing to move from one failure to the next with no loss of enthusiasm.

Happiness = Reality minus Expectations Being humble → being happy Being proud → disappointment, envy, resentment

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We are addressing the factors driving the rise in the proportion of American kids who are anxious, depressed, and/or disengaged. The factors we are addressing today include: 1) The breaking of bonds across generations 2) The prioritizing of peer relationships over the parent-child relationship 3) The culture of disrespect 4) The new cult of fame and wealth 5) Video games 6) Social media

Two other factors which are important contributors, but which we do not have time to address, include 7) endocrine disruptors; and 8) confusion regarding the reality of the categories “male” and “female.” I address factor 7 in my books Girls on the Edge and Boys Adrift. I devote the final four chapters of my book Why Gender Matters to addressing factor 8.

Longitudinal cohort studies demonstrating the importance of Conscientiousness:

Brent W. Roberts and colleagues, “The Power of Personality: The Comparative Validity of Personality Traits, Socioeconomic Status, and Cognitive Ability for Predicting Important Life Outcomes,” Perspectives on Psychological Science, 2:313-345, 2007, full text at http://classdat.appstate.edu/COB/MGT/VillanPD/OB%20Fall%202012/Unit%202/ Personality%20Articles/The%20Power%20of%20Personality%202007.pdf. Terrie E. Moffitt and colleagues, “A gradient of childhood self-control predicts health, wealth, and public safety”, Proceedings of the National Academy of Sciences, 108: 2693 – 2698, 2011, full text online at http://www.pnas.org/content/108/7/2693.full.pdf+html. These two graphs come from Moffitt et al. 2011: Leonard Sax MD PhD Page 11 of 16

Conscientiousness (self-control, honesty) measured at age 12 is the best predictor of health, wealth, and happiness twenty years later, at age 32.

Therefore: Teaching self-control and virtue should be your top priority for your daughter or son. That’s not a sermon; it’s a robust empirical finding.

Jennifer Finney Boylan, “A Common Core for All of Us” New York Times, March 23 2014, https://www.nytimes.com/2014/03/23/opinion/sunday/a-common-core-for-all-of-us.html. She asserts that you should set your child free so they can discover their own right and wrong. For a rebuttal, see The Collapse of Parenting, pp. 133 – 134.

There is a false dichotomy between the “Tiger Mom” and the “Irish Setter Dad.” The Tiger Mom is all about achievement. The Irish Setter Dad just wants kids to have a good time. Both are mistaken. (I borrow the phrase “Irish Setter Dad” from P. J. O’Rourke’s article “Irish Setter Dad,” The Weekly Standard, April 4 2011, http://www.weeklystandard.com/irish-setter-dad/article/555534. I do not endorse O’Rourke’s article.)

Why is human childhood so long? A four-year-old horse is a mature adult. A four-year- old child has a long way to go. For more citations on this point, see my book The Collapse of Parenting, pages 11 – 15.

For a teenager, having a meal with a parent greatly decreases the risk of problems, and improves life satisfaction, in a “dose-dependent” fashion from days 1 through 7 (there are 7 days in a week). See Frank Elgar, Journal of Adolescent Health. The graph I showed is Figure 1 from their paper. https://www.jahonline.org/article/S1054-139X(12)00317- 5/abstract.

Ban the bedroom! Kids should not spend their free time in the bedroom. They should spend their free time in a family room, even if they are not interacting with family. No screens in the bedroom. No TVs in the bedroom. No video game consoles in the bedroom.

No headsets in the car. No earbuds in the car. No screens in the car. When you are in the car, you should be listening to your son or to your daughter, and your daughter should be listening to you, not to Bruno Mars or Cardi B. Leonard Sax MD PhD Page 12 of 16

The search for meaning. Without meaning, life has no point. The result is anxiety, depression, and disengagement. Your job as a parent is to educate desire: to instill a longing for things higher and deeper.

Why are kids in the United States today so much more likely to be anxious and disengaged compared with kids from the same demographic 30 years or event 10 years ago, and compared with young Australians or Swiss today? Here are my answers:  The bonds across generations have been broken  You must restore them  We have allowed the same-age peer relations to displace the family  Prioritize the family. Cancel the playdate. Make a family date instead.  We have allowed screens to displace real-world experience  You must change that: limit, govern, and guide how your kids use social media and video games  American culture now prioritizes fame and wealth over virtue and character  You must challenge that. You can’t change Hollywood. But you can create a culture of respect within your own home.  Many kids accept the contemporary American assumption, that professional success is the best road to happiness. You must model an alternative: that humility and contentment are the best road to happiness. That’s what the research shows. For more on this point, see David Brook’s essay “Five Lies Our Culture Tells,” https://www.nytimes.com/2019/04/15/opinion/cultural-revolution- meritocracy.html.

