Well: Early Puberty in Girls Raises the Risk of Depression

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Credit Getty Images

When girls come in for their physical exams, one of the questions I routinely ask is “Do you get your period?” I try to ask before I expect the answer to be yes, so that if a girl doesn’t seem to know about the changes of puberty that lie ahead, I can encourage her to talk about them with her mother, and offer to help answer questions. And I often point out that even those who have not yet embarked on puberty themselves are likely to have classmates who are going through these changes, so, again, it’s important to let kids know that their questions are welcome, and will be answered accurately.

But like everybody else who deals with girls, I’m aware that this means bringing up the topic when girls are pretty young. Puberty is now coming earlier for many girls, with bodies changing in the third and fourth grade, and there is a complicated discussion about the reasons, from obesity and family stress to chemicals in the environment that may disrupt the normal effects of hormones. I’m not going to try to delineate that discussion here — though it’s an important one — because I want to concentrate on the effect, rather than the cause, of reaching puberty early.

A large study published in May in the journal Pediatrics looked at a group of 8,327 children born in Hong Kong in April and May of 1997, for whom a great deal of health data has been collected. The researchers had access to the children’s health records, showing how their doctors had documented their physical maturity, according to what are known as the Tanner stages, for the standardized pediatric index of sexual maturation.

Before children enter puberty, we call it Tanner I; for girls, Tanner II is the beginning of breast development, while for boys, it’s the enlargement of the scrotum and testes and the reddening and changing of the scrotum skin. Boys and girls then progress through the intermediate changes to stage V, full physical maturity.

In this study, the researchers looked at the relationship between the age at which children moved from Tanner I to Tanner II — that is, the age at which the physical beginnings of puberty were noticed — and the likelihood of depression in those children when they were 12 to 15 years old, as detected on a screening questionnaire.

“What we found was the girls who had earlier breast development had a higher risk of depressive symptoms, or more depressive symptoms,” said Dr. C. Mary Schooling, an epidemiologist who is a professor at the City University of New York School of Public Health, and was the senior author on the study. “We didn’t see the same thing for boys.” Earlier onset of breast development in girls was associated with a higher risk of depression in early adolescence even after controlling for many other factors, including socioeconomic status, weight or parents’ marital status.

Other studies, including in the United States, have shown this same pattern, with girls who begin developing earlier than their peers vulnerable to depression in adolescence. Some studies have found this in boys, though it’s not as clear. But there is concern that girls whose development starts earlier than their peers are at risk in a number of ways, and across different cultural backgrounds.

“Early puberty is a challenge and a stress, and it’s associated with more than depression,” said Dr. Jane Mendle, a clinical psychologist in the department of human development at Cornell University. She named anxiety, disordered eating and self-injury as some of the risks for girls. In her studies of puberty, she has found associations between early development and depression in both genders in New York children. In boys, the tempo of puberty was significant, as well as the timing; boys who moved more rapidly from one Tanner stage to the next were at higher risk and the increased depression risk seemed to be related to changes in their peer relationships.

Before puberty, Dr. Mendle said, depression occurs at roughly the same rate in both sexes, but by the midpoint of puberty, girls are two and a half times more likely to be depressed than boys.

Some of these children may already be at risk; Dr. Mendle said that early puberty is more common in children who have grown up in circumstances of adversity, in poverty, in the foster care system. But some of it is heredity and some of it is body type and some of it, probably, is chance.

Researchers have wondered about hormonal associations with depression; Dr. Schooling pointed out that their study found that depression was associated with early breast development, controlled by estrogens, but not with early pubic hair development, controlled by androgens. “There is no physical factor that we know about that would explain this; estrogen has been eliminated as a driver of depression in earlier research,” she said in an email. “We probably need to explore social factors to seek an explanation.” They also plan to follow up with their study population at age 17.

The biological transition of puberty, of course, occurs in a social and cultural context. One very important effect of developing early, Dr. Mendle said, is that it changes the way that people treat you, from your peers to the adults in your life to strangers. “When kids navigate puberty they start to look different,” she said. “It can be hard for them to maintain friendships with kids who haven’t developed, and we also know that early maturing girls are more likely to be harassed and victimized by other kids in their grade.”

Parents should be aware of the difficulties that children may experience if they start puberty earlier than their peers, but lots of children handle early development with resiliency, and even pride.

Children who start puberty early – say, 8 instead of 12 — are faced with handling those physical changes while they are more childlike in their knowledge and their cognitive development, and in their emotional understanding of what goes on around them.

Parents should keep in mind that the same protective factors that help children navigate other challenges of growing up are helpful here: All children do better when they have good relationships with their parents, and when they feel connected at school. And we should be talking about the changes to their bodies before they happen, and make it clear that all of these topics are open for discussion.

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Personal Health: Parenting Advice From ‘America’s Worst Mom’

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Credit Joyce Hesselberth

Lenore Skenazy, a New York City mother of two, earned the sobriquet “America’s Worst Mom” after reporting in a newspaper column that she had allowed her younger son, then 9, to ride the subway alone.

