research in child and adolescent development ppt

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1 Chapter 1: Introduction to Child Development

Chapter objectives.

After this chapter, you should be able to:

• Describe the principles that underlie development.
• Differentiate periods of human development.
• Evaluate issues in development.
• Distinguish the different methods of research.
• Explain what a theory is.
• Compare and contrast different theories of child development.

Introduction

Welcome to Child Growth and Development. This text is a presentation of how and why children grow, develop, and learn.

We will look at how we change physically over time from conception through adolescence. We examine cognitive change, or how our ability to think and remember changes over the first 20 years or so of life. And we will look at how our emotions, psychological state, and social relationships change throughout childhood and adolescence. 1

Principles of Development

There are several underlying principles of development to keep in mind:

• Development is lifelong and change is apparent across the lifespan (although this text ends with adolescence). And early experiences affect later development.
• Development is multidirectional. We show gains in some areas of development, while showing loss in other areas.
• Development is multidimensional. We change across three general domains/dimensions; physical, cognitive, and social and emotional.
• The physical domain includes changes in height and weight, changes in gross and fine motor skills, sensory capabilities, the nervous system, as well as the propensity for disease and illness.
• The cognitive domain encompasses the changes in intelligence, wisdom, perception, problem-solving, memory, and language.
• The social and emotional domain (also referred to as psychosocial) focuses on changes in emotion, self-perception, and interpersonal relationships with families, peers, and friends.

All three domains influence each other. It is also important to note that a change in one domain may cascade and prompt changes in the other domains.

• Development is characterized by plasticity, which is our ability to change and that many of our characteristics are malleable. Early experiences are important, but children are remarkably resilient (able to overcome adversity).
• Development is multicontextual. 2 We are influenced by both nature (genetics) and nurture (the environment) – when and where we live and our actions, beliefs, and values are a response to circumstances surrounding us.  The key here is to understand that behaviors, motivations, emotions, and choices are all part of a bigger picture. 3

Now let’s look at a framework for examining development.

Periods of Development

Think about what periods of development that you think a course on Child Development would address. How many stages are on your list? Perhaps you have three: infancy, childhood, and teenagers. Developmentalists (those that study development) break this part of the life span into these five stages as follows:

• Prenatal Development (conception through birth)
• Infancy and Toddlerhood (birth through two years)
• Early Childhood (3 to 5 years)
• Middle Childhood (6 to 11 years)
• Adolescence (12 years to adulthood)

This list reflects unique aspects of the various stages of childhood and adolescence that will be explored in this book. So while both an 8 month old and an 8 year old are considered children, they have very different motor abilities, social relationships, and cognitive skills. Their nutritional needs are different and their primary psychological concerns are also distinctive.

Prenatal Development

Conception occurs and development begins. All of the major structures of the body are forming and the health of the mother is of primary concern. Understanding nutrition, teratogens (or environmental factors that can lead to birth defects), and labor and delivery are primary concerns.

Figure 1.1 – A tiny embryo depicting some development of arms and legs, as well as facial features that are starting to show. 4

Infancy and Toddlerhood

The two years of life are ones of dramatic growth and change. A newborn, with a keen sense of hearing but very poor vision is transformed into a walking, talking toddler within a relatively short period of time. Caregivers are also transformed from someone who manages feeding and sleep schedules to a constantly moving guide and safety inspector for a mobile, energetic child.

Figure 1.2 – A swaddled newborn. 5

Early Childhood

Early childhood is also referred to as the preschool years and consists of the years which follow toddlerhood and precede formal schooling. As a three to five-year-old, the child is busy learning language, is gaining a sense of self and greater independence, and is beginning to learn the workings of the physical world. This knowledge does not come quickly, however, and preschoolers may initially have interesting conceptions of size, time, space and distance such as fearing that they may go down the drain if they sit at the front of the bathtub or by demonstrating how long something will take by holding out their two index fingers several inches apart. A toddler’s fierce determination to do something may give way to a four-year-old’s sense of guilt for action that brings the disapproval of others.

Figure 1.3 – Two young children playing in the Singapore Botanic Gardens 6

Middle Childhood

The ages of six through eleven comprise middle childhood and much of what children experience at this age is connected to their involvement in the early grades of school. Now the world becomes one of learning and testing new academic skills and by assessing one’s abilities and accomplishments by making comparisons between self and others. Schools compare students and make these comparisons public through team sports, test scores, and other forms of recognition. Growth rates slow down and children are able to refine their motor skills at this point in life. And children begin to learn about social relationships beyond the family through interaction with friends and fellow students.

Figure 1.4 – Two children running down the street in Carenage, Trinidad and Tobago 7

Adolescence

Adolescence is a period of dramatic physical change marked by an overall physical growth spurt and sexual maturation, known as puberty. It is also a time of cognitive change as the adolescent begins to think of new possibilities and to consider abstract concepts such as love, fear, and freedom. Ironically, adolescents have a sense of invincibility that puts them at greater risk of dying from accidents or contracting sexually transmitted infections that can have lifelong consequences. 8

Figure 1.5 – Two smiling teenage women. 9

There are some aspects of development that have been hotly debated. Let’s explore these.

Issues in Development

Nature and nurture.

Why are people the way they are? Are features such as height, weight, personality, being diabetic, etc. the result of heredity or environmental factors-or both? For decades, scholars have carried on the “nature/nurture” debate. For any particular feature, those on the side of Nature would argue that heredity plays the most important role in bringing about that feature. Those on the side of Nurture would argue that one’s environment is most significant in shaping the way we are. This debate continues in all aspects of human development, and most scholars agree that there is a constant interplay between the two forces. It is difficult to isolate the root of any single behavior as a result solely of nature or nurture.

Continuity versus Discontinuity

Is human development best characterized as a slow, gradual process, or is it best viewed as one of more abrupt change? The answer to that question often depends on which developmental theorist you ask and what topic is being studied. The theories of Freud, Erikson, Piaget, and Kohlberg are called stage theories. Stage theories or discontinuous development assume that developmental change often occurs in distinct stages that are qualitatively different from each other, and in a set, universal sequence. At each stage of development, children and adults have different qualities and characteristics. Thus, stage theorists assume development is more discontinuous. Others, such as the behaviorists, Vygotsky, and information processing theorists, assume development is a more slow and gradual process known as continuous development. For instance, they would see the adult as not possessing new skills, but more advanced skills that were already present in some form in the child. Brain development and environmental experiences contribute to the acquisition of more developed skills.

Figure 1.6 – The graph to the left shows three stages in the continuous growth of a tree. The graph to the right shows four distinct stages of development in the life cycle of a ladybug. 10

Active versus Passive

How much do you play a role in your own developmental path? Are you at the whim of your genetic inheritance or the environment that surrounds you? Some theorists see humans as playing a much more active role in their own development. Piaget, for instance believed that children actively explore their world and construct new ways of thinking to explain the things they experience. In contrast, many behaviorists view humans as being more passive in the developmental process. 11

How do we know so much about how we grow, develop, and learn? Let’s look at how that data is gathered through research

Research Methods

An important part of learning any science is having a basic knowledge of the techniques used in gathering information. The hallmark of scientific investigation is that of following a set of procedures designed to keep questioning or skepticism alive while describing, explaining, or testing any phenomenon. Some people are hesitant to trust academicians or researchers because they always seem to change their story. That, however, is exactly what science is all about; it involves continuously renewing our understanding of the subjects in question and an ongoing investigation of how and why events occur. Science is a vehicle for going on a never-ending journey. In the area of development, we have seen changes in recommendations for nutrition, in explanations of psychological states as people age, and in parenting advice. So think of learning about human development as a lifelong endeavor.

Take a moment to write down two things that you know about childhood. Now, how do you know? Chances are you know these things based on your own history (experiential reality) or based on what others have told you or cultural ideas (agreement reality) (Seccombe and Warner, 2004). There are several problems with personal inquiry. Read the following sentence aloud:

Paris in the

Are you sure that is what it said? Read it again:

If you read it differently the second time (adding the second “the”) you just experienced one of the problems with personal inquiry; that is, the tendency to see what we believe. Our assumptions very often guide our perceptions, consequently, when we believe something, we tend to see it even if it is not there. This problem may just be a result of cognitive ‘blinders’ or it may be part of a more conscious attempt to support our own views. Confirmation bias is the tendency to look for evidence that we are right and in so doing, we ignore contradictory evidence. Popper suggests that the distinction between that which is scientific and that which is unscientific is that science is falsifiable; scientific inquiry involves attempts to reject or refute a theory or set of assumptions (Thornton, 2005). Theory that cannot be falsified is not scientific. And much of what we do in personal inquiry involves drawing conclusions based on what we have personally experienced or validating our own experience by discussing what we think is true with others who share the same views.

Science offers a more systematic way to make comparisons guard against bias.

Scientific Methods

One method of scientific investigation involves the following steps:

• Determining a research question
• Reviewing previous studies addressing the topic in question (known as a literature review)
• Determining a method of gathering information
• Conducting the study
• Interpreting results
• Drawing conclusions; stating limitations of the study and suggestions for future research
• Making your findings available to others (both to share information and to have your work scrutinized by others)

Your findings can then be used by others as they explore the area of interest and through this process a literature or knowledge base is established. This model of scientific investigation presents research as a linear process guided by a specific research question. And it typically involves quantifying or using statistics to understand and report what has been studied. Many academic journals publish reports on studies conducted in this manner.

Another model of research referred to as qualitative research may involve steps such as these:

• Begin with a broad area of interest
• Gain entrance into a group to be researched
• Gather field notes about the setting, the people, the structure, the activities or other areas of interest
• Ask open ended, broad “grand tour” types of questions when interviewing subjects
• Modify research questions as study continues
• Note patterns or consistencies
• Explore new areas deemed important by the people being observed
• Report findings

In this type of research, theoretical ideas are “grounded” in the experiences of the participants. The researcher is the student and the people in the setting are the teachers as they inform the researcher of their world (Glazer & Strauss, 1967). Researchers are to be aware of their own biases and assumptions, acknowledge them and bracket them in efforts to keep them from limiting accuracy in reporting. Sometimes qualitative studies are used initially to explore a topic and more quantitative studies are used to test or explain what was first described.

Let’s look more closely at some techniques, or research methods, used to describe, explain, or evaluate. Each of these designs has strengths and weaknesses and is sometimes used in combination with other designs within a single study.

Observational Studies

Observational studies involve watching and recording the actions of participants. This may take place in the natural setting, such as observing children at play at a park, or behind a one-way glass while children are at play in a laboratory playroom. The researcher may follow a checklist and record the frequency and duration of events (perhaps how many conflicts occur among 2-year-olds) or may observe and record as much as possible about an event (such as observing children in a classroom and capturing the details about the room design and what the children and teachers are doing and saying). In general, observational studies have the strength of allowing the researcher to see how people behave rather than relying on self-report. What people do and what they say they do are often very different. A major weakness of observational studies is that they do not allow the researcher to explain causal relationships. Yet, observational studies are useful and widely used when studying children. Children tend to change their behavior when they know they are being watched (known as the Hawthorne effect) and may not survey well.

Experiments

Experiments are designed to test hypotheses (or specific statements about the relationship between variables) in a controlled setting in efforts to explain how certain factors or events produce outcomes. A variable is anything that changes in value. Concepts are operationalized or transformed into variables in research, which means that the researcher must specify exactly what is going to be measured in the study.

Three conditions must be met in order to establish cause and effect. Experimental designs are useful in meeting these conditions.

The independent and dependent variables must be related. In other words, when one is altered, the other changes in response. (The independent variable is something altered or introduced by the researcher. The dependent variable is the outcome or the factor affected by the introduction of the independent variable. For example, if we are looking at the impact of exercise on stress levels, the independent variable would be exercise; the dependent variable would be stress.)

The cause must come before the effect. Experiments involve measuring subjects on the dependent variable before exposing them to the independent variable (establishing a baseline). So we would measure the subjects’ level of stress before introducing exercise and then again after the exercise to see if there has been a change in stress levels. (Observational and survey research does not always allow us to look at the timing of these events, which makes understanding causality problematic with these designs.)

The cause must be isolated. The researcher must ensure that no outside, perhaps unknown variables are actually causing the effect we see. The experimental design helps make this possible. In an experiment, we would make sure that our subjects’ diets were held constant throughout the exercise program. Otherwise, diet might really be creating the change in stress level rather than exercise.

A basic experimental design involves beginning with a sample (or subset of a population) and randomly assigning subjects to one of two groups: the experimental group or the control group. The experimental group is the group that is going to be exposed to an independent variable or condition the researcher is introducing as a potential cause of an event. The control group is going to be used for comparison and is going to have the same experience as the experimental group but will not be exposed to the independent variable. After exposing the experimental group to the independent variable, the two groups are measured again to see if a change has occurred. If so, we are in a better position to suggest that the independent variable caused the change in the dependent variable.

The major advantage of the experimental design is that of helping to establish cause and effect relationships. A disadvantage of this design is the difficulty of translating much of what happens in a laboratory setting into real life.

Case Studies

Case studies involve exploring a single case or situation in great detail. Information may be gathered with the use of observation, interviews, testing, or other methods to uncover as much as possible about a person or situation. Case studies are helpful when investigating unusual situations such as brain trauma or children reared in isolation. And they are often used by clinicians who conduct case studies as part of their normal practice when gathering information about a client or patient coming in for treatment. Case studies can be used to explore areas about which little is known and can provide rich detail about situations or conditions. However, the findings from case studies cannot be generalized or applied to larger populations; this is because cases are not randomly selected and no control group is used for comparison.

Figure 1.7 – Illustrated poster from a classroom describing a case study. 12

Surveys are familiar to most people because they are so widely used. Surveys enhance accessibility to subjects because they can be conducted in person, over the phone, through the mail, or online. A survey involves asking a standard set of questions to a group of subjects. In a highly structured survey, subjects are forced to choose from a response set such as “strongly disagree, disagree, undecided, agree, strongly agree”; or “0, 1-5, 6-10, etc.” This is known as Likert Scale . Surveys are commonly used by sociologists, marketing researchers, political scientists, therapists, and others to gather information on many independent and dependent variables in a relatively short period of time. Surveys typically yield surface information on a wide variety of factors, but may not allow for in-depth understanding of human behavior.

Of course, surveys can be designed in a number of ways. They may include forced choice questions and semi-structured questions in which the researcher allows the respondent to describe or give details about certain events. One of the most difficult aspects of designing a good survey is wording questions in an unbiased way and asking the right questions so that respondents can give a clear response rather than choosing “undecided” each time. Knowing that 30% of respondents are undecided is of little use! So a lot of time and effort should be placed on the construction of survey items. One of the benefits of having forced choice items is that each response is coded so that the results can be quickly entered and analyzed using statistical software. Analysis takes much longer when respondents give lengthy responses that must be analyzed in a different way. Surveys are useful in examining stated values, attitudes, opinions, and reporting on practices. However, they are based on self-report or what people say they do rather than on observation and this can limit accuracy.

Developmental Designs

Developmental designs are techniques used in developmental research (and other areas as well). These techniques try to examine how age, cohort, gender, and social class impact development.

Longitudinal Research

Longitudinal research involves beginning with a group of people who may be of the same age and background, and measuring them repeatedly over a long period of time. One of the benefits of this type of research is that people can be followed through time and be compared with them when they were younger.

Figure 1.8 – A longitudinal research design. 13

A problem with this type of research is that it is very expensive and subjects may drop out over time. The Perry Preschool Project which began in 1962 is an example of a longitudinal study that continues to provide data on children’s development.

Cross-sectional Research

Cross-sectional research involves beginning with a sample that represents a cross-section of the population. Respondents who vary in age, gender, ethnicity, and social class might be asked to complete a survey about television program preferences or attitudes toward the use of the Internet. The attitudes of males and females could then be compared, as could attitudes based on age. In cross-sectional research, respondents are measured only once.

Figure 1.9 – A cross-sectional research design. 14

This method is much less expensive than longitudinal research but does not allow the researcher to distinguish between the impact of age and the cohort effect. Different attitudes about the use of technology, for example, might not be altered by a person’s biological age as much as their life experiences as members of a cohort.

Sequential Research

Sequential research involves combining aspects of the previous two techniques; beginning with a cross-sectional sample and measuring them through time.

Figure 1.10 – A sequential research design. 15

This is the perfect model for looking at age, gender, social class, and ethnicity. But the drawbacks of high costs and attrition are here as well. 16

Table 1 .1 – Advantages and Disadvantages of Different Research Designs 17

Consent and Ethics in Research

Research should, as much as possible, be based on participants’ freely volunteered informed consent. For minors, this also requires consent from their legal guardians. This implies a responsibility to explain fully and meaningfully to both the child and their guardians what the research is about and how it will be disseminated. Participants and their legal guardians should be aware of the research purpose and procedures, their right to refuse to participate; the extent to which confidentiality will be maintained; the potential uses to which the data might be put; the foreseeable risks and expected benefits; and that participants have the right to discontinue at any time.

But consent alone does not absolve the responsibility of researchers to anticipate and guard against potential harmful consequences for participants. 18 It is critical that researchers protect all rights of the participants including confidentiality.

Child development is a fascinating field of study – but care must be taken to ensure that researchers use appropriate methods to examine infant and child behavior, use the correct experimental design to answer their questions, and be aware of the special challenges that are part-and-parcel of developmental research. Hopefully, this information helped you develop an understanding of these various issues and to be ready to think more critically about research questions that interest you. There are so many interesting questions that remain to be examined by future generations of developmental scientists – maybe you will make one of the next big discoveries! 19

Another really important framework to use when trying to understand children’s development are theories of development. Let’s explore what theories are and introduce you to some major theories in child development.

Developmental Theories

What is a theory.

Students sometimes feel intimidated by theory; even the phrase, “Now we are going to look at some theories…” is met with blank stares and other indications that the audience is now lost. But theories are valuable tools for understanding human behavior; in fact they are proposed explanations for the “how” and “whys” of development. Have you ever wondered, “Why is my 3 year old so inquisitive?” or “Why are some fifth graders rejected by their classmates?” Theories can help explain these and other occurrences. Developmental theories offer explanations about how we develop, why we change over time and the kinds of influences that impact development.

A theory guides and helps us interpret research findings as well. It provides the researcher with a blueprint or model to be used to help piece together various studies. Think of theories as guidelines much like directions that come with an appliance or other object that requires assembly. The instructions can help one piece together smaller parts more easily than if trial and error are used.

Theories can be developed using induction in which a number of single cases are observed and after patterns or similarities are noted, the theorist develops ideas based on these examples. Established theories are then tested through research; however, not all theories are equally suited to scientific investigation.  Some theories are difficult to test but are still useful in stimulating debate or providing concepts that have practical application. Keep in mind that theories are not facts; they are guidelines for investigation and practice, and they gain credibility through research that fails to disprove them. 20

Let’s take a look at some key theories in Child Development.

Sigmund Freud’s Psychosexual Theory

We begin with the often controversial figure, Sigmund Freud (1856-1939). Freud has been a very influential figure in the area of development; his view of development and psychopathology dominated the field of psychiatry until the growth of behaviorism in the 1950s. His assumptions that personality forms during the first few years of life and that the ways in which parents or other caregivers interact with children have a long-lasting impact on children’s emotional states have guided parents, educators, clinicians, and policy-makers for many years. We have only recently begun to recognize that early childhood experiences do not always result in certain personality traits or emotional states. There is a growing body of literature addressing resilience in children who come from harsh backgrounds and yet develop without damaging emotional scars (O’Grady and Metz, 1987). Freud has stimulated an enormous amount of research and generated many ideas. Agreeing with Freud’s theory in its entirety is hardly necessary for appreciating the contribution he has made to the field of development.