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Here are some comments about my books:

Why Gender Matters “. . . is a lucid guide to male and female brain differences.” New York Times

Boys Adrift “. . . is powerfully and persuasively presented. . . Excellent and informative references and information are provided.” Journal of the American Medical Association

Boys Adrift: “A must-read for any parent of boys. This is real science, and Dr. Sax thoroughly uncovers the important health issues that parents of boys need to be tuned into.” Dr. Mehmet Oz, host of “The Dr. Oz Show”

Girls on the Edge: “Packed with advice and concrete suggestions for parents, Girls on the Edge is a treasure trove of rarely-seen research on girls, offering families guidance on some of the most pressing issues facing girls today. Dr Sax’s commitment to girls’ success comes through on every page.” Rachel Simmons, author of Odd Girl Out and The Curse of the Good Girl

Girls on the Edge: “This is essential reading for parents and teachers, and one of the most thought-provoking books on teen development available.” Library Journal

Girls on the Edge: “The best book about the current state of girls and young women in America . . . offers astonishing and troubling new insight . . .” The Atlantic

The Collapse of Parenting: “One of the premier experts on parenting, Dr. Leonard Sax brilliantly articulates the problems parents experience with their children, then gives solutions. The Collapse of Parenting is academic but practical, simple but deep. If you have time to read only one book this year, read this one.” Meg Meeker MD, author of Strong Fathers, Strong Daughters and Strong Mothers, Strong Sons

The Collapse of Parenting: “With years of experience and research working directly with parents and children, Dr. Leonard Sax provides an important glimpse into parenting in modern times, where it’s gone wrong, and how to fix it. Being a parent has never been more important and Dr. Sax explains how to avoid parenting pitfalls and raise your children well.” Bill Bennett PhD, former US Secretary of Education

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The Collapse of Parenting: “A comprehensive breakdown of where parents have gone awry and how they can get back on track to teach virtue and character to their children. . . .Sax provides a series of easy-to-follow solutions that help bring parents and children back to the same page, working toward a healthier, more respectful, and conscientious attitude. . . .With the author’s solid advice, parents have a good shot at achieving these goals.” Kirkus Reviews

If you're going to read one book on parenting this year, make it The Collapse of Parenting by Leonard Sax. What makes a good nonfiction instructional book is an author who has extensive real world experience in the subject matter and who has the ability to write clearly. Leonard Sax has both.... This is quite simply a good book that is easily read and will provide sound advice for giving our children the best chance to succeed in life. New York Journal of Books

Contact information: Leonard Sax MD PhD MCRCAD (Montgomery Center for Research in Child & Adolescent Development) 64 East Uwchlan Avenue, #259 Exton, Pennsylvania 19341 Telephone: 610 296 2821 Fax: 610 993 3139 e-mail: [email protected] and [email protected] and [email protected] www.leonardsax.com

Documentation of the immigrant paradox: Here are some citations demonstrating that girls and boys whose families have recently immigrated to North America are less likely to be anxious, or depressed, compared with girls and boys born and raised in North America: • Margarita Alegria and colleagues, “Prevalence of mental illness in immigrant and non- immigrant Latino groups,” American Journal of Psychiatry, volume 165, pp. 359 – 369, 2008, full text online at no charge at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2712949/. • Huong Nguyen, “Asians and the immigrant paradox,” in Asian American and Pacific Islander Children and Mental Health, edited by Frederick Leong and Linda Juang, volume 1, pp. 1 – 22, 2011. • Liza Suárez and colleagues, “Prevalence and correlates of childhood-onset anxiety disorders among Latinos and non-Latino Whites in the United States,” Psicologia Leonard Sax MD PhD Page 15 of 16