The damning criticism she endured, including a threat of arrest for child endangerment, intensified her desire to encourage anxious parents to give their children the freedom they need to develop the self-confidence and resilience to cope effectively with life’s many challenges.

One result was the publication in 2009 of her book “Free Range Kids: How to Raise Safe, Self-Reliant Children (Without Going Nuts With Worry).” A second result is the Free Range Kids Project and a 13-part series, starting Thursday on Discovery Life Channel, called “World’s Worst Mom.” In it, Ms. Skenazy intervenes to rescue bubble-wrapped kids from their overprotective parents by guiding the children safely through a sequence of once-forbidden activities and showing their anxious parents how well the children perform and how proud they are of what they accomplished.

The term “helicopter parents” applies to far more than those who hover relentlessly over their children’s academic and musical development. As depicted in the first episode of the series, it applies to 10-year-old Sam’s very loving mother who wouldn’t let him ride a bike (“she’s afraid I’ll fall and get hurt”), cut up his own meat (“Mom thinks I’ll cut my fingers off”), or play “rough sports” like skating. The plea from a stressed-out, thwarted Sam: “I just want to do things by myself.”

In an interview, Ms. Skenazy said, “Having been brainwashed by all the stories we hear, there’s a prevailing fear that any time you’re not directly supervising your child, you’re putting the child in danger.” The widespread publicity now given to crimes has created an exaggerated fear of the dangers children face if left to navigate and play on their own.

Yet, according to Peter Gray, a research psychologist at Boston College, “the actual rate of strangers abducting or molesting children is very small. It’s more likely to happen at the hands of a relative or family friend. The statistics show no increase in childhood dangers. If anything, there’s been a decrease.”

Experts say there is no more crime against children by strangers today — and probably significantly less — than when I was growing up in the 1940s and ’50s, a time when I walked to school alone and played outdoors with friends unsupervised by adults. “The world is not perfect — it never was — but we used to trust our children in it, and they learned to be resourceful,” Ms. Skenazy said. “The message these anxious parents are giving to their children is ‘I love you, but I don’t believe in you. I don’t believe you’re as competent as I am.’ ”

Dr. Gray, author of “Free to Learn: Why Unleashing the Instinct to Play Will Make Our Children Happier, More Self-Reliant, and Better Students for Life,” said in an interview, “If children are not allowed to take routine risks, they’ll be less likely to be able to handle real risks when they do occur.”

Case in point: His college’s counseling office has seen a doubling in the rate of emergency calls in the last five years, “mainly for problems kids used to solve on their own,” like being called a bad name by a roommate or finding a mouse in the room. “Students are prepared academically, but they’re not prepared to deal with day-to-day life, which comes from a lack of opportunity to deal with ordinary problems,” Dr. Gray said. “Over the past 60 years, there’s been a huge change, well documented by social scientists, in the hours a day children play outdoors — less than half as much as parents did at their children’s ages,” he said.

In decades past, children made up their own games and acquired important life skills in the process. “In pickup games,” Dr. Gray said, “children make the rules, negotiate, and figure out what’s fair to keep everyone happy. They develop creativity, empathy and the ability to read the minds of other players, instead of having adults make the rules and solve all the problems.”

Dr. Gray links the astronomical rise in childhood depression and anxiety disorders, which are five to eight times more common than they were in the 1950s, to the decline in free play among young children. “Young people today are less likely to have a sense of control over their own lives and more likely to feel they are the victims of circumstances, which is predictive of anxiety and depression,” he said.

There are also physical consequences to restricting children’s outdoor play because there are no adults available to supervise it. Children today spend many more hours indoors than in years past, which in part accounts for the rise in childhood obesity and Type 2 diabetes. Many elementary schools have even canceled recess, believing it is time better spent cramming children’s heads with facts and figures.

“Childhood should be a time of freedom and play, not building a résumé for college,” Dr. Gray said.

As Ms. Skenazy put it, “if parents truly believe children must be supervised every second of the day, then they can’t walk to school, play in the park, or wake up Saturday morning, get on their bikes and go have an adventure.”

Some 2,000 families were screened by the Discovery Life Channel to find 13 families crippled by anxiety yet willing to have an intervention. “The parents weren’t easy pushovers,” Ms. Skenazy said. “Some were very unhappy to see me at first. But once pride in what their children achieved replaced their fears, they were ecstatic — relaxed and happy instead of crippled with fear.”

Ms. Skenazy spent four days with each family, introducing a different challenge each day. Sam learned to cut cheese and slice a tomato with a sharp knife and then made sandwiches for his parents. He also learned to ride a two-wheeler.

“I don’t guarantee I’ll take away all their worry, just give them the confidence to loosen the reins on their kids,” she said. “Kids need roots and wings. Parents give them roots. I give them wings.”

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