Figure 1.11 – Sigmund Freud. 21

Freud’s theory of self suggests that there are three parts of the self.

The id is the part of the self that is inborn. It responds to biological urges without pause and is guided by the principle of pleasure: if it feels good, it is the thing to do. A newborn is all id. The newborn cries when hungry, defecates when the urge strikes.

The ego develops through interaction with others and is guided by logic or the reality principle. It has the ability to delay gratification. It knows that urges have to be managed. It mediates between the id and superego using logic and reality to calm the other parts of the self.

The superego represents society’s demands for its members. It is guided by a sense of guilt. Values, morals, and the conscience are all part of the superego.

The personality is thought to develop in response to the child’s ability to learn to manage biological urges. Parenting is important here. If the parent is either overly punitive or lax, the child may not progress to the next stage. Here is a brief introduction to Freud’s stages.

Table 1. 2 – Sigmund Freud’s Psychosexual Theory

Strengths and Weaknesses of Freud’s Theory

Freud’s theory has been heavily criticized for several reasons. One is that it is very difficult to test scientifically. How can parenting in infancy be traced to personality in adulthood? Are there other variables that might better explain development? The theory is also considered to be sexist in suggesting that women who do not accept an inferior position in society are somehow psychologically flawed. Freud focuses on the darker side of human nature and suggests that much of what determines our actions is unknown to us. So why do we study Freud? As mentioned above, despite the criticisms, Freud’s assumptions about the importance of early childhood experiences in shaping our psychological selves have found their way into child development, education, and parenting practices. Freud’s theory has heuristic value in providing a framework from which to elaborate and modify subsequent theories of development. Many later theories, particularly behaviorism and humanism, were challenges to Freud’s views. 22

Erik Erikson’s Psychosocial Theory

Now, let’s turn to a less controversial theorist, Erik Erikson. Erikson (1902-1994) suggested that our relationships and society’s expectations motivate much of our behavior in his theory of psychosocial development. Erikson was a student of Freud’s but emphasized the importance of the ego, or conscious thought, in determining our actions. In other words, he believed that we are not driven by unconscious urges. We know what motivates us and we consciously think about how to achieve our goals. He is considered the father of developmental psychology because his model gives us a guideline for the entire life span and suggests certain primary psychological and social concerns throughout life.

Figure 1.12 – Erik Erikson. 23

Erikson expanded on his Freud’s by emphasizing the importance of culture in parenting practices and motivations and adding three stages of adult development (Erikson, 1950; 1968). He believed that we are aware of what motivates us throughout life and the ego has greater importance in guiding our actions than does the id. We make conscious choices in life and these choices focus on meeting certain social and cultural needs rather than purely biological ones. Humans are motivated, for instance, by the need to feel that the world is a trustworthy place, that we are capable individuals, that we can make a contribution to society, and that we have lived a meaningful life. These are all psychosocial problems.

Erikson divided the lifespan into eight stages. In each stage, we have a major psychosocial task to accomplish or crisis to overcome.  Erikson believed that our personality continues to take shape throughout our lifespan as we face these challenges in living. Here is a brief overview of the eight stages:

Table 1. 3 – Erik Erikson’s Psychosocial Theory

These eight stages form a foundation for discussions on emotional and social development during the life span. Keep in mind, however, that these stages or crises can occur more than once. For instance, a person may struggle with a lack of trust beyond infancy under certain circumstances. Erikson’s theory has been criticized for focusing so heavily on stages and assuming that the completion of one stage is prerequisite for the next crisis of development. His theory also focuses on the social expectations that are found in certain cultures, but not in all. For instance, the idea that adolescence is a time of searching for identity might translate well in the middle-class culture of the United States, but not as well in cultures where the transition into adulthood coincides with puberty through rites of passage and where adult roles offer fewer choices. 24

Behaviorism

While Freud and Erikson looked at what was going on in the mind, behaviorism rejected any reference to mind and viewed overt and observable behavior as the proper subject matter of psychology. Through the scientific study of behavior, it was hoped that laws of learning could be derived that would promote the prediction and control of behavior. 25

Ivan Pavlov

Ivan Pavlov (1880-1937) was a Russian physiologist interested in studying digestion. As he recorded the amount of salivation his laboratory dogs produced as they ate, he noticed that they actually began to salivate before the food arrived as the researcher walked down the hall and toward the cage. “This,” he thought, “is not natural!” One would expect a dog to automatically salivate when food hit their palate, but BEFORE the food comes? Of course, what had happened was . . . you tell me. That’s right! The dogs knew that the food was coming because they had learned to associate the footsteps with the food. The key word here is “learned”. A learned response is called a “conditioned” response.

Figure 1.13 – Ivan Pavlov. 26

Pavlov began to experiment with this concept of classical conditioning . He began to ring a bell, for instance, prior to introducing the food. Sure enough, after making this connection several times, the dogs could be made to salivate to the sound of a bell. Once the bell had become an event to which the dogs had learned to salivate, it was called a conditioned stimulus . The act of salivating to a bell was a response that had also been learned, now termed in Pavlov’s jargon, a conditioned response. Notice that the response, salivation, is the same whether it is conditioned or unconditioned (unlearned or natural). What changed is the stimulus to which the dog salivates. One is natural (unconditioned) and one is learned (conditioned).

Let’s think about how classical conditioning is used on us. One of the most widespread applications of classical conditioning principles was brought to us by the psychologist, John B. Watson.

John B. Watson

John B. Watson (1878-1958) believed that most of our fears and other emotional responses are classically conditioned. He had gained a good deal of popularity in the 1920s with his expert advice on parenting offered to the public.

Figure 1.14 – John B. Watson. 27

He tried to demonstrate the power of classical conditioning with his famous experiment with an 18 month old boy named “Little Albert”. Watson sat Albert down and introduced a variety of seemingly scary objects to him: a burning piece of newspaper, a white rat, etc. But Albert remained curious and reached for all of these things. Watson knew that one of our only inborn fears is the fear of loud noises so he proceeded to make a loud noise each time he introduced one of Albert’s favorites, a white rat. After hearing the loud noise several times paired with the rat, Albert soon came to fear the rat and began to cry when it was introduced. Watson filmed this experiment for posterity and used it to demonstrate that he could help parents achieve any outcomes they desired, if they would only follow his advice. Watson wrote columns in newspapers and in magazines and gained a lot of popularity among parents eager to apply science to household order.

Operant conditioning, on the other hand, looks at the way the consequences of a behavior increase or decrease the likelihood of a behavior occurring again. So let’s look at this a bit more.

B.F. Skinner and Operant Conditioning

B. F. Skinner (1904-1990), who brought us the principles of operant conditioning, suggested that reinforcement is a more effective means of encouraging a behavior than is criticism or punishment. By focusing on strengthening desirable behavior, we have a greater impact than if we emphasize what is undesirable. Reinforcement is anything that an organism desires and is motivated to obtain.

Figure 1.15 – B. F. Skinner. 28

A reinforcer is something that encourages or promotes a behavior. Some things are natural rewards. They are considered intrinsic or primary because their value is easily understood. Think of what kinds of things babies or animals such as puppies find rewarding.

Extrinsic or secondary reinforcers are things that have a value not immediately understood. Their value is indirect. They can be traded in for what is ultimately desired.

The use of positive reinforcement involves adding something to a situation in order to encourage a behavior. For example, if I give a child a cookie for cleaning a room, the addition of the cookie makes cleaning more likely in the future. Think of ways in which you positively reinforce others.

Negative reinforcement occurs when taking something unpleasant away from a situation encourages behavior. For example, I have an alarm clock that makes a very unpleasant, loud sound when it goes off in the morning. As a result, I get up and turn it off. By removing the noise, I am reinforced for getting up. How do you negatively reinforce others?

Punishment is an effort to stop a behavior. It means to follow an action with something unpleasant or painful. Punishment is often less effective than reinforcement for several reasons. It doesn’t indicate the desired behavior, it may result in suppressing rather than stopping a behavior, (in other words, the person may not do what is being punished when you’re around, but may do it often when you leave), and a focus on punishment can result in not noticing when the person does well.

Not all behaviors are learned through association or reinforcement. Many of the things we do are learned by watching others. This is addressed in social learning theory.

Social Learning Theory

Albert Bandura (1925-) is a leading contributor to social learning theory. He calls our attention to the ways in which many of our actions are not learned through conditioning; rather, they are learned by watching others (1977). Young children frequently learn behaviors through imitation

Figure 1.16 – Albert Bandura. 29

Sometimes, particularly when we do not know what else to do, we learn by modeling or copying the behavior of others. A kindergartner on his or her first day of school might eagerly look at how others are acting and try to act the same way to fit in more quickly. Adolescents struggling with their identity rely heavily on their peers to act as role-models. Sometimes we do things because we’ve seen it pay off for someone else. They were operantly conditioned, but we engage in the behavior because we hope it will pay off for us as well. This is referred to as vicarious reinforcement (Bandura, Ross and Ross, 1963).

Bandura (1986) suggests that there is interplay between the environment and the individual. We are not just the product of our surroundings, rather we influence our surroundings. Parents not only influence their child’s environment, perhaps intentionally through the use of reinforcement, etc., but children influence parents as well. Parents may respond differently with their first child than with their fourth. Perhaps they try to be the perfect parents with their firstborn, but by the time their last child comes along they have very different expectations both of themselves and their child. Our environment creates us and we create our environment. 30

Theories also explore cognitive development and how mental processes change over time.

Jean Piaget’s Theory of Cognitive Development

Jean Piaget (1896-1980) is one of the most influential cognitive theorists. Piaget was inspired to explore children’s ability to think and reason by watching his own children’s development. He was one of the first to recognize and map out the ways in which children’s thought differs from that of adults. His interest in this area began when he was asked to test the IQ of children and began to notice that there was a pattern in their wrong answers. He believed that children’s intellectual skills change over time through maturation. Children of differing ages interpret the world differently.

Figure 1.17 – Jean Piaget. 32

Piaget believed our desire to understand the world comes from a need for cognitive equilibrium . This is an agreement or balance between what we sense in the outside world and what we know in our minds. If we experience something that we cannot understand, we try to restore the balance by either changing our thoughts or by altering the experience to fit into what we do understand. Perhaps you meet someone who is very different from anyone you know. How do you make sense of this person? You might use them to establish a new category of people in your mind or you might think about how they are similar to someone else.

A schema or schemes are categories of knowledge. They are like mental boxes of concepts. A child has to learn many concepts. They may have a scheme for “under” and “soft” or “running” and “sour”. All of these are schema. Our efforts to understand the world around us lead us to develop new schema and to modify old ones.

One way to make sense of new experiences is to focus on how they are similar to what we already know. This is assimilation . So the person we meet who is very different may be understood as being “sort of like my brother” or “his voice sounds a lot like yours.” Or a new food may be assimilated when we determine that it tastes like chicken!

Another way to make sense of the world is to change our mind. We can make a cognitive accommodation to this new experience by adding new schema. This food is unlike anything I’ve tasted before. I now have a new category of foods that are bitter-sweet in flavor, for instance. This is  accommodation . Do you accommodate or assimilate more frequently? Children accommodate more frequently as they build new schema. Adults tend to look for similarity in their experience and assimilate. They may be less inclined to think “outside the box.”

Piaget suggested different ways of understanding that are associated with maturation. He divided this into four stages:

Table 1.4 – Jean Piaget’s Theory of Cognitive Development

Criticisms of Piaget’s Theory

Piaget has been criticized for overemphasizing the role that physical maturation plays in cognitive development and in underestimating the role that culture and interaction (or experience) plays in cognitive development. Looking across cultures reveals considerable variation in what children are able to do at various ages. Piaget may have underestimated what children are capable of given the right circumstances. 33

Lev Vygotsky’s Sociocultural Theory

Lev Vygotsky (1896-1934) was a Russian psychologist who wrote in the early 1900s but whose work was discovered in the United States in the 1960s but became more widely known in the 1980s. Vygotsky differed with Piaget in that he believed that a person not only has a set of abilities, but also a set of potential abilities that can be realized if given the proper guidance from others. His sociocultural theory emphasizes the importance of culture and interaction in the development of cognitive abilities. He believed that through guided participation known as scaffolding, with a teacher or capable peer, a child can learn cognitive skills within a certain range known as the zone of proximal development . 34 His belief was that development occurred first through children’s immediate social interactions, and then moved to the individual level as they began to internalize their learning. 35

Figure 1.18- Lev Vygotsky. 36

Have you ever taught a child to perform a task? Maybe it was brushing their teeth or preparing food. Chances are you spoke to them and described what you were doing while you demonstrated the skill and let them work along with you all through the process. You gave them assistance when they seemed to need it, but once they knew what to do-you stood back and let them go. This is scaffolding and can be seen demonstrated throughout the world. This approach to teaching has also been adopted by educators. Rather than assessing students on what they are doing, they should be understood in terms of what they are capable of doing with the proper guidance. You can see how Vygotsky would be very popular with modern day educators. 37

Comparing Piaget and Vygotsky

Vygotsky concentrated more on the child’s immediate social and cultural environment and his or her interactions with adults and peers. While Piaget saw the child as actively discovering the world through individual interactions with it, Vygotsky saw the child as more of an apprentice, learning through a social environment of others who had more experience and were sensitive to the child’s needs and abilities. 38

Like Vygotsky’s, Bronfenbrenner looked at the social influences on learning and development.

Urie Bronfenbrenner’s Ecological Systems Model

Urie Bronfenbrenner (1917-2005) offers us one of the most comprehensive theories of human development. Bronfenbrenner studied Freud, Erikson, Piaget, and learning theorists and believed that all of those theories could be enhanced by adding the dimension of context. What is being taught and how society interprets situations depends on who is involved in the life of a child and on when and where a child lives.

Figure 1.19 – Urie Bronfenbrenner. 39

Bronfenbrenner’s ecological systems model explains the direct and indirect influences on an individual’s development.

Table 1.5 – Urie Bronfenbrenner’s Ecological Systems Model

For example, in order to understand a student in math, we can’t simply look at that individual and what challenges they face directly with the subject. We have to look at the interactions that occur between teacher and child. Perhaps the teacher needs to make modifications as well. The teacher may be responding to regulations made by the school, such as new expectations for students in math or constraints on time that interfere with the teacher’s ability to instruct. These new demands may be a response to national efforts to promote math and science deemed important by political leaders in response to relations with other countries at a particular time in history.

Figure 1.20 – Bronfenbrenner’s ecological systems theory. 40

Bronfenbrenner’s ecological systems model challenges us to go beyond the individual if we want to understand human development and promote improvements. 41

In this chapter we looked at:

underlying principles of development

the five periods of development

three issues in development

Various methods of research

important theories that help us understand development

Next, we are going to be examining where we all started with conception, heredity, and prenatal development.

Child Growth and Development Copyright © by Jean Zaar is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License , except where otherwise noted.

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Child Growth and Development

(13 reviews)

Jennifer Paris

Antoinette Ricardo

Dawn Rymond

Alexa Johnson

Copyright Year: 2018

Last Update: 2019

Publisher: College of the Canyons

Language: English

Formats Available

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Learn more about reviews.

Reviewed by Joanne Leary, adjunct faculty, North Shore Community College on 6/9/24

Child Growth and Development is a text that can be seamlessly used to accompany any Child Development Course Pre-birth through Adolescence. The material lays the foundation for understanding development along with the many theorists that paved... read more

Comprehensiveness rating: 5 see less

Child Growth and Development is a text that can be seamlessly used to accompany any Child Development Course Pre-birth through Adolescence. The material lays the foundation for understanding development along with the many theorists that paved the way to notice how genetics, environment, culture, family and experience impact growth and development.

Content Accuracy rating: 4

This text has an emphasis on object and sound development and best practices to support development.

Relevance/Longevity rating: 5

Content includes the latest research and best practices in the field. It gives the reader a sense of what is current in the field and notices current trends.

Clarity rating: 5

The Chapters begin with objectives and an introduction and end with a conclusion of key concepts addressed. Within the Chapters are found material bringing the theory and best practice to life.

Consistency rating: 5

The Chapters begin with objectives and an introduction and end with a conclusion of key concepts addressed. Physical Development, Cognitive Development and Social Emotional Development are covered in-depth for each age group. The format becomes predictable and familiar as the Chapters are read.

Modularity rating: 5

Each Chapter follows a familiar pattern. Each developmental domain within each age category has easy to follow information. The book also includes mini-lectures and powerpoint presentations to support the reading material.

Organization/Structure/Flow rating: 5

The early Chapters are outlined to give background information about the history of Child Development and factors effecting the family before birth. From Chapter 3 through the remainder of the text attention is given chronologically to each age group and developmental domain within each age category through Adolescence.

Interface rating: 5

The organization of the text is both linear and spiraling. Material covered in one Chapter is often seen again in later Chapters with more in-depth information.

Grammatical Errors rating: 5

Throughout the text an effort is clearly made to limit educational jargon and keep the language accessible to all readers.

Cultural Relevance rating: 5

The Chapters include relevant information about current topics, resources and pictures representing the diverse backgrounds of children and families that are in our classrooms and communities.

Child Growth and Development is a text that can be seamlessly used to accompany any Child Development Course Pre-birth through Adolescence. The material lays the foundation for understanding development along with the many theorists that paved the way to notice how genetics, environment, culture, family and experience impact growth and development. The organization of the text is both linear and spiraling. The early Chapters are outlined to give background information about the history of Child Development and factors effecting the family before birth. From Chapter 3 through the remainder of the text attention is given chronologically to each age group and developmental domain within each age category through Adolescence. Physical Development, Cognitive Development and Social Emotional Development are covered in-depth for each age group. The Chapters begin with objectives and an introduction and end with a conclusion of key concepts addressed. Each Chapters also include relevant information about current topics, resources and pictures representing the diverse backgrounds of children and families that are in our classrooms and communities.

Reviewed by Mistie Potts, Assistant Professor, Manchester University on 11/22/22

This text covers some topics with more detail than necessary (e.g., detailing infant urination) yet it lacks comprehensiveness in a few areas that may need revision. For example, the text discusses issues with vaccines and offers a 2018 vaccine... read more

Comprehensiveness rating: 4 see less

This text covers some topics with more detail than necessary (e.g., detailing infant urination) yet it lacks comprehensiveness in a few areas that may need revision. For example, the text discusses issues with vaccines and offers a 2018 vaccine schedule for infants. The text brushes over “commonly circulated concerns” regarding vaccines and dispels these with statements about the small number of antigens a body receives through vaccines versus the numerous antigens the body normally encounters. With changes in vaccines currently offered, shifting CDC viewpoints on recommendations, and changing requirements for vaccine regulations among vaccine producers, the authors will need to revisit this information to comprehensively address all recommended vaccines, potential risks, and side effects among other topics in the current zeitgeist of our world.

Content Accuracy rating: 3

At face level, the content shared within this book appears accurate. It would be a great task to individually check each in-text citation and determine relevance, credibility and accuracy. It is notable that many of the citations, although this text was updated in 2019, remain outdated. Authors could update many of the in-text citations for current references. For example, multiple in-text citations refer to the March of Dimes and many are dated from 2012 or 2015. To increase content accuracy, authors should consider revisiting their content and current citations to determine if these continue to be the most relevant sources or if revisions are necessary. Finally, readers could benefit from a reference list in this textbook. With multiple in-text citations throughout the book, it is surprising no reference list is provided.