Conductual / Behavioral Psychology, volume 17, pp. 89 – 109, 2009, full text available online at no charge at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2800359/. • David Takeuchi and colleagues, “Immigration and mental health: diverse findings in Asian, Black, and Latino populations,” American Journal of Public Health, volume 97, pp. 11 – 12, 2007. This article is an introduction to a special issue of the American Journal of Public Health (AJPH) devoted to documenting and understanding the interaction between immigration status and mental health in the United States. Full text online at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1716240/. From that special issue of AJPH, see for example “Immigration-related factors and mental disorders among Asian Americans,” American Journal of Public Health, volume 97, pp. 84 – 90, full text at http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2006.088401. Here is some of the evidence that girls and boys whose families have recently immigrated to the United States are less likely to engage in binge drinking or other forms of alcohol abuse, and/or substance abuse: • Michele Allen and colleagues, “The relationship between Spanish language use and substance use behaviors among Latino youth,” Journal of Adolescent Health, volume 43, pp. 372 – 379, 2008. • Donald Hernandez and colleagues, “Children in immigrant families: demography, policy, and evidence for the immigrant paradox,” in Cynthia García Coll and Amy Kerivan Marks (editors), The Immigrant Paradox in Children and Adolescents: is becoming American a developmental risk? Washington DC: American Psychological Association, 2011. • Guillermo Prado and colleagues, “What accounts for differences in substance use among U.S.-born and immigrant Hispanic adolescents? Results from a longitudinal prospective cohort study.” Journal of Adolescent Health, volume 45, pp. 118 – 125, 2009. Prado and his colleagues document that foreign-born Hispanic adolescents are significantly less likely to engage in drug abuse, compared with similarly-situated U.S.- born Hispanic adolescents. They conclude that the key difference is that the U.S.-born Hispanic teens are looking to their same-age peers for guidance, while the foreign-born Hispanic teens are looking to their parents and to other adults for guidance. • William Armando Vega and colleagues, “Illicit drug use among Mexicans and Mexican Americans in California: the effects of gender and acculturation,” Addiction, volume 93, pp. 1839 – 1850, 1998. For more documentation of the immigrant paradox with regard to adolescent sexuality, and intercourse before 15 years of age, see Marcela Raffaelli, Hyeyoung Kang, and Tristan Leonard Sax MD PhD Page 16 of 16

Guarini, “Exploring the immigrant paradox in adolescent sexuality: an ecological perspective”, chapter 5 in Coll and Marks, The Immigrant Paradox in Children and Adolescents: is becoming American a developmental risk? See also Tristan Guarini and colleagues, “The immigrant paradox in sexual risk behavior among Latino adolescents: impact of immigrant generation and gender,” Applied Developmental Science, volume 15, pp. 201 – 209, 2011.

Additional references regarding video games:

1 Edward Swing and colleagues, “Television and video game exposure and the development of attention problems,” Pediatrics, volume 126, pp. 214 – 221, 2010. See also Douglas Gentile and colleagues, “Video game playing, attention problems, and impulsiveness: evidence of bidirectional causality,” Psychology of Popular Media Culture, volume 1, pp. 62 – 70, 2012. 2 Jay Hull, Ana Draghici, and James Sargent, “A longitudinal study of risk-glorifying video games and reckless driving,” Psychology of Popular Media Culture, volume 1, pp. 244 – 253, 2012. See also Jay Hull and colleagues, “A longitudinal study of risk-glorifying video games and behavioral deviance,” 3 Kathleen Beullens and Jan Van den Bulck, “Predicting young drivers’ car crashes: music video viewing and the playing of driving games. Results from a prospective cohort study,” Media Psychology, volume 16, issue 1, 2013. 4 Stervo Mario and colleagues, “Frequent video-game playing in young males is associated with central adiposity and high-sugar, low-fibre dietary consumption,” Eating and Weight Disorders, volume 19, pp. 515-520, 2014. See also Catherine Berkey and colleagues, “Activity, dietary intake, and weight changes in a longitudinal study of preadolescent and adolescent boys and girls,” Pediatrics, volume 105, 2000, pp. e56; and Elizabeth Vandewater and colleagues, “Linking obesity and activity level with children’s television and video game use,” Journal of Adolescence, volume 27, pp. 71 – 85, 2004. 5 Jean-Philippe Chaput and colleagues, “Video game playing increases food intake in adolescents: a randomized crossover study,” American Journal of Clinical Nutrition, volume 93, pp. 1196 – 1203, 2011. 6 Megan Mathers and colleagues, “Electronic media use and adolescent health and well-being: cross-sectional community study,” Academic Pediatrics, volume 9, pp. 307 – 314, 2009.