Relevance/Longevity rating: 4

This text would be ideal for an introduction to child development course and could possibly be used in a high school dual credit or beginning undergraduate course or certificate program such as a CDA. The outdated citations and formatting in APA 6th edition cry out for updating. Putting those aside, the content provides a solid base for learners interested in pursuing educational domains/careers relevant to child development. Certain issues (i.e., romantic relationships in adolescence, sexual orientation, and vaccination) may need to be revisited and updated, or instructors using this text will need to include supplemental information to provide students with current research findings and changes in these areas.

Clarity rating: 4

The text reads like an encyclopedia entry. It provides bold print headers and brief definitions with a few examples. Sprinkled throughout the text are helpful photographs with captions describing the images. The words chosen in the text are relatable to most high school or undergraduate level readers and do not burden the reader with expert level academic vocabulary. The layout of the text and images is simple and repetitive with photographs complementing the text entries. This allows the reader to focus their concentration on comprehension rather than deciphering a more confusing format. An index where readers could go back and search for certain terms within the textbook would be helpful. Additionally, a glossary of key terms would add clarity to this textbook.

Chapters appear in a similar layout throughout the textbook. The reader can anticipate the flow of the text and easily identify important terms. Authors utilized familiar headings in each chapter providing consistency to the reader.

Modularity rating: 4

Given the repetitive structure and the layout of the topics by developmental issues (physical, social emotional) the book could be divided into sections or modules. It would be easier if infancy and fetal development were more clearly distinct and stages of infant development more clearly defined, however the book could still be approached in sections or modules.

Organization/Structure/Flow rating: 4

The text is organized in a logical way when we consider our own developmental trajectories. For this reason, readers learning about these topics can easily relate to the flow of topics as they are presented throughout the book. However, when attempting to find certain topics, the reader must consider what part of development that topic may inhabit and then turn to the portion of the book aligned with that developmental issue. To ease the organization and improve readability as a reference book, authors could implement an index in the back of the book. With an index by topic, readers could quickly turn to pages covering specific topics of interest. Additionally, the text structure could be improved by providing some guiding questions or reflection prompts for readers. This would provide signals for readers to stop and think about their comprehension of the material and would also benefit instructors using this textbook in classroom settings.

Interface rating: 4

The online interface for this textbook did not hinder readability or comprehension of the text. All information including photographs, charts, and diagrams appeared to be clearly depicted within this interface. To ease reading this text online authors should create a live table of contents with bookmarks to the beginning of chapters. This book does not offer such links and therefore the reader must scroll through the pdf to find each chapter or topic.

No grammatical errors were found in reviewing this textbook.

Cultural Relevance rating: 3

Cultural diversity is represented throughout this text by way of the topics described and the images selected. The authors provide various perspectives that individuals or groups from multiple cultures may resonate with including parenting styles, developmental trajectories, sexuality, approaches to feeding infants, and the social emotional development of children. This text could expand in the realm of cultural diversity by addressing current issues regarding many of the hot topics in our society. Additionally, this textbook could include other types of cultural diversity aside from geographical location (e.g., religion-based or ability-based differences).

While this text lacks some of the features I would appreciate as an instructor (e.g., study guides, review questions, prompts for critical thinking/reflection) and it does not contain an index or glossary, it would be appropriate as an accessible resource for an introduction to child development. Students could easily access this text and find reliable and easily readable information to build basic content knowledge in this domain.

Reviewed by Caroline Taylor, Instructor, Virginia Tech on 12/30/21

Each chapter is comprehensively described and organized by the period of development. Although infancy and toddlerhood are grouped together, they are logically organized and discussed within each chapter. One helpful addition that would largely... read more

Each chapter is comprehensively described and organized by the period of development. Although infancy and toddlerhood are grouped together, they are logically organized and discussed within each chapter. One helpful addition that would largely contribute to the comprehensiveness is a glossary of terms at the end of the text.

From my reading, the content is accurate and unbiased. However, it is difficult to confidently respond due to a lack of references. It is sometimes clear where the information came from, but when I followed one link to a citation the link was to another textbook. There are many citations embedded within the text, but it would be beneficial (and helpful for further reading) to have a list of references at the end of each chapter. The references used within the text are also older, so implementing updated references would also enhance accuracy. If used for a course, instructors will need to supplement the textbook readings with other materials.

This text can be implemented for many semesters to come, though as previously discussed, further readings and updated materials can be used to supplement this text. It provides a good foundation for students to read prior to lectures.

This text is unique in its writing style for a textbook. It is written in a way that is easily accessible to students and is also engaging. The text doesn't overly use jargon or provide complex, long-winded examples. The examples used are clear and concise. Many key terms are in bold which is helpful to the reader.

For the terms that are in bold, it would be helpful to have a definition of the term listed separately on the page within the side margins, as well as include the definition in a glossary at the end.

Each period of development is consistently described by first addressing physical development, cognitive development, and then social-emotional development.

This text is easily divisible to assign to students. There were few (if any) large blocks of texts without subheadings, graphs, or images. This feature not only improves modularity but also promotes engagement with the reading.

The organization of the text flows logically. I appreciate the order of the topics, which are clearly described in the first chapter by each period of development. Although infancy and toddlerhood are grouped into one period of development, development is appropriately described for both infants and toddlers. Key theories are discussed for infants and toddlers and clearly presented for the appropriate age.

There were no significant interface issues. No images or charts were distorted.

It would be helpful to the reader if the table of contents included a navigation option, but this doesn't detract from the overall interface.

I did not see any grammatical errors.

This text includes some cultural examples across each area of development, such as differences in first words, parenting styles, personalities, and attachments styles (to list a few). The photos included throughout the text are inclusive of various family styles, races, and ethnicities. This text could implement more cultural components, but does include some cultural examples. Again, instructors can supplement more cultural examples to bolster the reading.

This text is a great introductory text for students. The text is written in a fun, approachable way for students. Though the text is not as interactive (e.g., further reading suggestions, list of references, discussion points at the end of each chapter, etc.), this is a great resource to cover development that is open access.

Reviewed by Charlotte Wilinsky, Assistant Professor of Psychology, Holyoke Community College on 6/29/21

This text is very thorough in its coverage of child and adolescent development. Important theories and frameworks in developmental psychology are discussed in appropriate depth. There is no glossary of terms at the end of the text, but I do not... read more

This text is very thorough in its coverage of child and adolescent development. Important theories and frameworks in developmental psychology are discussed in appropriate depth. There is no glossary of terms at the end of the text, but I do not think this really hurts its comprehensiveness.

Content Accuracy rating: 5

The citations throughout the textbook help to ensure its accuracy. However, the text could benefit from additional references to recent empirical studies in the developmental field.

It seems as if updates to this textbook will be relatively easy and straightforward to implement given how well organized the text is and its numerous sections and subsections. For example, a recent narrative review was published on the effects of corporal punishment (Heilmann et al., 2021). The addition of a reference to this review, and other more recent work on spanking and other forms of corporal punishment, could serve to update the text's section on spanking (pp. 223-224; p. 418).

The text is very clear and easily understandable.

Consistency rating: 4

There do not appear to be any inconsistencies in the text. The lack of a glossary at the end of the text may be a limitation in this area, however, since glossaries can help with consistent use of language or clarify when different terms are used.

This textbook does an excellent job of dividing up and organizing its chapters. For example, chapters start with bulleted objectives and end with a bulleted conclusion section. Within each chapter, there are many headings and subheadings, making it easy for the reader to methodically read through the chapter or quickly identify a section of interest. This would also assist in assigning reading on specific topics. Additionally, the text is broken up by relevant photos, charts, graphs, and diagrams, depending on the topic being discussed.

This textbook takes a chronological approach. The broad developmental stages covered include, in order, birth and the newborn, infancy and toddlerhood, early childhood, middle childhood, and adolescence. Starting with the infancy and toddlerhood stage, physical, cognitive, and social emotional development are covered.

There are no interface issues with this textbook. It is easily accessible as a PDF file. Images are clear and there is no distortion apparent.

I did not notice any grammatical errors.

Cultural Relevance rating: 4

This text does a good job of including content relevant to different cultures and backgrounds. One example of this is in the "Cultural Influences on Parenting Styles" subsection (p. 222). Here the authors discuss how socioeconomic status and cultural background can affect parenting styles. Including references to specific studies could further strengthen this section, and, more broadly, additional specific examples grounded in research could help to fortify similar sections focused on cultural differences.

Overall, I think this is a terrific resource for a child and adolescent development course. It is user-friendly and comprehensive.

Reviewed by Lois Pribble, Lecturer, University of Oregon on 6/14/21

This book provides a really thorough overview of the different stages of development, key theories of child development and in-depth information about developmental domains. read more

This book provides a really thorough overview of the different stages of development, key theories of child development and in-depth information about developmental domains.

The book provides accurate information, emphasizes using data based on scientific research, and is stated in a non-biased fashion.

The book is relevant and provides up-to-date information. There are areas where updates will need to be made as research and practices change (e.g., autism information), but it is written in a way where updates should be easy to make as needed.

The book is clear and easy to read. It is well organized.

Good consistency in format and language.

It would be very easy to assign students certain chapters to read based on content such as theory, developmental stages, or developmental domains.

Very well organized.

Clear and easy to follow.

I did not find any grammatical errors.

General content related to culture was infused throughout the book. The pictures used were of children and families from a variety of cultures.

This book provides a very thorough introduction to child development, emphasizing child development theories, stages of development, and developmental domains.

Reviewed by Nancy Pynchon, Adjunct Faculty, Middlesex Community College on 4/14/21

Overall this textbook is comprehensive of all aspects of children's development. It provided a brief introduction to the different relevant theorists of childhood development . read more

Overall this textbook is comprehensive of all aspects of children's development. It provided a brief introduction to the different relevant theorists of childhood development .

Most of the information is accurately written, there is some outdated references, for example: Many adults can remember being spanked as a child. This method of discipline continues to be endorsed by the majority of parents (Smith, 2012). It seems as though there may be more current research on parent's methods of discipline as this information is 10 years old. (page 223).

The content was current with the terminology used.

Easy to follow the references made in the chapters.

Each chapter covers the different stages of development and includes the theories of each stage with guided information for each age group.

The formatting of the book makes it reader friendly and easy to follow the content.

Very consistent from chapter to chapter.

Provided a lot of charts and references within each chapter.

Formatted and written concisely.

Included several different references to diversity in the chapters.

There was no glossary at the end of the book and there were no vignettes or reflective thinking scenarios in the chapters. Overall it was a well written book on child development which covered infancy through adolescents.

Reviewed by Deborah Murphy, Full Time Instructor, Rogue Community College on 1/11/21

The text is excellent for its content and presentation. The only criticism is that neither an index nor a glossary are provided. read more

Comprehensiveness rating: 3 see less

The text is excellent for its content and presentation. The only criticism is that neither an index nor a glossary are provided.

The material seems very accurate and current. It is well written. It is very professionally done and is accessible to students.

This text addresses topics that will serve this field in positive ways that should be able to address the needs of students and instructors for the next several years.

Complex concepts are delivered accurately and are still accessible for students . Figures and tables complement the text . Terms are explained and are embedded in the text, not in a glossary. I do think indices and glossaries are helpful tools. Terminology is highlighted with bold fonts to accentuate definitions.

Yes the text is consistent in its format. As this is a text on Child Development it consistently addresses each developmental domain and then repeats the sequence for each age group in childhood. It is very logically presented.

Yes this text is definitely divisible. This text addresses development from conception to adolescents. For the community college course that my department wants to use it is very adaptable. Our course ends at middle school age development; our courses are offered on a quarter system. This text is adaptable for the content and our term time schedule.

This text book flows very clearly from Basic principles to Conception. It then divides each stage of development into Physical, Cognitive and Social Emotional development. Those concepts and information are then repeated for each stage of development. e.g. Infants and Toddler-hood, Early Childhood, and Middle Childhood. It is very clearly presented.

It is very professionally presented. It is quite attractive in its presentation .

I saw no errors

The text appears to be aware of being diverse and inclusive both in its content and its graphics. It discusses culture and represents a variety of family structures representing contemporary society.

It is wonderfully researched. It will serve our students well. It is comprehensive and constructed very well. I have enjoyed getting familiar with this text and am looking forward to using it with my students in this upcoming term. The authors have presented a valuable, well written book that will be an addition to our field. Their scholarly efforts are very apparent. All of this text earns high grades in my evaluation. My only criticism is, as mentioned above, is that there is not a glossary or index provided. All citations are embedded in the text.

Reviewed by Ida Weldon, Adjunct Professor, Bunker Hill Community College on 6/30/20

The overall comprehensiveness was strong. However, I do think some sections should have been discussed with more depth read more

The overall comprehensiveness was strong. However, I do think some sections should have been discussed with more depth

Most of the information was accurate. However, I think more references should have been provided to support some claims made in the text.

The material appeared to be relevant. However, it did not provide guidance for teachers in addressing topics of social justice, equality that most children will ask as they try to make sense of their environment.

The information was presented (use of language) that added to its understand-ability. However, I think more discussions and examples would be helpful.

The text appeared to be consistent. The purpose and intent of the text was understandable throughout.

The text can easily be divided into smaller reading sections or restructured to meet the needs of the professor.

The organization of the text adds to its consistency. However, some sections can be included in others decreasing the length of the text.

Interface issues were not visible.

The text appears to be free of grammatical errors.

While cultural differences are mentioned, more time can be given to helping teachers understand and create a culturally and ethnically focused curriculum.

The textbook provides a comprehensive summary of curriculum planing for preschool age children. However, very few chapters address infant/toddlers.

Reviewed by Veronica Harris, Adjunct Faculty, Northern Essex Community College on 6/28/20

This text explores child development from genetics, prenatal development and birth through adolescence. The text does not contain a glossary. However, the Index is clear. The topics are sequential. The text addresses the domains of physical,... read more

This text explores child development from genetics, prenatal development and birth through adolescence. The text does not contain a glossary. However, the Index is clear. The topics are sequential. The text addresses the domains of physical, cognitive and social emotional development. It is thorough and easy to read. The theories of development are inclusive to give the reader a broader understanding on how the domains of development are intertwined. The content is comprehensive, well - researched and sequential. Each chapter begins with the learning outcomes for the upcoming material and closes with an outline of the topics covered. Furthermore, a look into the next chapter is discussed.

The content is accurate, well - researched and unbiased. An historical context is provided putting content into perspective for the student. It appears to be unbiased.

Updated and accurate research is evidenced in the text. The text is written and organized in such a way that updates can be easily implemented. The author provides theoretical approaches in the psychological domains with examples along with real - life scenarios providing meaningful references invoking understanding by the student.

The text is written with clarity and is easily understood. The topics are sequential, comprehensive and and inclusive to all students. This content is presented in a cohesive, engaging, scholarly manner. The terminology used is appropriate to students studying Developmental Psychology spanning from birth through adolescents.

The book's approach to the content is consistent and well organized. . Theoretical contexts are presented throughout the text.

The text contains subheadings chunking the reading sections which can be assigned at various points throughout the course. The content flows seamlessly from one idea to the next. Written chronologically and subdividing each age span into the domains of psychology provides clarity without overwhelming the reader.

The book begins with an overview of child development. Next, the text is divided logically into chapters which focus on each developmental age span. The domains of each age span are addressed separately in subsequent chapters. Each chapter outlines the chapter objectives and ends with an outline of the topics covered and share an idea of what is to follow.

Pages load clearly and consistently without distortion of text, charts and tables. Navigating through the pages is met with ease.

The text is written with no grammatical or spelling errors.

The text did not present with biases or insensitivity to cultural differences. Photos are inclusive of various cultures.

The thoroughness, clarity and comprehensiveness promote an approach to Developmental Psychology that stands alongside the best of texts in this area. I am confident that this text encompasses all the required elements in this area.

Reviewed by Kathryn Frazier, Assistant Professor, Worcester State University on 6/23/20

This is a highly comprehensive, chronological text that covers genetics and conception through adolescence. All major topics and developmental milestones in each age range are given adequate space and consideration. The authors take care to... read more

This is a highly comprehensive, chronological text that covers genetics and conception through adolescence. All major topics and developmental milestones in each age range are given adequate space and consideration. The authors take care to summarize debates and controversies, when relevant and include a large amount of applied / practical material. For example, beyond infant growth patterns and motor milestone, the infancy/toddler chapters spend several pages on the mechanics of car seat safety, best practices for introducing solid foods (and the rationale), and common concerns like diaper rash. In addition to being generally useful information for students who are parents, or who may go on to be parents, this text takes care to contextualize the psychological research in the lived experiences of children and their parents. This is an approach that I find highly valuable. While the text does not contain an index, the search & find capacity of OER to make an index a deal-breaker for me.

The text includes accurate information that is well-sourced. Relevant debates, controversies and historical context is also provided throughout which results in a rich, balanced text.

This text provides an excellent summary of classic and updated developmental work. While the majority of the text is skewed toward dated, classic work, some updated research is included. Instructors may wish to supplement this text with more recent work, particularly that which includes diverse samples and specifically addresses topics of class, race, gender and sexual orientation (see comment below regarding cultural aspects).

The text is written in highly accessible language, free of jargon. Of particular value are the many author-generated tables which clearly organize and display critical information. The authors have also included many excellent figures, which reinforce and visually organize the information presented.

This text is consistent in its use of terminology. Balanced discussion of multiple theoretical frameworks are included throughout, with adequate space provided to address controversies and debates.

The text is clearly organized and structured. Each chapter is self-contained. In places where the authors do refer to prior or future chapters (something that I find helps students contextualize their reading), a complete discussion of the topic is included. While this may result in repetition for students reading the text from cover to cover, the repetition of some content is not so egregious that it outweighs the benefit of a flexible, modular textbook.

Excellent, clear organization. This text closely follows the organization of published textbooks that I have used in the past for both lifespan and child development. As this text follows a chronological format, a discussion of theory and methods, and genetics and prenatal growth is followed by sections devoted to a specific age range: infancy and toddlerhood, early childhood (preschool), middle childhood and adolescence. Each age range is further split into three chapters that address each developmental domain: physical, cognitive and social emotional development.

All text appears clearly and all images, tables and figures are positioned correctly and free of distortion.

The text contains no spelling or grammatical errors.

While this text provides adequate discussion of gender and cross-cultural influences on development, it is not sufficient. This is not a problem unique to this text, and is indeed a critique I have of all developmental textbooks. In particular, in my view this text does not adequately address the role of race, class or sexual orientation on development.

All in all, this is a comprehensive and well-written textbook that very closely follows the format of standard chronologically-organized child development textbooks. This is a fantastic alternative for those standard texts, with the added benefit of language that is more accessible, and content that is skewed toward practical applications.

Reviewed by Tony Philcox, Professor, Valencia College on 6/4/20

The subject of this book is Child Growth and Development and as such covers all areas and ideas appropriate for this subject. This book has an appropriate index. The author starts out with a comprehensive overview of Child Development in the... read more

The subject of this book is Child Growth and Development and as such covers all areas and ideas appropriate for this subject. This book has an appropriate index. The author starts out with a comprehensive overview of Child Development in the Introduction. The principles of development were delineated and were thoroughly presented in a very understandable way. Nine theories were presented which gave the reader an understanding of the many authors who have contributed to Child Development. A good backdrop to start a conversation. This book discusses the early beginnings starting with Conception, Hereditary and Prenatal stages which provides a foundation for the future developmental stages such as infancy, toddler, early childhood, middle childhood and adolescence. The three domains of developmental psychology – physical, cognitive and social emotional are entertained with each stage of development. This book is thoroughly researched and is written in a way to not overwhelm. Language is concise and easily understood.

This book is a very comprehensive and detailed account of Child Growth and Development. The author leaves no stone unturned. It has the essential elements addressed in each of the developmental stages. Thoroughly researched and well thought out. The content covered was accurate, error-free and unbiased.

The content is very relevant to the subject of Child Growth and Development. It is comprehensive and thoroughly researched. The author has included a number of relevant subjects that highlight the three domains of developmental psychology, physical, cognitive and social emotional. Topics are included that help the student see the relevancy of the theories being discussed. Any necessary updates along the way will be very easy and straightforward to insert.

The text is easily understood. From the very beginning of this book, the author has given the reader a very clear message that does not overwhelm but pulls the reader in for more information. The very first chapter sets a tone for what is to come and entices the reader to learn more. Well organized and jargon appropriate for students in a Developmental Psychology class.

This book has all the ingredients necessary to address Child Growth and Development. Even at the very beginning of the book the backdrop is set for future discussions on the stages of development. Theorists are mentioned and embellished throughout the book. A very consistent and organized approach.

This book has all the features you would want. There are textbooks that try to cover too much in one chapter. In this book the sections are clearly identified and divided into smaller and digestible parts so the reader can easily comprehend the topic under discussion. This book easily flows from one subject to the next. Blocks of information are being built, one brick on top of another as you move through the domains of development and the stages of development.

This book starts out with a comprehensive overview in the introduction to child development. From that point forward it is organized into the various stages of development and flows well. As mentioned previously the information is organized into building blocks as you move from one stage to the next.

The text does not contain any significant interface issued. There are no navigation problems. There is nothing that was detected that would distract or confuse the reader.

There are no grammatical errors that were identified.

This book was not culturally insensitive or offensive in any way.

This book is clearly a very comprehensive approach to Child Growth and Development. It contains all the essential ingredients that you would expect in a discussion on this subject. At the very outset this book went into detail on the principles of development and included all relevant theories. I was never left with wondering why certain topics were left out. This is undoubtedly a well written, organized and systematic approach to the subject.

Reviewed by Eleni Makris, Associate Professor, Northeastern Illinois University on 5/6/20

This book is organized by developmental stages (infancy, toddler, early childhood, middle childhood and adolescence). The book begins with an overview of conception and prenatal human development. An entire chapter is devoted to birth and... read more

This book is organized by developmental stages (infancy, toddler, early childhood, middle childhood and adolescence). The book begins with an overview of conception and prenatal human development. An entire chapter is devoted to birth and expectations of newborns. In addition, there is a consistency to each developmental stage. For infancy, early childhood, middle childhood, and adolescence, the textbook covers physical development, cognitive development, and social emotional development for each stage. While some textbooks devote entire chapters to themes such as physical development, cognitive development, and social emotional development and write about how children change developmentally in each stage this book focuses on human stages of development. The book is written in clear language and is easy to understand.

There is so much information in this book that it is a very good overview of child development. The content is error-free and unbiased. In some spots it briefly introduces multicultural traditions, beliefs, and attitudes. It is accurate for the citations that have been provided. However, it could benefit from updating to research that has been done recently. I believe that if the instructor supplements this text with current peer-reviewed research and organizations that are implementing what the book explains, this book will serve as a strong source of information.

While the book covers a very broad range of topics, many times the citations have not been updated and are often times dated. The content and information that is provided is correct and accurate, but this text can certainly benefit from having the latest research added. It does, however, include a great many topics that serve to inform students well.

The text is very easy to understand. It is written in a way that first and second year college students will find easy to understand. It also introduces students to current child and adolescent behavior that is important to be understood on an academic level. It does this in a comprehensive and clear manner.

This book is very consistent. The chapters are arranged by developmental stage. Even within each chapter there is a consistency of theorists. For example, each chapter begins with Piaget, then moves to Vygotsky, etc. This allows for great consistency among chapters. If I as the instructor decide to have students write about Piaget and his development theories throughout the life span, students will easily know that they can find this information in the first few pages of each chapter.

Certainly instructors will find the modularity of this book easy. Within each chapter the topics are self-contained and extensive. As I read the textbook, I envisioned myself perhaps not assigning entire chapters but assigning specific topics/modules and pages that students can read. I believe the modules can be used as a strong foundational reading to introduce students to concepts and then have students read supplemental information from primary sources or journals to reinforce what they have read in the chapter.

The organization of the book is clear and flows nicely. From the table of context students understand how the book is organized. The textbook would be even stronger if there was a more detailed table of context which highlights what topics are covered within each of the chapter. There is so much information contained within each chapter that it would be very beneficial to both students and instructor to quickly see what content and topics are covered in each chapter.

The interface is fine and works well.

The text is free from grammatical errors.

While the textbook does introduce some multicultural differences and similarities, it does not delve deeply into multiracial and multiethnic issues within America. It also offers very little comment on differences that occur among urban, rural, and suburban experiences. In addition, while it does talk about maturation and sexuality, LGBTQ issues could be more prominent.

Overall I enjoyed this text and will strongly consider using it in my course. The focus is clearly on human development and has very little emphasis on education. However, I intend to supplement this text with additional readings and videos that will show concrete examples of the concepts which are introduced in the text. It is a strong and worthy alternative to high-priced textbooks.

Reviewed by Mohsin Ahmed Shaikh, Assistant Professor, Bloomsburg University of Pennsylvania on 9/5/19

The content extensively discusses various aspects of emotional, cognitive, physical and social development. Examples and case studies are really informative. Some of the areas that can be elaborated more are speech-language and hearing... read more

The content extensively discusses various aspects of emotional, cognitive, physical and social development. Examples and case studies are really informative. Some of the areas that can be elaborated more are speech-language and hearing development. Because these components contribute significantly in development of communication abilities and self-image.

Content covered is pretty accurate. I think the details impressive.

The content is relevant and is based on the established knowledge of the field.

Easy to read and follow.

The terminology used is consistent and appropriate.

I think of using various sections of this book in some of undergraduate and graduate classes.

The flow of the book is logical and easy to follow.

There are no interface issues. Images, charts and diagram are clear and easy to understand.

Well written

The text appropriate and do not use any culturally insensitive language.

I really like that this is a book with really good information which is available in open text book library.

Table of Contents

• Chapter 1: Introduction to Child Development
• Chapter 2: Conception, Heredity, & Prenatal Development
• Chapter 3: Birth and the Newborn
• Chapter 4: Physical Development in Infancy & Toddlerhood
• Chapter 5: Cognitive Development in Infancy and Toddlerhood
• Chapter 6: Social and Emotional Development in Infancy and Toddlerhood
• Chapter 7: Physical Development in Early Childhood
• Chapter 8: Cognitive Development in Early Childhood
• Chapter 9: Social Emotional Development in Early Childhood
• Chapter 10: Middle Childhood - Physical Development
• Chapter 11: Middle Childhood – Cognitive Development
• Chapter 12: Middle Childhood - Social Emotional Development
• Chapter 13: Adolescence – Physical Development
• Chapter 14: Adolescence – Cognitive Development
• Chapter 15: Adolescence – Social Emotional Development

Ancillary Material

About the book.

Welcome to Child Growth and Development. This text is a presentation of how and why children grow, develop, and learn. We will look at how we change physically over time from conception through adolescence. We examine cognitive change, or how our ability to think and remember changes over the first 20 years or so of life. And we will look at how our emotions, psychological state, and social relationships change throughout childhood and adolescence.

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CHILD AND ADOLESCENT DEVELOPMENT

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• Published: 07 October 2024

Screen time and mental health: a prospective analysis of the Adolescent Brain Cognitive Development (ABCD) Study

• Jason M. Nagata 1   na1 ,
• Abubakr A.A. Al-Shoaibi 1   na1 ,
• Alicia W. Leong 2 ,
• Gabriel Zamora 1 ,
• Alexander Testa 3 ,
• Kyle T. Ganson 4 &
• Fiona C. Baker 5 , 6  

BMC Public Health volume  24 , Article number:  2686 ( 2024 ) Cite this article

13 Accesses

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Metrics details

Despite the ubiquity of adolescent screen use, there are limited longitudinal studies that examine the prospective relationships between screen time and child behavioral problems in a large, diverse nationwide sample of adolescents in the United States, which was the objective of the current study.

We analyzed cohort data of 9,538 adolescents (9–10 years at baseline in 2016–2018) with two years of follow-up from the Adolescent Brain Cognitive Development (ABCD) Study. We used mixed-effects models to analyze associations between baseline self-reported screen time and parent-reported mental health symptoms using the Child Behavior Checklist, with random effects adjusted for age, sex, race/ethnicity, household income, parent education, and study site. We tested for effect modification by sex and race/ethnicity.

The sample was 48.8% female and racially/ethnically diverse (47.6% racial/ethnic minority). Higher total screen time was associated with all mental health symptoms in adjusted models, and the association was strongest for depressive (B = 0.10, 95% CI 0.06, 0.13, p  < 0.001), conduct (B = 0.07, 95% CI 0.03, 0.10, p  < 0.001), somatic (B = 0.06, 95% CI 0.01, 0.11, p  = 0.026), and attention-deficit/hyperactivity symptoms (B = 0.06, 95% CI 0.01, 0.10, p  = 0.013). The specific screen types with the greatest associations with depressive symptoms included video chat, texting, videos, and video games. The association between screen time and depressive, attention-deficit/hyperactivity, and oppositional defiant symptoms was stronger among White compared to Black adolescents. The association between screen time and depressive symptoms was stronger among White compared to Asian adolescents.

Conclusions

Screen time is prospectively associated with a range of mental health symptoms, especially depressive symptoms, though effect sizes are small. Video chat, texting, videos, and video games were the screen types with the greatest associations with depressive symptoms. Future research should examine potential mechanisms linking screen use with child behavior problems.

Peer Review reports

Introduction

Globally, mental disorders are significant contributors to disease burden and the leading cause of disability in adolescents (10–19 years) [ 1 ]. Research has documented the rising prevalence of adolescent mental health concerns in the United States. Adolescents are 50% more likely to experience a major depressive episode today than in the early 2000s [ 2 ]. Between 2000 and 2018, suicide rates increased by 30% in this population [ 3 ]. Internalizing (e.g., anxiety, depression) and externalizing (e.g., aggression, inattention) problems in childhood or adolescence have been linked to substance use and cognitive, psychosocial, and physical health impairments later in life [ 4 , 5 , 6 , 7 ]. Given that the peak and median age at onset for any mental disorder worldwide is 14.5 and 18 years, respectively [ 8 ], underlying factors contributing to the development of mental health problems during this developmental period may be important to target in interventions. Furthermore, the COVID-19 pandemic led to worse mental health among adolescents, with 42% of high school students reporting persistent feelings of sadness or hopelessness, a 50% increase from 2011 [ 9 ]. Despite the increasing prevalence and burden of mental health problems in adolescents, these factors are complex, intertwined, and poorly understood [ 1 , 10 ].

An increase in the amount of time spent on screen-based technologies has been hypothesized to contribute to observed increases in the prevalence of mental health problems and suicide among adolescents [ 11 , 12 , 13 ]. Smartphones, tablets, television, and other screen-based technologies have become increasingly ubiquitous and embedded into family life [ 14 ]. On average, 8- to 12-year-olds spend 5.5 h per day using screen media, excluding time spent online for educational and homework purposes. For teenagers aged 13 to 18 years, screen time rises to 8.5 h per day [ 14 ]. Screen time in adolescents rose by 52% on average during the pandemic [ 15 , 16 ]. Some research has demonstrated a link between self-reported screen time (total amount of time spent on screens; default measure of digital technology use in most studies to date) and poor mental health outcomes [ 17 , 18 , 19 , 20 ]. Increased screen time may be a possible reflection of problematic screen use, including difficulty self-regulating use and consequent personal, familial, social, and school-related functional impairments. Studies have linked increased screen exposure to decreased inhibitory control neurologically and behaviorally [ 21 , 22 ]. Problematic screen use has been shown to be associated with poorer mental health in adolescents [ 23 ]. However, it should be noted that higher levels of screen exposure can represent both a cause and manifestation of behavioral and emotional symptoms [ 24 ].

This positive association between screen time and poorer mental health symptoms has prompted calls for guidelines to limit screen use among adolescents [ 25 ]. Some intervention studies, conducted primarily among adults, have shown that reductions in digital media use are associated with improvements in mental health outcomes, but other studies have also found no effect or negative consequences for well-being [ 26 , 27 ]. A recent cluster randomized controlled trial found that adults who were allocated to reduce their household recreational digital screen use to less than three hours per week per person reported significantly improved mental well-being and mood at two-week follow-up [ 28 ]. Another randomized controlled trial found that reducing smartphone social media use in undergraduate students aged 16 to 24 years yielded significant improvements in appearance esteem and anxiety symptoms over four weeks [ 29 ].

However, the field has relied largely on cross-sectional and correlational data, with much of the conversation on screen time and mental health treating adolescents as a relatively uniform category without recognition of the potential differential impacts of screen time based on factors such as digital media modality, sex, and race/ethnicity [ 20 ]. Furthermore, a more detailed investigation of the associations between screen time and specific domains or even disorders of adolescent psychopathology is needed to provide more targeted recommendations and strategies.

The Child Behavior Checklist (CBCL), one of the most widely used and investigated tools for detecting emotional and behavioral symptoms in children and adolescents [ 30 ], provides a dimensional assessment of child psychopathology [ 31 ]. The CBCL includes Diagnostic and Statistical Manual of Mental Disorders (DSM)-oriented scales, which were developed based on expert consensus to be consistent with diagnostic categories from the DSM [ 32 ]. The DSM-oriented scales are as follows: affective/depressive, anxiety, attention-deficit/hyperactivity (ADHD), somatic, oppositional defiant (ODD), and conduct symptoms [ 31 ]. Studies have demonstrated an acceptable correspondence between the DSM-oriented scales and DSM diagnoses [ 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ]. Although the scores in the clinical range for specific DSM-oriented scales of the CBCL are not directly equivalent to the corresponding specific diagnosis [ 41 , 42 ], the CBCL’s DSM-oriented scales for depression, anxiety disorders, ADHD, somatic symptoms, ODD, and conduct disorders can be used in clinical settings for screening for psychopathology based on the DSM classification system and enhancing diagnostic assessment [ 40 ].

Of the disorders included in the CBCL’s DSM-oriented scales, depression has been the most investigated in association with screen time. More screen time has been associated with depressive symptoms among children and adolescents in several systematic reviews [ 11 , 12 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ]. In a systematic review of longitudinal studies examining the relationship between screen time and internalizing mental health symptoms, Tang et al. (2021) found a small but significant correlation between screen time and subsequent depressive symptoms among adolescents aged 10 to 24 years.

In contrast to depressive symptoms, there are relatively few cross-sectional studies and even fewer longitudinal studies examining the association of screen time with anxiety, ADHD, somatic symptoms, ODD, and conduct disorders among children and adolescents [ 12 , 51 ]. Some studies support a positive cross-sectional and longitudinal association between screen time and anxiety symptoms in adolescents [ 52 , 53 ], but others found no significant association between screen time at baseline and changes in anxiety over time [ 54 , 55 ]. Given the limited number of studies with mixed findings, systematic reviews have deemed the existing literature insufficient to draw conclusions [ 12 , 45 ].

Attention-deficit/hyperactivity disorder

Synthesizing data from eight cross-sectional and three longitudinal studies, a systematic review from 2015 concluded that there was strong evidence to support a positive association between screen time and hyperactivity/inattention symptoms in children and adolescents [ 56 ]. A more recent review evaluating the longitudinal associations between digital media use and ADHD symptoms found reciprocal associations between digital media use and ADHD symptoms [ 57 ].

Somatic symptoms

Somatic symptom disorder is a psychiatric condition characterized by a significant focus on one or more physical symptoms, such as pain in different locations of the body, weakness, dizziness, nausea, and shortness of breath [ 58 , 59 ]. Prior cross-sectional studies have examined the relationship between screen time and somatic symptoms in children, adolescents, and young adults [ 60 , 61 , 62 , 63 , 64 , 65 , 66 ], with the majority finding a positive association between screen time and somatic symptoms. To our knowledge, analyses of the longitudinal associations between screen time and somatic symptoms have not been published.

Conduct disorder and oppositional defiant disorder

Similarly, previous cross-sectional studies have found potential associations between screen time and symptoms of conduct disorder and ODD among adolescents [ 67 , 68 , 69 , 70 , 71 , 72 ]. One study of 151 adolescents at risk for mental health symptoms found an association between average daily digital technology use and more conduct disorder symptoms both on the same day and 18 months later [ 73 ]. Consistent with these findings, our group has previously found higher screen time to be prospectively associated with higher odds of conduct disorder and ODD at one-year follow-up, based on longitudinal data from a larger ( n  = 11,875), national cohort of adolescents who participated in the ABCD Study [ 74 ].

Gaps in prior literature

Certain methodological issues, such as sampling strategies and cross-sectional design, limit the generalizability of results across studies. For instance, few existing studies feature longitudinal time frames and account for additional demographic factors, particularly race/ethnicity and sex [ 12 , 75 , 76 ]. Accounting for potential moderators (e.g., sex and race/ethnicity) on the impact of screen exposure on adolescent mental health could help explain the heterogeneity seen across study findings. Additionally, investigating these potential moderators may improve the identification of at-risk populations and aid in the development of more targeted interventions [ 51 , 76 ]. Prior studies have identified sex differences in the relationship between screen time and mental health outcomes, but this evidence remains inconsistent across studies [ 11 , 12 , 51 ], calling for additional longitudinal analyses to provide further insight into the moderating effect of sex. The moderating effect of race/ethnicity in the relationship between screen time and mental health has not been as extensively studied, although there are documented disparities in screen use [ 77 , 78 , 79 ] and mental health outcomes [ 80 , 81 , 82 , 83 ] across race/ethnicity in children and adolescents. For instance, data from the ABCD Study showed that, compared to White adolescents, Black adolescents reported greater total screen time use and Asian adolescents reported lower screen time use [ 77 ]. The same analysis found that, while male adolescents reported higher overall screen time than female adolescents, female adolescents reported higher daily use of social networking, texting, and video chatting [ 77 ]. Such differences by sex and race/ethnicity could be reflected in differences in associations between screen time and mental health outcomes which warrant further investigation.

Few studies examining longitudinal links between screen time and mental health symptoms have included large national cohorts of adolescents in North America. In a recent systematic review and meta-analysis on screen time and internalizing and externalizing behaviors among children and adolescents aged 12 years or younger [ 84 ], only three North American studies included a national cohort with a sample size of 10,000 or more [ 62 , 85 , 86 ]. Further, all three studies featured a cross-sectional study design and did not investigate the longitudinal relationship between screen time and internalizing and externalizing behaviors in adolescents. The cross-sectional design of the majority of these studies limits the ability to establish causal and temporal effects. Longitudinal studies provide more robust data and enable the examination of correlations over time [ 12 ].

Furthermore, it remains unclear whether specific modalities of screen time (e.g., device type, digital media type, and specific websites and applications) are differentially associated with adolescent mental health outcomes, prompting a call for researchers to conduct more nuanced measurements and analyses of screen use that focus on the contents, contexts, and environments in which digital media exposures occur [ 11 , 51 , 87 , 88 , 89 , 90 ]. To address such methodological limitations in existing studies, we aim to examine the longitudinal relationships between screen time (total aggregate screen time and specific types of screen time) and mental health symptoms measured by the CBCL’s DSM-oriented scales in a national cohort of adolescents in the United States [ 85 ]. Participants in the current analysis were 9 to 10 years old at baseline and were followed for two years. We hypothesized that higher screen time would be prospectively associated with higher scores on all CBCL DSM-oriented scales (anxiety, affective/depressive, somatic, ADHD, ODD, and conduct symptoms) at one- and two-year follow-up.

Study population

We used longitudinal data from baseline to Year 2 from the Adolescent Brain Cognitive Development (ABCD) Study (4.0 release). The ABCD Study is an ongoing prospective cohort study of health and cognitive development including 11,875 participants (ages 9–10 years at baseline in 2016–2018) from 21 recruitment sites across the U.S. The ABCD Study participants, recruitment, protocol, and measures are described in detail elsewhere [ 91 ]. Among 11,875 participants, 2,337 had missing data for total screen time and confounders, especially in Year 2, leaving 9,538 participants for the current analysis. Appendix A shows sociodemographic characteristics of participants who were included versus excluded from the current analysis. Institutional review board approval was received from the University of California, San Diego, and the respective IRBs of each study site. Written assent was obtained from participants, and written informed consent was obtained from their caregivers.

Independent variable: screen time

Screen time was obtained from the ABCD Youth Screen Time Survey [ 92 ]. Participants were asked to answer questions about the number of hours per weekday/weekend day they spent on six different screen modalities (excluding school use), including watching/streaming TV shows or movies, watching/streaming videos [e.g., YouTube], playing videogames, texting, video chatting [e.g., Skype, Facetime], and social media [e.g., Facebook, Instagram, Twitter]. Total screen time was calculated separately for weekdays and weekend days, based on a previously validated measure [ 93 , 94 , 95 ]. The following formula was used to calculate the weighted average: [(weekday average x 5) + (weekend average x 2)/7] [ 62 ]. The weighted average of total screen time was reported as a continuous variable.

Dependent variables: Child Behavior Checklist (CBCL)

The CBCL is a screening tool consisting of 112 items asking a parent/caretaker about multiple behavioral, emotional, and mental health symptoms in children and adolescents aged 4 to 18 years [ 96 , 97 ]. The CBCL included six DSM-oriented scales, including depressive, anxiety, somatic, attention-deficit/hyperactivity, oppositional defiant, and conduct symptoms. Parents/caretakers responded to statements about their child’s behavior using a scale from 0 (not true) to 2 (very true/often true) over the past six months. T-scores were calculated based on the CBCL scoring rubric. The CBCL has high test-retest reliability (ICC = 0.95), strong validity (ability of all items to discriminate significantly p  < 0.01) [ 98 ], and acceptable internal consistency with alphas ranging from 0.63 to 0.79 [ 99 ]. Confirmatory factor analysis results for the DSM-oriented scales indicated good fit (Comparative Fit Index [CFI] of 0.96 and Root Mean Square Error of Approximation [RMSEA] of 0.045 [ 100 , 101 ].

Confounders

The following variables were used in statistical models as potential confounders of the association between baseline screen time and CBCL measures including age (years), sex (female, male), race/ethnicity (White, Latino/Hispanic, Black, Asian, Native American, and other), household income (U.S. dollars, six categories: less than $25,000, $25,000 through $49,999, $50,000 through $74,999, $75,000 through $99,999, $100,000 through $199,999, and $200,000 and greater), highest parent education (high school or less vs. college or more), and study site. Because the two-year follow-up data collection period (2018–2020) coincided with the COVID-19 pandemic, which affected both screen time and mental health, we controlled for the data collection period (before or during the COVID-19 pandemic, using March 13, 2020 as the start date of the COVID-19 pandemic in the US) in the analyses of the Year 2 data. In addition, sleep and physical activity could mediate the association between screen time and mental health, as more time on screens could displace time for sleep and physical activity, which are both beneficial for mental well-being. Sleep duration was measured by parent report based on an item from the Sleep Disturbance Scale for Children [ 102 ]. Physical activity was measured based on adolescent reports of the number of days in the last 7 days of spending at least 60 min per day physically active (the recommended daily level for children and adolescents from the Physical Activity Guidelines for Americans) [ 91 , 103 ].

Statistical analysis

We used total screen time and each of the six screen time components at baseline as the primary independent variable. The dependent variables were repeated measures from CBCL DSM-oriented scale scores derived as repeated measures of t-scores at each year, from baseline to Year 2. We used mixed-effects models with random effects to assess the association of baseline screen time with each CBCL DSM-oriented scale. Model 1 was unadjusted. In Model 2, the outcomes were CBCL DSM-oriented scale t-scores from Year 1 and Year 2, adjusted for baseline CBCL DSM-oriented scale t-scores and the following confounders at baseline: age, sex, race/ethnicity, household income, parent education, data collection period, and study site. We also conducted a supplemental analysis adjusting for sleep and physical activity in addition to age, sex, race/ethnicity, household income, parent education, data collection period, and study site. We tested for effect modification by sex and race/ethnicity in the association between screen time and CBCL DSM-oriented scales. We present results stratified by sex or race/ethnicity for behavioral outcomes where there was evidence of effect modification by sex or race/ethnicity, respectively ( p for interaction < 0.05). P -values < 0.05 were considered to indicate statistical significance. Data analyses were performed using Stata 18.0 (College Station, TX) and applied propensity weights based on the American Community Survey [ 104 ].

Characteristics of the 9,538 participants are shown in Table  1 . The mean age at baseline was 9.9 ± 0.6 years; 51.2% of the participants were male, and 47.6% were non-White. The average total screen time at baseline was 4.0 ± 3.2 h per day, with most time spent watching television shows/movies (1.3 ± 1.1 h/day), watching/streaming videos (1.3 ± 1.2 h/day) and playing video games (1.2 ± 1.1 h/day). Furthermore, somatic symptoms had the highest t-score (55.4), among the CBCL DSM-oriented scales (Table  1 ).

Table  2 shows the unadjusted (Model 1) and adjusted (Model 2) models for associations between total screen time and CBCL DSM-oriented symptom scale t-scores. Higher total screen time was associated with all DSM-oriented scales in adjusted models (Model 2), and the association was strongest for depressive symptoms (B = 0.10, 95% CI 0.06, 0.13, p  < 0.001), conduct symptoms (B = 0.07, 95% CI 0.03, 0.10, p  < 0.001), somatic symptoms (B = 0.06, 95% CI 0.01, 0.11, p  = 0.026), and attention-deficit/hyperactivity symptoms (B = 0.06, 95% CI 0.01, 0.10, p  = 0.013). Supplemental analyses adjusting for sleep and physical activity in addition to the covariates adjusted for in Model 2 showed similar results although some associations were slightly attenuated (Appendix B ).

We stratified results by race/ethnicity for outcomes where there was evidence of significant effect modification by race/ethnicity on the associations between total screen time and CBCL DSM-oriented symptom scales. In adjusted models (Table  3 ), screen time was associated with higher depressive (B = 0.13, 95% CI 0.09, 0.17), attention-deficit/hyperactivity (B = 0.07, 95% CI 0.02, 0.13), and oppositional defiant (B = 0.05, 95% CI 0.01, 0.10) symptom scores in White adolescents but not among Black adolescents. The association between screen time and depressive symptoms was stronger among White compared to Asian adolescents. There was no evidence of effect modification of screen time by sex for any of the outcomes ( p for screen time*sex interaction > 0.05).

In a demographically diverse, nationwide, longitudinal cohort of 9,538 early adolescents in the United States, the current study found that higher total screen time was prospectively associated with higher scores on all DSM-oriented scales of the CBCL at both one- and two-year follow-up, even after adjusting for confounders. These results were held after adjusting for CBCL DSM-oriented scores at baseline. The specific DSM-oriented scale most strongly associated with total screen time was depressive symptoms. In this study, the average total screen time at baseline, when participants were 9 to 10 years old, was 4.0 ± 3.2 h per day. While the digital and in-person socialization landscape during the study’s baseline period (2016 to 2018) is distinct from that of the contemporary context, the average total screen time of this study’s sample is comparable to more recent national statistics for average screen time among children and younger adolescents aged 8 to 12 years in 2021 (5.5 h per day) [ 14 ].

The present study adds to the current literature on the relationship between screen time and adolescent mental health by assessing the longitudinal impact of different screen time modalities on specific domains of adolescent psychopathology that have clinical relevance. Recent reviews and meta-analyses have concluded that the literature on the mental health impacts of screen time among adolescents presents mixed findings that are difficult to collectively interpret [ 75 , 105 , 106 ], highlighting the need to consider different modalities of screen time [ 11 , 51 , 87 , 89 , 90 ], control for demographic variables and other potential confounders [ 107 ], and include more longitudinal perspectives [ 75 , 108 , 109 ].

Consistent with previous analyses, which have included longitudinal data and larger cohorts other than the ABCD Study cohort, we found weak but significant correlations between screen time and adolescents’ internalizing and externalizing behavior symptoms, including depression, anxiety, ADHD, somatic, ODD, and conduct symptoms [ 12 , 57 , 84 , 110 , 111 ]. There are various factors to consider when interpreting the small effect sizes. While some have suggested that the small effect sizes suggest a small or even negligible impact of increased screen time on the prevalence of mental health symptoms among adolescents [ 12 ], others have suggested that the consequences of screen time at a population level are likely meaningful despite small effect sizes [ 84 , 112 ]. Regarding the interpretation of longitudinal effect sizes, it has been argued that even small associations may be of importance when controlling for baseline levels [ 113 ]. Controlling for stability effects often attenuates the magnitude of effect size coefficients in longitudinal designs. It is thus misleading to apply the same guidelines for interpreting longitudinal effect size coefficients in models that control for stability effects versus cross-sectional effect size coefficients in analyses that control for confounds, but not stability effects [ 113 ]. Further, the effect sizes reported are for each hour of screen time; given that average screen time for adolescents rose to nearly eight hours per day during the COVID-19 pandemic, these effects could be magnified [ 16 ]. These effect sizes per hour of screen time are similar in magnitude to the effect sizes previously reported on screen time and nutrition as measured by the MIND (Mediterranean-DASH [Dietary Approaches to Stop Hypertension] Intervention for Neurodegenerative Delay) diet score [ 114 ].

In this study, the specific DSM-oriented scale most strongly associated with screen time was depressive symptoms. These findings may be explained, in part, by some combination of various media effects theories that have been proposed [ 115 ], including the displacement hypothesis [ 116 , 117 ]. The displacement hypothesis posits that screen time may replace time adolescents spend engaging in physical activity, sleep, in-person interactions, and other beneficial pursuits demonstrated to help reduce depression and anxiety symptoms [ 118 , 119 , 120 ]. Studies have also shown that higher levels of screen time were associated with reduced sleep duration and more sleep disturbances, which were in turn associated with internalizing, externalizing, and peer problems [ 62 , 121 ]. The weaker but still significant associations between screen time and depressive symptoms, along with the other assessed CBCL DSM-oriented scales found after adjusting for sleep and physical activity (i.e., displacement hypothesis) in Appendix B suggest that displacement theory partially accounts for, but does not fully explain, the relationship between screen time and early adolescents’ mental health symptoms.

The specific screen types with the greatest associations with depression include video chat, texting, videos (e.g., YouTube), and video games. Of note, there was not a statistically significant association between social media and depression or any of the mental health outcomes, although the coefficients were all in the positive direction. This may be due to the fact that participants’ age during the data collection period for social media screen time (9–10 years old) is younger than the minimum age requirement to have a social media account (13 years old). Thus, participants on average reported spending the least screen time on social media, out of all the screen types assessed.

Moderating effect of race/ethnicity in the prospective relationship between screen time and mental health

The present study investigated the impact of race/ethnicity as a moderator in the association between screen time and mental health symptoms, demonstrating a significant association between total screen time and depressive, ADHD, and ODD symptoms in White adolescents, but not in Black adolescents. This suggests that the longitudinal associations between screen time and several mental health symptoms are significantly weaker among Black adolescents than White adolescents. In addition, the association between total screen time and depressive symptoms was stronger among White compared to Asian adolescents. The extant literature on the impact of screen exposure on the psychosocial outcomes of racial and ethnic minority adolescents in the United States is sparse [ 122 , 123 , 124 ]. However, it is possible that adolescents from racial/ethnic minority backgrounds who might experience isolation, bullying, or discrimination in person may use screens to connect with others with similar backgrounds, which could buffer from depression, anxiety, and other symptoms of poor mental health [ 125 ]. Further research is needed to further elucidate potential differences by race/ethnicity. Other possible explanations include cultural variability in symptom presentation, which may not be comprehensively captured by the diagnostic classification system [ 126 ]. Furthermore, as parents complete rating scales in the CBCL, they may make implicit comparisons to a culturally-based standard for how children should behave or to their child’s local peers [ 127 ]. Internalized stigma about mental health may dissuade individuals from reporting symptoms or seeking help and services [ 126 ].

Strengths and limitations

Strengths of this study include the longitudinal data spanning two years of follow-up in a large, nationwide sample of adolescents in the US that was diverse, allowing the examination of moderation of effects by sex and race/ethnicity between screen time and mental health symptoms. Limitations should also be noted. Screen time was based on self-report which could be subject to response, recall, and social desirability bias. Screen time does not capture the content or context of screen use, which could be examined in future research [ 20 , 128 ]. The current analysis was limited by the availability of data from the ongoing ABCD Study and could only follow adolescents for two years, starting from age 9 to 10. However, given that digital technology use among children increases with age, particularly during adolescence [ 129 , 130 ], it is important to continue characterizing the relationships between digital technology use and mental health over time. Although we examined the prospective association of screen time leading to mental health outcomes, there is the possibility of inverse causality. Bidirectional associations between screen time and mental health could be supported by the self-perpetuating feedback loop model [ 131 ], whereby screen use leads to worsening mental health and poor mental health leads to increasing reliance on screens to cope [ 132 ]. Although we controlled for age, sex, race/ethnicity, household income, parent education, and study site, there is the possibility of unmeasured confounders. The effect sizes were relatively small.

Our longitudinal study identified several important prospective associations between screen time and DSM-oriented symptoms in a national sample of adolescents, most notably depression and conduct symptoms. These findings can help to inform developmentally appropriate guidance related to screen use, especially for adolescents and their parents. The American Academy of Pediatrics advocates for a Family Media Use plan for children 5 to 18 years old [ 133 ], which could be individualized for adolescents based on some of the associations noted in the current study, and nuances in some associations by sex and race/ethnicity. Education, prevention, and intervention efforts may be particularly important in early adolescence given that depression and other mental health conditions increase in mid- to late-adolescence; therefore, acting of modifiable behaviors in early adolescence could be protective. Future research could examine longer-term associations with additional years of follow-up as the ABCD Study cohort ages through mid-to-late adolescence.

Data availability

Data used in the preparation of this article were obtained from the ABCD Study ( https://abcdstudy.org ), held in the NIMH Data Archive (NDA). Investigators can apply for data access through the NDA ( https://nda.nih.gov/ ).

Abbreviations

Adolescent Brain Cognitive Development Study

Attention-deficit/hyperactivity

Child Behavior Checklist

Comparative Fit Index

Diagnostic and Statistical Manual of Mental Disorders

Institutional review board

Oppositional defiant

Root Mean Square Error of Approximation

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Acknowledgements

The authors thank Anthony Kung, Jonanne Talebloo, Sean Kim, Zain Memon, and Richard Do for editorial assistance. The ABCD Study was supported by the National Institutes of Health and additional federal partners under award numbers U01DA041022, U01DA041025, U01DA041028, U01DA041048, U01DA041089, U01DA041093, U01DA041106, U01DA041117, U01DA041120, U01DA041134, U01DA041148, U01DA041156, U01DA041174, U24DA041123, and U24DA041147. A listing of participating sites and a complete listing of the study investigators can be found at https://abcdstudy.org/principal-investigators.html . ABCD consortium investigators designed and implemented the study and/or provided data but did not necessarily participate in the analysis or writing of this report.

J.M.N. was funded by the National Institutes of Health (R01MH135492 and K08HL159350) and the Doris Duke Charitable Foundation (2022056).

Author information

Jason M. Nagata and Abubakr A.A. Al-Shoaibi contributed equally to this work.

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Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, Box 0503, San Francisco, CA, 94143, USA

Jason M. Nagata, Abubakr A.A. Al-Shoaibi & Gabriel Zamora

Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, 10029, USA

Alicia W. Leong

Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston, 7000 Fannin St, Houston, TX, 77030, USA

Alexander Testa

Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor St W, Toronto, ON, M5S 1V4, Canada

Kyle T. Ganson

Center for Health Sciences, SRI International, 333 Ravenswood Ave, Menlo Park, CA, 94025, USA

Fiona C. Baker

School of Physiology, University of the Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, Johannesburg, 2000, South Africa

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Jason Nagata - conceptualization, analysis, writing-original draft and revisions, supervision Abubakr Al-shoaibi – conceptualization, data analysis, writing –original draft and revisions Alicia Leong – conceptualization, writing –original draft and revisions Gabriel Zamora – conceptualization, writing –original draft and revisions Kyle Ganson, Alexander Testa – writing -critical revisions Fiona Baker - conceptualization, data acquisition, writing-original draft and revisionsAll authors approve of the final submitted version.

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Nagata, J.M., Al-Shoaibi, A.A., Leong, A.W. et al. Screen time and mental health: a prospective analysis of the Adolescent Brain Cognitive Development (ABCD) Study. BMC Public Health 24 , 2686 (2024). https://doi.org/10.1186/s12889-024-20102-x

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• Published: 06 October 2024

Decision-making for children and adolescents: a scoping review of interventions increasing participation in decision-making

• Inga Bosch 1 ,
• Hermann Siebel 1 ,
• Maike Heiser 1 &
• Laura Inhestern 1  

Pediatric Research ( 2024 ) Cite this article

Metrics details

To review and synthesize the literature on interventions to facilitate shared decision-making or to increase participation in decision-making in pediatrics focusing on interventions for children and adolescents.

We systematically searched three electronic databases (September 2021, update in September 2022). We included studies that aimed to increase involvement of children and adolescents in medical or treatment decisions, regardless of study design and reported outcomes. Study quality was assessed using the MMAT. The synthesis strategy followed a narrative methodology.

21 studies met the inclusion criteria. Interventions aimed to increase participation by provision of information, encouraging active participation and collaboration. Didactic strategies included digital interactive applications ( n  = 12), treatment protocols and guiding questions ( n  = 12), questionnaires or quizzes about patients’ condition or their knowledge ( n  = 8), visual aids ( n  = 4), and educational courses (n = 1). Findings indicate positive effects on some of the investigated outcomes. However, the heterogeneity of studies made it difficult to draw consistent conclusions about the effectiveness of interventions.

Conclusions

Interventions used a variety of approaches to facilitate SDM and increase participation. The findings suggest that interventions have inconsistent effects across different outcome variables. The evidence was limited due to the methodological shortcomings of the included studies.

To increase the participation of children and adolescents in decision-making, interventions targeting them are needed. Most intervention focus on the provision of information and encouragement for active participation.

The results suggest high feasibility and, mostly, positive effects in participation, health-related knowledge, patient-HCP relationship, and adherence

The study highlights that further high-quality studies using similar outcome parameters are needed to investigate the effects of interventions to facilitate participation in decision-making.

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Introduction.

In pediatrics, decision-making does not only include the patient and the healthcare professional (HCP), but also the parents as surrogated for a child’s decision. Hence, the process of decision-making becomes triadic. It has been shown that interventions to support decision-making in pediatrics mainly target parents 1 and that children and adolescents are often not involved in treatment or decision processes or that their wishes are not taken into account. 2 , 3 , 4

Preferences of children and adolescents show, that they want to be addressed directly in healthcare contexts and want to play an active role in issues related to their health and treatment. 5 , 6 A recent study shows that almost three out of four adolescents prefer active participation and shared decision-making (SDM) in medical decisions. 7 Most adolescents want to be at the center of their medical encounter and to be treated as adult patient, 8 whereas some children and adolescents experience high pressure and distress when being involved in decision-making. 9 , 10 Therefore, healthcare encounters need to take into account child’s and adolescent’s preference for participation. 11 , 12 , 13 To identify patients’ preferences of involvement, information and communication provided by HCPs should be age-appropriate and proactively targeted at children and adolescents. 14 In addition, HCPs should enable children and adolescents to participate in their healthcare by providing information about the risks and benefits of decisions, giving them the opportunity to interact with experts, and allowing them to reflect on their own values. Adolescents have been shown to have competencies relevant to medical decision-making. 15 Active participation in medical decisions can lead to reduced anxiety and increased sense of control in children and adolescents. 16 In addition, adherence to treatment and self-management of illness and health are positively associated with participation. 17 , 18

While the development and implementation of interventions to facilitate shared decision-making (SDM) in adult care have been promoted in recent decades, 19 , 20 recent studies suggest that routine implementation of SDM interventions in pediatric healthcare is rare. 21 , 22 However, there is an increasing awareness for the participation of children and adolescents in decision-making processes. 23 Interventions have been developed to facilitate participation. 1 , 24 , 25 Many of these interventions focus on parents as relevant partner in pediatric medical decision-making. 1 Interventions targeting children or adolescents or focusing on HCP-child dyads are limited. 26 , 27 , 28 , 29 Nevertheless, information and evidence on decision-making interventions in pediatrics may provide relevant information for HCPs to promote patient participation, satisfaction, and knowledge and to enhance health outcomes and treatment adherence. 25 According to the classification suggested by Grande et al., 30 different types of tools can support and facilitate the decision-making process. 30

Our aim was to provide an overview of interventions that increase participation in decision-making (including SDM interventions) that target at children and adolescents or HCP-child dyads. Our focus was to systematically describe the content and didactic strategies of these interventions. We also aimed to review findings on the effectiveness of interventions.

We conducted a scoping review using a systematic literature search to follow our study aim. The reporting of this scoping review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-Statement extension for Scoping Reviews (Supplementary Material  S1 ).

Search strategy

Search terms were defined according to the PICO criteria. 31 For each aspect of PICO, relevant search terms were gathered and applied in our systematic search. The final search included terms related to decision-making, patient participation, pediatrics, and healthcare. Full search strategies are provided in Supplementary Material  S2 . We searched the following electronic databases in September 2021: CINAHL, PsycINFO, and PubMed. In addition, we performed a systematic reference and citation screening of the retrieved full texts and related systematic reviews. The search was updated in September 2022.

Eligibility criteria

We included studies of decision-making interventions for children and adolescents (up to 18 years). If young adults were included in a study, the intervention also had to be aimed at children and/or adolescents and they had to be included in the study. As the focus of the scoping review was to obtain an overview of interventions, it was not relevant whether the results were reported separately for children, adolescents, and young adults. There was no restriction to a specific disease or treatment. Studies were excluded if the interventions focused on parental decision-making or if the HCPs were not working in pediatric setting (Table 1 ).

Intervention

Interventions were included if they aimed to increase patient involvement in decision-making (information, activation, and/or collaboration) or to facilitate SDM. There were no restrictions on the setting or format of the interventions. Studies were excluded if they focused on hypothetical decisions, non-medical decisions (e.g., school), decisions about pregnancy, peri- or neonatal care, advanced care planning, decisions about participation in research, or self-management interventions without a focus on decision-making.

In addition to information and details about the interventions, any measures of the usability, feasibility, or effectiveness of the interventions were included. Studies were excluded if (a) they only presented the development and design of the intervention, (b) the description of the intervention was missing or not sufficiently reported, and/or (c) no data on usability, feasibility, or effectiveness were provided.

Study design

We included all types of studies that reported original data on the feasibility or effects of the interventions (qualitative, quantitative, or mixed-methods design). Studies were excluded if they were literature reviews, commentaries, or unpublished research.

Other inclusion criteria were publication in a peer-reviewed journal and German, English, or Spanish language.

Study selection

Studies identified by the search strategy were exported from the databases to Endnote software. Duplicates were identified and removed. Title and abstract screening was performed according to the inclusion and exclusion criteria. Approximately 50% of the title and abstract screening was done by two of the authors (IB, HS). Full-text screening of the identified relevant articles and search of citations and references was performed independently by two reviewers (IB, HS or LI). In case of ambiguity regarding inclusion, eligibility was resolved by discussion with LI.

Data extraction and quality assessment

Data extraction followed predefined variables covering citation, country, target group, and description of intervention, study design, outcome parameters, and study outcome.

Quality assessment was performed for studies that included any type of evaluation of their intervention. The methodological quality of the included studies was assessed by the first author (IB) and double-checked by one of the other authors (HS, MH) using the Mixed Methods Appraisal Tool (MMAT). 32 Disagreement was resolved with LI. The MMAT allows for the quality assessment of studies with different study designs and has been shown to be reliable and valid. 32

Data synthesis

The synthesis strategy followed a narrative methodology. Study characteristics and results were integrated and summarized. Interventions were classified as a) information, b) information and activation or c) information, activation, and collaboration. 30 A meta-analytic strategy was not feasible due to heterogeneous study designs and outcome parameters.

A total of 1967 studies were identified through our systematic electronic search and 32 additional articles were identified through other sources. The search update in September 2022 yielded a further 20 articles. After removing duplicates, 1899 titles and abstracts were screened for eligibility. In the end, 65 full texts were retrieved. Of these, 44 were excluded for various reasons, leaving a final sample of 21 for the synthesis (Fig.  1 and Supplementary Material Table  S2 ).

Flow chart of study selection.

Study characteristics

A detailed overview of all included studies, including descriptions of the interventions and their results, is provided in Table 2 (see also Supplementary Material  S3 for references of Table 2 ).

Of the 21 included studies, 8 were conducted in the United States, 3 studies each are from Canada and the United Kingdom, 2 studies originate from Australia and 1 study each is from Sweden, Egypt, Norway, Japan, and the Netherlands. All studies were published in 2017 or later.

Most of the studies ( n  = 13) used only quantitative methods to evaluate the intervention, while 3 studies reported only qualitative data. The remaining 5 have a mixed study design, using both quantitative and qualitative methods. Of the quantitative (and mixed) studies, 7 reported randomized controlled trials. The sample sizes ranged from n  = 5 to n  = 746 participants.

Of the 21 interventions, 10 were aimed at both children and adolescents, 6 studies were aimed at adolescents only, and 3 studies aimed at children only. Three studies additionally included young adults (up to 21 years/25 years). One study each focused on adolescents and HCPs and one on children and HCPs. The children and adolescents included in the studies had different conditions. Eleven interventions were specifically designed and used for somatic conditions such as diabetes, cancer, or asthma, while 6 interventions focused on mental health conditions such as depression, anxiety, or self-harm. In 3 studies, no specific health condition was targeted because the intervention was intended to be applied across different conditions. One study examined decision-making processes during dental examinations in healthy children.

The quality of the included studies is heterogeneous with some limitations, but can overall be deemed as moderate to good using the MMAT. A detailed overview of the MMAT quality assessment for each study is provided in Table  S1 (Supplementary Material).

Aims and didactic strategies

The majority of studies ( n  = 15) 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 aimed to inform or educate patients about their patient’s health condition, treatment options, principles, and behavior patterns of SDM either alone ( n  = 3) or as a base for further intervention steps ( n  = 12). Further, interventions ( n  = 6) aim to support active involvement of patients in discussions with HCPs regarding further treatment 37 , 40 , 43 , 44 , 45 , 48 or to involve patients’ treatment-related questions, wishes, or preferences indirectly (e.g., by question lists) without a direct conversation between patients and HCPs. 35 , 41 , 42 , 47 , 49 , 50 , 51 In terms of goal setting and engaging in decision-making, interventions employed a decision aid to assist patients in planning upcoming discussions with their HCPs ( n  = 8). 34 , 37 , 39 , 46 , 47 , 51 , 52 , 53 Eleven interventions combined two aims. 34 , 35 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 51 Two interventions pursued more than two aims. 37 , 47 Overall, most interventions employed strategies to enhance information and activation. Few interventions additionally aimed to engage children and adolescents by explicitly enhancing collaboration.

Thirteen studies used d igital interactive applications , available on either a web-based platform or on a mobile device. 33 , 34 , 36 , 38 , 39 , 42 , 44 , 45 , 46 , 47 , 49 , 50 , 52 Twelve interventions used t reatment protocols and preparing guiding questions and decision plans ( n  = 12), 34 , 37 , 38 , 39 , 43 , 44 , 45 , 46 , 47 , 48 , 51 , 52 which patients should keep and prepare. Implementation of surveys or quizzes ( n  = 8) concerning patients’ condition or their knowledge on their disease, treatment alternatives, or decision-making behavior generally were used to increase patients’ interest and involvement in the treatment process. 34 , 35 , 36 , 41 , 44 , 45 , 46 , 47 Four studies included v isual aids to improve SDM processes ( n  = 4), for instance, booklets containing information on SDM 34 , 40 , 43 , 48 A m ulti-day training and education course with the aim to promote SDM practices in pediatric healthcare settings for HCPs, patients, and their parents was used in one study. 53

In 12 studies, multi-component interventions incorporated two or more of the aforementioned didactic strategies, 34 , 35 , 36 , 38 , 39 , 43 , 44 , 45 , 46 , 47 , 48 , 52 For instance, in all seven studies employing digital decision aid tools, 34 , 39 , 44 , 45 , 46 , 47 , 52 the tool was presented as a digital interactive application and provided sections for treatment protocols, guiding questions and decision plans as well as questionnaires or quizzes within the digital space.

Intervention effectiveness

The statistical methods, sample sizes, and measurement tools differ across studies. We summarized the results of effectiveness based on the outcome variables.

Feasibility

Ten studies assessed the feasibility, usability, and/or acceptability of the applied intervention as a specific outcome variable. Most studies found that the tools to be comprehensible, clear, and easy to use. 34 , 36 , 37 , 39 , 42 , 51 Few studies reported negative findings or barriers of use, such as the decision-making intervention taking up too much time. 48 , 51 Technical problems were also identified as a barrier for usage. 52 The communication device used by Rexwinkel 43 showed low usage rates with only 25% of participants who used the device having prepared questions in advance to consultation with their HCP (in contrast to 17% of those who did not use it) as planned in the program. 43 Additional aspects reported to be relevant for usability and acceptability included the lack of individualization of information, suboptimal timing of information delivery, and the limited opportunity for direct communication with the HCP. 46

Patient-HCP relationship and therapy adherence

Seven studies investigated the effect of the applied decision-making intervention on patient-HCP relationship and adherence measures. Carlsson et al. investigated the impact of a digital interactive communication tool and found that children were included in communication with the HCP and recognized as a person. 49 Positive changes in interaction ratings were also reported regarding teamwork with HCPs, the family support network, 53 and empathy of HCPs. 41 In contrast, in the study by Langer et al., patients of the intervention group (IG) reported significantly lower therapeutic alliance scores directly following the treatment planning session as part of the SDM intervention ( p  = 0.017). HCPs also reported lower therapeutic alliance scores following treatment planning ( p  = 0.03), but not at mid- or post-treatment assessment. 37

Therapy adherence was explicitly assessed in three studies: El Miedany et al. found that 88% of IG patients who used an interactive decision aid tool (compared to 71% of patients of the control group (CG)) adhered to their medical therapy ( p  < 0.01). 33 Simmons et al. reported that 76% of their patient cohort who had used an online decision aid tool were still in their original treatment for depression at follow-up. 44 Lipstein et al. 48 found no significant differences in medication adherence between IG and CG patients. 48

Decisional conflict

Eight studies investigated changes in perceived decisional conflict induced by the applied decision-making interventions. Significant reduction of decisional conflict in the IG compared to CGs was reported. 37 , 44 , 51 However, these results could not be demonstrated either at follow-up 44 nor for specific subgroups of patients with mental disorders. 37 Other studies found no significant differences in decisional conflict between IG and CG patients 35 , 42 , 48 or did not provide enough data to draw certain conclusions. 39

Health-related knowledge

Four studies explicitly investigated the amount of knowledge conveyed by the decision-making interventions. Qualitative findings suggest increased awareness of social support sources. 42 One study reported high levels of knowledge about the risks and benefits of treatment after using a patient decision aid. 40 Moreover, greater condition-specific knowledge was observed in IG compared to CG 31 or in pre-post comparisons. 44

Participation in decision-making processes

Twelve studies explicitly investigated the direct effect of the applied decision-making intervention on the level of patient participation in decision-making processes. Participants of the IG experienced higher levels of involvement in the decision-making or treatment-planning processes. 33 , 37 , 43 , 44 , 45 , 53 It has been reported that HCPs showed more interaction, more proactive communication, and more effort to involve patients. 40 , 50 More proactive communication (e.g., asking questions, expressing concerns, non-verbal participation) has also been reported in children and adolescents. 41 Several studies reported no positive effects or differences in IG compared to CG in terms of speaking time, 50 , 51 , 52 , 53 decision self-efficacy, 37 duration of clinical encounter, 41 willingness to participate, 42 and empowerment. 53 Lipstein et al. 48 found significant differences between IG and CG patients in observed SDM, but not in subjectively perceived SDM. 48 The study by Matula et al. 39 did not provide enough data to draw any conclusions about SDM-related outcomes. 41

Clinical outcome measures

Five studies investigated the effects of the applied intervention on clinical outcome measures. Positive effects were reported for the frequency of asthma exacerbation (asthma attacks, clinic visits, and oral steroid prescription) in asthma patients. 38 Lipstein et al. 48 found no positive effects on disease activity scores for pediatric inflammatory bowel disease. 48 Regarding interventions for children and adolescents with mental disorders, studies show inconsistent findings: Simmons 44 reported a significant decrease in depression scores compared to baseline, 44 whereas other studies found no positive effects of the applied decision-making intervention on mental health outcomes in IG patients compared to CG. 35 , 37

Other outcome parameters

Qualitative results suggest increased self-reflexivity, improved emotional state, and ability to weigh pros and cons of relevant issues after the application of a decision-making intervention. 52 Moreover, significantly higher levels of quality of life were reported compared to CG. 33 Studies investigating satisfaction with decisions found higher satisfaction among HCPs compared to CG 37 and high levels of satisfaction with the decision following the intervention. 44 , 45 However, Simmons et al. found no differences in satisfaction compared to a historical comparison group, 45 and Lipstein et al. 48 did not identify differences in quality of life between IG and CG. 48

Decision-making in the context of pediatric healthcare has received increasing attention in recent years. While other reviews on decision-making interventions focused on parents as the target group, 1 only partially included interventions in the pediatric context 27 or did not include interventions that focus on children, 26 our review focused primarily on interventions for children and adolescents that aim at increasing participation in healthcare decisions. Moreover, we only included studies that reported results on the feasibility or effectiveness of the interventions based on original data.

In total, we identified 21 publications including 20 different interventions to increase the participation of children and/or adolescents in decision-making. Most of the interventions aimed at information and activation. Only few interventions also explicitly focused on collaboration during an encounter. 30 A wide range of didactic strategies were used to convey the content of the interventions: digital interactive applications, guiding questions or plans, questionnaires and quizzes, visual aids, or trainings/educational sessions.

Fourteen of the 21 studies included in our review were published after 2019, indicating a trend toward the development and evaluation of interventions targeting children and adolescents. The interventions show high feasibility and acceptability rates among participants and appear to be helpful. In some studies, technical or other usage barriers were reported, information was perceived as too much (overloaded decision-aid tools) or to little (poorly understandable decision-aid tools). These aspects should be considered when developing interventions. One promising way to address potential barriers may be to already include pediatric patients in the developmental process of an intervention. 54

The results suggest that the interventions have contributed to increasing the level of patient participation in decision-making processes. Most studies identified a positive effect of interventions on the HCP-patient relationship, therapy adherence, and health knowledge. However, few studies did not report improvements in specific outcome parameters. Inconsistent results were found for the impact of interventions on decisional conflict or clinical outcomes. The findings are similar to those of previous reviews mainly including interventions targeting at parents. These also identified rather positive effects of the interventions. 1 , 55 However, methodological shortcomings of the included studies are discussed and interventions were mostly aimed at parents. 1 , 55

Similarly, the studies in our scoping reviews are very heterogeneous in terms of the statistical methods, sample sizes, measurement tools, and interpretations of whether and how an intervention could improve patients’ involvement in decision-making processes, making it difficult to synthesize and compare the results and draw overarching evidence about effectiveness. Further research is needed to understand the processes and to identify factors that influence the effects of decision-making interventions.

To provide an overview of existing interventions, we included most types of patients and diseases. Differences between diagnostic groups (e.g., mental vs. physical illness) could be investigated in the future. Boland et al. identify various barriers and facilitators for SDM on the part of patients and parents (e.g., health status, emotional state, socioeconomic status, or language) as well as professionals (e.g. SDM skills, specialty, role). 56 In the future, it could be interesting to see how the identified interventions can be adapted with regard to these barriers and how effective they are.

Limitations

A limitation of this review is that abstract and title screening was only partly conducted by two independent reviewers. We may have missed studies at this review stage. However, we conducted an extensive search of citations and references by two reviewers to minimize the possibility of missing relevant literature. Due to our aim of providing a broad overview of existing interventions and their feasibility and effectiveness, the depth of detail of the analysis was limited. Moreover, we did not include interventions focusing on hypothetical decisions, non-medical decisions (e.g., school), decisions about pregnancy, peri- or neonatal care, advanced care planning, decisions about participation in research, or self-management interventions without a focus on decision-making. Three studies also included young adult patients, who may not be comparable to children or adolescents, for example, because of different legal situations regarding own decision-making.

Another limitation of this review is the quality of the underlying data. In our review, 7 of the 21 included studies followed a randomized controlled study design. The MMAT revealed moderate to good quality within the applied study design. However, many studies have methodological shortcomings such as small sample size or lack of CG. Moreover, there seems to be a lack of standardized outcome measures for (shared) decision-making in the context of children’s health. Therefore, different study designs and different outcome measures hinder the overall estimation of the effects of decision-making interventions.

This scoping review provides an overview of existing interventions for children and adolescents to increase participation in decision-making in the healthcare context or to facilitate SDM. Most interventions provided information and encourage children and adolescents to participate in the decision process, e.g., digital information tools and digital decision aids. Few interventions additionally used collaborative approaches. The results support the feasibility of the interventions and indicate preliminary positive effects of the interventions on certain outcome parameters such as participation, adherence, or health-related knowledge. However, the underlying database does not allow for full conclusions. Further high-quality studies investigating the effects are needed. Standardized outcome measures and further randomized controlled trials should be used to increase the generalizability of the findings.

Data availability

All relevant data are presented within the manuscript and supplementary material.

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This review was conducted in the context of the professorship for healthcare research in rare diseases in children endowed by the Kindness-for-Kids Foundation. Open Access funding enabled and organized by Projekt DEAL.

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Inga Bosch, Hermann Siebel, Maike Heiser & Laura Inhestern

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I.B. and L.I. designed the review. I.B., H.S., M.H., and L.I. performed the screening and data extraction. I.B., H.S. and L.I. analyzed the material. I.B., H.S., and L.I. drafted and finalized the manuscript. All authors critically reviewed the manuscript and approved the final manuscript.

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Bosch, I., Siebel, H., Heiser, M. et al. Decision-making for children and adolescents: a scoping review of interventions increasing participation in decision-making. Pediatr Res (2024). https://doi.org/10.1038/s41390-024-03509-5

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Digital self-presentation and adolescent mental health: Cross-sectional and longitudinal insights from the “LifeOnSoMe”-study

Gunnhild johnsen hjetland.

1 Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway

2 Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Oslo, Norway

Turi Reiten Finserås

Børge sivertsen.

3 Department of Research and Innovation, Helse Fonna HF, Haugesund, Norway

4 School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada

5 Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway

Randi Træland Hella

6 Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Research, Bergen, Norway

Amanda Iselin Olesen Andersen

Jens christoffer skogen.

7 Alcohol and Drug Research Western Norway, Stavanger University Hospital, Stavanger, Norway

Associated Data

The datasets analysed during the current study are not publicly available, as they contain sensitive information, and the ethical approval of the study does not include this option. Requests to access these datasets should be directed to GJH, [email protected].

The intensive use of social media among adolescents has caused concern about its impact on their mental health, but studies show that social media use is linked to both better and worse mental health. These seemingly contradictory findings may result from the diverse motivations, interactions, and experiences related to social media use, and studies investigating specific facets of social media use in relation to mental health and well-being, beyond general usage metrics, have been called for. Aspects of self-presentation on social media, such as feedback-seeking and upwards social comparison have been linked to worse mental health, however, there is a need for more studies exploring the relationship between self-presentation on social media and adolescent mental health over time.

The aim of this study was to explore the cross-sectional and longitudinal relationship between aspects of self-presentation and depression, anxiety, and well-being among adolescents.

This study utilised both cross-sectional and longitudinal datasets from the LifeOnSoMe-study, comprising 3,424 and 439 participants, respectively (OSF preregistration 10.17605/OSF.IO/BVPS8). Latent Class Analysis (LCA) was used to identify similar response patterns within the Self-Presentation and Upwards Social Comparison Inclination Scale (SPAUSCIS). Regression models and first differencing methods were applied to evaluate the cross-sectional and longitudinal associations between focus on self-presentation and mental health and well-being among adolescents.

A strong emphasis on self-presentation was linked to increased levels of depression and anxiety in both males and females, and reduced well-being in females when compared to those with lower or intermediate self-presentation focus. The effect sizes ranged from small to medium. Furthermore, an escalation in self-presentation focus over time was associated with a slight increase in symptoms of anxiety and depression; however, the association with well-being did not reach statistical significance.

The results of the present study suggest that a heightened focus on self-presentation, which includes behaviours such as seeking feedback, employing strategic self-presentation tactics, and engaging in upward social comparisons, is associated with an elevated risk of reduced mental health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-024-20052-4.

Introduction

The intensive use of social media among adolescents has caused concerns about its impact on their mental health and well-being, and a host of scientific papers have addressed this issue [ 1 ]. A recent umbrella review showed that the amount of time spent on social media use is weakly associated with both higher levels of mental health problems and with higher well-being among adolescents [ 2 ]. These seemingly contradictory findings may be attributed to heterogeneity of social media use and to person-specific effects [ 3 ], meaning that social media use can entail widely different motivations, interactions, experiences, and behaviours, and that any effects of social media use are likely to vary depending on how, why, and by whom they are used. Therefore, investigating how particular facets of social media use influence mental health and well-being, beyond general metrics of frequency and duration of use, has been called for [ 2 ]. In addition, research should focus on key attributes spanning a range of different social media platforms, in line with an affordance approach [ 4 ], to stay relevant in the ever evolving social media landscape. In the context of social media, affordances refer to “the perception of action possibilities users have when engaging with social media and its features” ([ 5 ], pp. 408–409).

One aspect of social media use that has been studied in relation to mental health and well-being is self-presentation [ 6 , 7 ]. Social approval is seen as one of the main goals of self-presentation on social media [ 8 ], and some adolescents place great emphasis on their online personas [ 9 – 11 ]. In line with Goffman’s theory of self-presentation and social interaction [ 12 ], all social encounters entail some form of performance to manage how one is perceived by others (i.e., self-presentation). To present the best possible version of themselves, people downplay certain characteristics and enhance others; a process called impression management [ 12 ]. Compared to traditional face-to-face interactions, social media affordances facilitate impression management and idealized self-presentation by allowing users to manipulate their text and image based communication [ 13 ]. Furthermore, the number of likes and number or content of comments can easily be compared to others’ to quantify one’s social success [ 14 ]. Some people make great efforts to receive the desired feedback, referred to as feedback-seeking or digital status seeking [ 15 ]. Arguably, as self-presentation on social media is often idealized and is mainly positive, upward social comparison, i.e., comparing oneself to someone who is viewed as better than oneself [ 16 ], may be particularly likely [ 14 , 17 ]. Social media use also increases the number of available comparison targets to include not only peers in one’s immediate surroundings, but also a wider network of acquaintances, ‘influencers’, and celebrities, thereby expanding the opportunities for engaging in upward social comparison.

Studies on adolescents have shown that different aspects of self-presentation, such as feedback-seeking, strategic self-presentation such as editing photos, and upward social comparison, are associated with worse mental health in terms of more symptoms of anxiety and depression, and reduced body satisfaction and well-being [ 11 , 18 – 21 ]. These findings can be linked to the broader concept of ‘approval anxiety’, i.e., the degree of psychological arousal about others’ reactions to one’s messages and posts on social media, which has been proposed as one component of digital stress [ 22 ]. Digital stress, in turn, has been shown to increase the risk of negative mental health outcomes as a result of social media use. Self-presentation on social media may therefore be one aspect of social media use that can have negative consequences for adolescent mental health. Most previous studies are, however, based on cross-sectional data, and more longitudinal studies are needed to establish the relevance of aspects of self-presentation on social media to adolescent mental health. The few longitudinal studies that exist have shown that posting a lot of content on social media, being preoccupied with one’s physical attractiveness in social media photos, feedback-seeking, and upward social comparison are linked to symptoms of anxiety and depression, and reduced well-being [ 18 , 23 , 24 ].

Adolescence is a period when peer approval becomes increasingly relevant, and seeking approval alongside a heightened sensitivity to social rewards may be a an important motivator for using social media during this developmental phase [ 5 ]. Adolescents seem to vary a great deal in their preoccupation with self-presentation on social media. In a previous study, we investigated how adolescents differed in their preoccupation with likes, comments, and followers, in deleting posts with too few likes and manipulating images to look better, and in upward social comparison, collectively referred to as “focus on self-presentation” [ 25 ]. The results showed that females and adolescents with low emotional stability and high scores on extraversion, were more likely to be highly focused on self-presentation. Similarly, adolescent girls have been found to report higher levels of feedback-seeking and social comparison [ 11 , 18 ], post more ‘selfies’, be more focused on their physical appearance, and be more concerned about peer feedback, compared to adolescent boys [ 26 ]. While some research has found that the associations between aspects of self-presentation on social media and mental health problems are similar for boys and girls [ 24 ], some findings indicate that the association is stronger for girls [ 11 , 18 ].

The aim of the present study was to further explore the relationship between focus on self-presentation and depression, anxiety, and well-being. Firstly, a latent class analysis was used to map out response patterns on a seven-item scale assessing focus on self-presentation among adolescents. Secondly, the association between these response patterns and mental health was assessed separately for males and females using a cross-sectional dataset. Lastly, the longitudinal association between focus on self-presentation and mental health was assessed over two time-points.

The present study (OSF preregistration 10.17605/OSF.IO/BVPS8) was based on data from an online survey conducted in two rounds in 2020 and 2021, in Bergen, Norway, called the LifeOnSoMe-study. Bergen is the second-largest city in Norway and has a population of about 300,000. All senior high school pupils of 16 years or older were invited to participate in the survey via their teachers and information screens on their school. The pupils received a link to a website and logged in using their electronic ID. Before starting the survey, they received information about the study and provided their informed consent. In addition, those that had participated in the 2020 data collection received an email with a link to the survey. The participation rate was 53% in 2020 and 35% in 2021. The broader aim of the LifeOnSoMe-study was to explore the relationship between adolescents’ motivations, experiences, and behaviours related to social media use and sociodemographic variables, lifestyle and social factors, and mental health.

The present study was based on two separate datasets. The cross-sectional dataset comprised responses from the two rounds of the survey. For those who completed the survey both in 2020 and 2021 ( n  = 461), we only used their 2020 responses. The total number of participants in the cross-sectional dataset was 3,771. Of these, participants missing information about gender ( n  = 5) or age ( n  = 158) were excluded. Furthermore, only 40 participants ticked the option “non-binary” for gender. This number is too low to perform meaningful analyses, and these participants were excluded from the study. Those with 100% missing values on the independent variable ( n  = 144) were excluded from the analyses, resulting in a total sample size of n  = 3,424. The longitudinal dataset was based on the responses of those who completed the survey both in 2020 and 2021 ( N  = 461, 59% females). Of these, 22 participants missing 100% of the items of the independent variable were excluded ( n  = 4 at T1 and n  = 18 at T2), resulting in a total sample of n  = 439.

Focus on self-presentation

To assess focus on self-presentation on social media, we used the Self-Presentation and Upward Social Comparison Inclination Scale (SPAUSCIS), which was developed based on qualitative focus group interviews with adolescents. The development of the scale is described in detail elsewhere [ 11 , 25 ]. In a previous study, we showed that the SPAUSCIS had one latent factor and high internal consistency in a sample of adolescents [ 25 ]. The scale consists of 7 statements regarding focus on self-presentation on social media, covering feedback-seeking, strategic self-presentation, and upward social comparison (see supplementary Table S1). The participants were asked how much each statement pertained to them, and the response options were “not at all”, “very little”, “sometimes/partly true”, “a lot”, and “very much”, coded 1–5. The total score was computed by averaging the sum score on the total number of items, resulting in a total score ranging from 1–5. Cronbach’s alpha was 0.87 in the cross-sectional sample and 0.86 in the longitudinal sample (at T1).

Social media use

The participants’ frequency of social media use was measured by the following question: “How often do you use social media?” The response alternatives were “almost never”, “several times a month, but less than once a week”, “1–2 times per week”, “3–4 times per week”, “5–6 times per week”, “every day”, “several times each day”, and “almost constantly”. In the present study, we created a tripartite variable which differentiated between “daily or less”, “many times each day”, and “almost constantly”. The participants’ duration of social media use was assessed by the following question: “On the days that you use social media, approximately how much time do you spend on social media?” The seven response options ranged from “less than 30 min” to “more than 5 h”. The response options were categorized into “less than 2 h”, “2–4 h”, “4–5 h”, and “more than 5 h”.

Symptoms of anxiety

Symptoms of anxiety were measured using the General Anxiety Disorder 7 (GAD-7; [ 27 ]). The GAD-7 consists of 7 questions related to symptoms of general anxiety. The response options ranges from 0 (not at all) to 3 (almost every day). The measure was used as a continuous variable with the total score ranging from 0 to 21. Cronbach’s alpha was 0.90 in the cross-sectional sample and 0.89 in the longitudinal sample (at T1).

Symptoms of depression

Symptoms of depression were measured using the Short Mood and Feelings Questionnaire (SMFQ; [ 28 ]). The SMFQ consists of 13 statements related to symptoms of depression. The response options are 0 (not true), 1 (sometimes true), and 2 (true). The scores on each item are summed to a total score ranging from 0 to 26. The measure was used as a continuous variable. Cronbach’s alpha was 0.91 in the cross-sectional sample and 0.88 in the longitudinal sample (at T1).

The Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) was used to assess the participants’ level of mental well-being [ 29 ]. The WEMWBS focuses solely on positive aspects of mental health, covering positive affect, satisfying personal relationships, and positive functioning. The scale has 14 positively scored items and responses are given on a 5-point Likert scale ranging from “none of the time” (1) to “all of the time” (5). The minimum score is 14 and the maximum score is 70, with a higher score indicating better mental well-being. The responses are based on the previous two weeks. The Norwegian version of the WEMWBS was used in the present study, which has shown good validity and reliability for Norwegian adolescents [ 30 ]. Cronbach’s alpha was 0.93 in the cross-sectional sample and 0.92 in the longitudinal sample (at T1).

Background variables

Participants provided their age, gender, and which year in senior high school (first, second, or third) and which program they attended college (preparatory or vocational education). Subjective socioeconomic status (SES) was assessed by the question “How well off do you consider you own family to be compared to others?” The response options ranged from 0 (“very poor”) to 10 (“very well off”). In the current study, SES was recoded into a tripartite variable of low SES (scores 0–4; 6.4%), medium SES (5–7, 52%), and high SES (8–10, 42%). Personality was measured using the Ten-Item Personality Inventory [ 31 ], consisting of ten items measuring two opposing traits of each personality dimension (Extraversion, agreeableness, conscientiousness, emotional stability, and openness to new experiences). The items are preceded by “I see myself as”, followed by trait adjectives. The response categories range from 1 (strongly disagree) to 7 (strongly agree). The total score on each trait is calculated by taking the average of the two items after recoding the reverse-scored item, resulting in a total score ranging from 2 to 14.

Statistical analyses

All analyses were performed using R version 4.1.3 [ 32 ] and RStudio version 2023.06.1 + 524 [ 33 ]. To assess the structural validity of the SPAUSCIS, a confirmatory factor analysis was performed using the cross-sectional dataset. Internal validity was assessed with Cronbach’s alpha, using the ‘psych’ package [ 34 ] and the confirmatory factor analysis was performed using the ‘lavaan’ package [ 35 ] and DWLS estimator suitable for ordinal variables [ 36 ]. Groups with similar response patterns on the items of the SPAUSCIS were identified using latent class analysis (LCA), using the ‘poLCA’ package [ 37 ]. The most appropriate number of latent classes was chosen based on several statistical criteria: Aikake information criterion (AIC), Bayesian information criterion (BIC), relative entropy, and the Lo-Mendell-Rubin ad hoc adjusted likelihood ratio test (LMR-LR), as well as interpretability of the model.

Cross-sectional associations

Linear regression was used to assess the associations between latent class membership and depressive symptoms, symptoms of anxiety, and well-being. The associations were estimated for the full sample and separately for males and females, and expressed as coefficients with corresponding standard errors, in addition to Cohen’s ds. As SES, frequency and duration of social media use, and the personality traits of extraversion and emotional stability has been linked to both focus on self-presentation [ 25 ] and to mental health outcomes in previous studies [ 2 , 38 , 39 ], all regressions were adjusted for these variables in multiple linear models. For the full sample, adjustments were also made for gender. Adjusted Cohen’s d values were calculated following the procedure included in the ESIZEREG module for Stata [ 40 ]. Likelihood ratio tests were used to examine a potential gender moderation in the associations between class membership and the dependent variables, comparing models with the interaction gender × class membership and models with gender included as a covariate. In all analyses, a p -value of < 0.05 indicated statistically significant associations. A post-hoc analysis assessing the correlation between the total score of the SPAUSCIS as a continuous variable with symptoms of depression and anxiety, and well-being using Spearman rank correlation.

Longitudinal associations

The ‘plm’ package [ 41 ] was used to estimate first difference models to assess the longitudinal associations between focus on self-presentation and mental health and well-being. First difference models difference out fixed effects such as gender, socioeconomic status and other variables that are assumed to be fixed over time [ 42 ]. Thus, the model avoids bias due to unobserved time-invariant variables. To ease interpretation of the results, we report both the “raw” coefficients and coefficients based on z-scored dependent variables. When using standardized dependent variables, the coefficients are interpreted as standard deviations: For every one-unit increase in the independent variable, the dependent variable increases by a given number of standard deviations.

Missing data

There were some missing data. After excluding those that were missing 100% of the SPAUSCIS items from the dataset, there were 0.8 to 3.9% missing on the items of the SPAUSCIS in the cross-sectional dataset, 0.2 to 1.1% missing in the longitudinal dataset at T1 and 1.1 to 4.3% at T2. The SPAUSCIS total score is calculated as the mean of the item scores and those missing one or more items received a mean based on the completed items.

The total scores of SMFQ, GAD-7 and WEMWBS were calculated by dividing the sum score of completed items on the number of completed items, multiplied by the total number of items of the relevant scale. Pairwise deletion was used throughout the analyses to retain as much information as possible.

Table ​ Table1 1 shows descriptive information for the cross-sectional data. The mean age of the sample was 17.28 years (SD 1.01), and 56% were girls. There were significant differences between girls and boys in all variables except age, school year and birth country. Females had higher scores on the duration and frequency of social media use and on focus on self-presentation, as well as on symptoms of depression and anxiety, and lower scores on well-being.

Table 1

Descriptives for the cross-sectional data

GAD-7 General Anxiety Disorder 7, SMFQ Short Mood and Feelings Questionnaire, SPAUSCIS Self-presentation and Upward Social Comparison Inclination Scale, WEMWBS Warwick-Edinburgh Mental Well-Being Scale

a Linear model ANOVA

b Pearson’s Chi-squared test

The CFA of the items of the SPAUSCIS resulted in a Comparative Fit Index (CFI) of 0.999, a Tucker-Lewis Index (TLI) of 0.998, a root mean square error of approximation (RMSEA) of 0.051 (95%CI 0.043–0.060, p  = .398), and a standardized root mean square residual (SRMR) of 0.021, all signalling god fit [ 43 ]. Items 2 and 3 and items 6 and 7 had highly correlated error terms, which were allowed for in the model.

The LCA yielded three classes corresponding to a low (class 1), intermediate (class 2), and high (class 3) focus on self-presentation, in line with the previous findings [ 25 ]. Predicted class membership was 44% in class 1, 33% in class 2, and 23% in class 3. Class 3 and 2 was dominated by females, while class 1 was dominated by males. Class 3 also had a lower proportion of adolescents with high SES, and a higher proportion of adolescents using social media ‘almost constantly’ compared to class 1 and 2. See supplementary figure S1 and table S2 for a more detailed description of the LCA results. See also supplementary table S3 for descriptives across class membership and S4 for an overview of SPAUSCIS scores across class membership.

Table ​ Table2 2 shows the results of the linear models. Being in class 3 was associated with higher symptoms of anxiety and depression compared to class 1 and 2 in both crude and fully adjusted cross-sectional analyses for the sample as a whole and for males and females when analysed separately (all p’s < .01). The effect sizes were small-to-medium in crude models (Cohen’s d s from 0.34–0.66 for anxiety and 0.43-0.74 for depression) and small in fully adjusted models (Cohen’s d s from 0.16–0.32 for anxiety and 0.25–0.33 for depression). For well-being, being in class 3 was associated with lower well-being compared to class 1 and 2 for males, females, and the sample as a whole in the crude models (all p’s < .05), with small effect sizes (Cohen’s d from -0.20- -0.46). In the fully adjusted models, the lower well-being associated with class 3 membership was no longer significant for males. Class 2 membership was not associated with any difference in symptoms of anxiety, depression or well-being compared to class 1 membership in adjusted models, but was associated with lower well-being for the sample as a whole in the crude model (Cohen’s d -0.13, p  < .001). The likelihood ratio tests comparing models with and without the interaction term class membership × gender were not significant, meaning that the associations between class membership and anxiety, depression, and well-being were not significantly different for males and females (results provided in the Appendix, all p’s > .05).

Table 2

Linear models for GAD-7, SMFQ, and WEMWBS separate for males and females and for males and females combined

* p  < .05, ** p  < .01, *** p  < .001

a Models adjusted for socioeconomic status, frequency and duration of social media use, extraversion, and emotional stability. Models including both genders also adjusted for gender

The post-hoc analysis showed that the correlation coefficient was 0.38 ( p  < .001) for the SPAUSCIS and symptoms of depression, 0.36 ( p  < .001) for SPAUSCIS and symptoms of anxiety, and -0.27 ( p  < .001) for well-being.

First difference modelling was used to assess how changes in focus on self-presentation, measured by the SPAUSCIS, from T1 to T2 was related to changes in symptoms of anxiety and depression, and well-being. The first difference model yielded a coefficient of 0.85 (SD 0.36, p  = .037) for symptoms of anxiety, 1.53 (SD 0.39, p  < .001) for symptoms of depression, and a non-significant coefficient for well-being (-1.24, SD 0.68, p  = .069). Thus, for each increase of 1 on the SPAUSCIS (total score ranging from 1 to 5) from T1 to T2, symptoms of anxiety increased by 0.85 and symptoms of depression increased by 1.53. The decrease in well-being for each increase of 1 on the SPAUSCIS scale did not reach statistical significance. Using standardized coefficients, each increase of 1 on the SPAUSCIS from T1 to T2 was associated with an increase of 0.17 standard deviations in symptoms of anxiety (SD 0.07, p  < .05) and 0.25 standard deviations in symptoms of depression (SD 0.06, p  < .001), both corresponding to small effect sizes [ 44 ], and a non-significant decrease of -0.13 (SD 0.07, p  = .069) in well-being.

In this study, we used both cross-sectional and longitudinal data to investigate the relationship between focus on self-presentation on social media and experiences of symptoms of depression, anxiety, and overall well-being among adolescents. The results of a latent class analysis revealed, in line with a previous study [ 25 ], that the participants’ response patterns could be best characterized by a three-class solution, representing varying degrees of focus on self-presentation: low, intermediate, and high. A high focus on self-presentation was associated with higher scores on symptoms of depression and anxiety for both males and females, and lower scores on well-being among females, compared to a low or intermediate focus on self-presentation. Effect sizes ranged from small to medium. Additionally, we found that an increasing emphasis on self-presentation over time was associated with an increase in symptoms of anxiety and depression, although these effects were relatively small. Conversely, the association between an increased focus on self-presentation and well-being did not reach statistical significance. Hence, our findings suggest that a heightened focus on self-presentation, which includes behaviours like seeking feedback, employing strategic self-presentation tactics, and engaging in upward social comparisons, is associated with a small increase in risk of negative mental health outcomes.

Our findings are in line with previous studies [ 11 , 18 – 21 ], and they add to the literature by showing these relationships by also using a longitudinal approach. Although this study is unable to establish a causal link between focus on self-presentation and mental health, there are some candidate mechanisms that could explain such a link. Firstly, placing importance on likes and comments may reflect a sense of self-worth that relies on online validation, making the individual vulnerable to fluctuations in likes and comments. Secondly, focus on self-presentation can be related to what Steele et al. [ 22 ] termed ‘approval anxiety’, which can contribute to an overall stress reaction (‘digital stress’) and consequently lead to symptoms of anxiety and depression, and lower mental well-being. Thirdly, a high focus on self-presentation may reflect a higher level of self-objectifications, i.e., an internalization of the observers’ gaze and viewing oneself as an object [ 45 ], which is regarded a risk factor for mental health problems [ 46 – 48 ]. Conversely, it is also possible that mental health problems lead to a higher focus on self-presentation. Studies have shown that underlying risk factors for poor mental health, such as shyness, loneliness, and neuroticism, predict heavier social media use and problematic social media use [ 49 , 50 ], and may also predict a higher focus on self-presentation. To disentangle the causal relationship between focus on self-presentation and mental health, large multi-wave longitudinal studies are needed. The current finding that focus on self-presentation and mental health problems change concurrently indicate a crucial avenue for further investigation.

The current results showed that the group with a high focus on self-presentation was dominated by girls, but that the associations between focus on self-presentation and depression, anxiety, and well-being were not statistically different for males and females, as indicated by the interaction analysis. Similarly, Maheux et al. [ 24 ] found that while girls reported a higher level of preoccupation with their physical attractiveness in social media photos, the longitudinal association with depressive symptoms were similar for boys and girls. In the fully adjusted models of the present study, however, well-being was only associated with class membership for the sample as a whole and for girls, but not for boys. This may be related to the overrepresentation of girls in the dataset or to unobserved variables that are affecting the association differently for each gender. In the present study, we had no information about the content of the participants’ self-presentation. Studies have shown that girls’ self-presentation differs from boys. For example, girls have been shown to post more selfies and be more invested in physical appearance [ 26 ], which may impact the association between focus on self-presentation and well-being. A study by Svensson, Johnson, & Olsson [ 51 ] also showed gender differences, finding that self-presentation was associated with internalizing symptoms for girls only. Future research should explore these gender differences in the interactions between aspects of social media use and well-being.

In our study, no longitudinal association was observed between focus on self-presentation and well-being. This suggests that while an increase in focus on self-presentation over time may be related to more symptoms of anxiety and depression, it does not appear to impact well-being. The small effect sizes found for symptoms of anxiety and depression support this notion. At the same time, our longitudinal sample size was relatively limited, which may have contributed to the nonsignificant association due to issues of statistical power. Furthermore, it is possible that focus on self-presentation does not change very much from one year to the next, and that a longer time span would yield larger differences between focus on self-presentation at baseline and follow-up and a clearer relationship between focus on self-presentation and mental health and well-being. It is also possible that the relationship between focus on self-presentation and mental health differs between younger and older adolescent, in line with a study showing that the strength of the relationship between social media use and life satisfaction changed depending on the adolescents’ age [ 52 ]. Specifically, higher social media use predicted decreases in life satisfaction one year later among girls at ages 11–13 and 19, and among boys at 13–15 and 19. Exploring how focus on self-presentation is related to well-being among younger adolescents than those included in our study (16 +), would be of interest.

Our findings are in line with the results of a recent study by Winstone and colleagues [ 23 ], who employed latent class analysis to identify different user types on social media among 13-year-olds and how these types were related to mental health outcomes. In their study, adolescents characterized by high levels of content sharing (‘Broadcasters’) had a higher risk of poor mental health one year later, compared to those with moderate content sharing. In the present study, we did not measure self-presentation activity such as frequency of posting content, but rather how preoccupied the participants were with the feedback they received, strategic self-presentation, and their degree of upward social comparison. It may be that adolescents who post a lot on social media are also highly preoccupied with their online self-presentation, and that it is their preoccupation with self-presentation that increases their risk of mental health problems and not posting per se. In fact, some research indicates that self-presenting on social media even can have some benefits. For example, studies have shown that people can experience an increase in self-esteem after viewing one’s own social media profile [ 53 , 54 ], and social media can facilitate authentic self-presentation of aspects of the self that are perceived as unwanted in offline social setting [ 55 ]. Furthermore, positive self-presentation (i.e., showing positive sides of the self) has been shown to increase subjective well-being, perhaps by supporting self-affirmation [ 56 ] and a positive self-image [ 57 ]. Future studies should explore these dynamics of posting on social media, different aspects of focus on self-presentation, and mental health in order to inform interventions to reduce mental health problems among adolescents.

Implications

Only a high focus on self-presentation was associated with a higher risk of symptoms of depression and anxiety in fully adjusted analyses; an intermediate focus did not show this relationship. This finding aligns with other research showing that moderate use of social media is not linked to negative outcomes, and that only high use or high investment is [ 58 – 60 ]. For example, one study found that using visual social media such as Instagram and Snapchat for more than two hours each day positively predicted internalizing symptoms, while less than two hours of use each day did not [ 59 ]. This implies that the common notion that all social media use is negative for mental health is unwarranted and can lead to unnecessary worrying among adolescents about their social media use. However, the results of the present study suggest that a high focus on self-presentation may increase the risk of mental health problems, and helping adolescents balance their preoccupation with self-presentation, for example using school-based programs, should be a priority. School-based programs that encourages adolescents to reflect and think critically about their own and others’ use of social media, may facilitate higher levels of social media literacy and build their resilience and ability to leverage the potential positive effects of social media, while negating negative effects [ 61 ]. Furthermore, in a clinical context, dimensions of social media use such as feedback-seeking and strategic self-presentation are important topics to consider, as there is a possibility that they contribute to a worsening of mental health. However, as social media also give opportunities for social support and friendship formation, particularly for marginalized groups (e.g., [ 62 ]), an open-minded approach is warranted. Furthermore, tech producers could help minimize any negative effects of social media use by for instance limiting affordances that trigger upward social comparison and feedback-seeking, such as beauty filters and likes, thus redesigning their social media platforms to support, rather than harm, mental health.

Strengths and limitations

In line with an affordances approach [ 4 ], this study focused on key attributes of social media platforms rather than specific social media platforms. Thus, the findings can be applicable to a wide range of platforms now and in the future. Furthermore, the measure of focus on self-presentation on social media was developed based on qualitative interviews with adolescents and adapted based on adolescent feedback, thus increasing the likelihood that the measure covered aspects of social media use that are relevant for adolescents and moving beyond quantity or frequency of self-presentation.

The present study also had some important limitations. Firstly, the validity of the observed longitudinal association rests on the assumption that there were no unobserved time-variant factors impacting the measured variables across the study period. The first difference model accounts for time-invariant factors such as gender, personality, and socioeconomic status, but factors that change over time are not accounted for. For example, given that the data were collected during the COVID-19 pandemic, it is possible that periods of lockdowns have led both to an increase in focus on self-presentation and in symptoms of depression and anxiety, and residual confounding cannot be ruled out. Secondly, the study included only two time points and is therefore limited in terms of determining cause and effect. Thirdly, assessing the relationship between focus on self-presentation and mental health and well-being over a longer time span could possibly have yielded a stronger relationship. To fully disentangle these causal relationships, further research employing large, multi-wave longitudinal studies is warranted. Furthermore, it is possible that the relationship between focus on self-presentation and mental health differs across different developmental periods, and studies should include a wider age range.

This study employed both cross-sectional and longitudinal data to investigate the link between adolescents’ focus on self-presentation on social media and their symptoms of depression, anxiety, and overall well-being. Analysing the data using LCA, we identified three distinct groups characterized by varying degrees of self-presentation focus: low, intermediate, and high. A high focus on self-presentation was associated with more symptoms of anxiety and depression for boys and girls, and with lower well-being for girls in fully adjusted models. Furthermore, an increase in self-presentation focus over time was associated with small increases in depressive and anxiety symptoms, while the effect on well-being was not statistically significant. These findings suggest that a high focus on self-presentation, including behaviours like seeking feedback, strategic self-presentation, and upward social comparisons, is associated with an elevated risk of poor mental health. The observed covariance between that focus on self-presentation and mental health problems underscores a significant relationship warranting further investigation.

Acknowledgements

We extend our gratitude to the pupils who took part in the survey, and we appreciate the collaboration and support provided by Bergen municipality and Vestland County Council for this study. Special thanks go to the resource group for their valuable contributions and discussions pertaining to the development of focus group interviews and the questionnaire.

Abbreviations

Authors’ contributions

Conceptualization, GJH and JCS; methodology, GJH and JCS; formal analysis, GJH and JCS; investigation, GJH, RTH, and JCS; writing—original draft preparation, GJH and JCS; writing—review and editing, GJH, TRF, BS, IC, RTH, AIOA, and JCS; project administration, JCS. All authors have read and agreed to the published version of the manuscript.

Open access funding provided by Norwegian Institute of Public Health (FHI) The work of GJH was supported by the Dam Foundation [grant number 2021/FO347287], while the work of TRF, AIOA and JCS was supported by The Research Council of Norway [grant number 319845]. The work of IC was partly supported by the Research Council of Norway through its Centers of Excellence funding scheme, project number 262700. The funding sources were not involved in the study design, in the collection, analysis, or interpretation of the data, or in the writing of the manuscript.

Availability of data and materials

Declarations.

The data collection was approved by the Regional Ethics Committee (REK) in Norway (reference number REK #65611) and was conducted in compliance with the principles outlined in the Helsinki Declaration. All participants were provided with information about the study’s overall objectives, both digitally and through communication with their teacher, and they provided electronic informed consent when participating. It was also made clear that participants had the option to withdraw from the study at any time. Additionally, all individuals invited to participate were at least 16 years old, granting them the legal capacity to independently provide consent; however, parents or guardians were also informed about the study.

Not applicable.

Dr. Colman has received consulting fees from Meta Inc.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

• Systematic Review
• Open access
• Published: 07 October 2024

Association between parental educational involvement and adolescent depressive symptoms: a systematic review and meta-analysis

• Ying Liu 1 , 2 ,
• Yidan Song 1 , 2 ,
• Yanlin Wu 1 , 2 ,
• Hongbo Lu 1 , 2 ,
• Yu Gao 1 , 2 ,
• Jing Tang 1 , 2 &
• Xifu Zheng 1 , 2  

BMC Psychology volume  12 , Article number:  538 ( 2024 ) Cite this article

Metrics details

Adolescents in their school-age period undergo rapid changes in various aspects, such as physiological development, academic pressure, and interpersonal relationships, constitute a high-risk group for depression. Parental educational involvement, as a critical family variable, influences not only children’s academic achievement but also their psychological well-being. However, previous research has shown significant discrepancies regarding the relationship between parental educational involvement and adolescent depressive symptoms.

To elucidate the overall strength of the association between parental educational involvement and adolescent depressive symptoms, this study systematically searched Web of Science, Medline, PubMed, CNKI, and other Chinese and English databases. A meta-analysis was conducted on 22 selected studies encompassing 36 effect sizes and involving 390,094 participants.

The results revealed a moderate negative correlation between parental educational involvement and adolescent depressive symptoms ( r  = -0.200, 95% CI [-0.26, -0.14]). Additionally, the relationship between parental educational involvement and adolescent depressive symptoms was found to be moderated by factors such as adolescent age, grade level and the reporter of parental educational involvement. However, it was not influenced by the female ratio or cultural background.

Conclusions

This study offers the inaugural comprehensive assessment of the relationship between parental educational involvement and adolescent depressive symptoms, with variations observed across different ages, grade levels, and reporter of parental educational involvement.

Peer Review reports

With intensifying societal competition, contemporary parents are experiencing growing levels of educational anxiety [ 1 ]. This is particularly evident in their involvement in their children’s academic activities and personal development. Parents hope to help their children achieve good grades, enter premier schools, and succeed in society by actively participating in their academic activities. Moreover, the formulation of relevant educational policies has further clarified the significance of parental educational involvement in children’s development, promoting greater parental engagement and increased scholarly attention [ 2 , 3 , 4 ]. For instance, the 2001 No Child Left Behind Act in the United States called for schools to enhance parental educational involvement to narrow social class and racial achievement gaps [ 5 , 6 ]. In China, the implementation of the Family Education Promotion Law on January 1, 2022, marked the country’s inaugural legislation specifically targeting family education, further standardizing and promoting family education practices [ 7 ].

Since its introduction in the 1960s, scholars have extensively researched parental educational involvement, yet inconsistencies remain in its definition and dimensions [ 8 , 9 , 10 ]. The predominant definition of parental educational involvement encompasses parents investing resources in their children’s education, focusing on interactions between parents and children in academic settings. This includes home-based educational involvement (e.g., reading and homework assistance) and school-based educational involvement (e.g., communication with the school and attending meetings) [ 8 , 11 ]. Hill and Tyson (2009) further expanded the definition of parental educational involvement by distinguishing between three dimensions: home-based educational involvement, school-based educational involvement, and academic socialization [ 10 ]. Researchers have widely adopted this typology [ 2 , 12 , 13 , 14 ]. Beyond the direct forms of involvement (i.e., home- and school-based educational involvement), academic socialization represents a more indirect influence, wherein parents communicate educational expectations, impart educational values, and discuss learning strategies with their children [ 12 ]. During early adolescence, children seek greater independence and autonomy and often question parental authority [ 15 ]. Consequently, interactions between parents and children become less hierarchical, manifested by increased bidirectional communication. Parental influence then tends to take on a more indirect form [ 16 ]. Research has found that parents’ attitudes toward education and beliefs about their children’s abilities significantly impact their children’s performance [ 17 ]. This three-dimensional framework allows for a nuanced analysis of parental educational involvement, capturing its multifaceted nature. Furthermore, studies have supported the efficacy of this three-dimensional approach in predicting educational outcomes [ 2 , 10 , 12 ]. Therefore, in our study, we adopted the broader definition proposed by Hill et al. (2009), which defines parental involvement in education as a multidimensional construct encompassing home parental educational involvement (HPEI), school parental educational involvement (SPEI), and academic socialization (AS).

Previous research has predominantly focused on the impact of parental educational involvement on adolescent academic achievement [ 9 , 18 , 19 ]. Numerous meta-analyses have consistently indicated the positive effect of parental educational involvement on academic performance [ 2 , 9 , 20 , 21 , 22 , 23 ]. Parental educational involvement in academic activities and guidance can boost children’s motivation to learn and help them acquire study skills [ 18 , 24 ]. However, recent studies have indicated that parental educational involvement not only affects students’ academic development, but also directly influences adolescents’ mental health [ 25 , 26 , 27 , 28 , 29 ], especially the widely recognized increase in depression among teenagers [ 25 , 30 , 31 , 32 , 33 ].

Depression in typically developing adolescents primarily manifests as depressive symptoms [ 34 , 35 , 36 ]. Adolescence widely recognized as a period characterized by rapid changes in physical, cognitive, and emotional domains, making it a high-risk period for mental health problems (e.g., depressive symptoms and anxiety) [ 37 ]. Surveys have indicated a significant increase in depressive moods during adolescence [ 37 ]. Unlike adults, depressive symptoms in adolescents are often more subtle and can persist into adulthood [ 38 ]. These symptoms can profoundly affect children’s and adolescents’ learning and lives. Without timely intervention, these symptoms may even elevate the risk of suicide [ 39 ]. During adolescence, depressive symptoms are often associated with various environmental factors [ 40 ]. Therefore, exploring external influences, such as parental educational involvement, on adolescent depressive symptoms is important for understanding the factors that may contribute to positive adaptation and development among teenagers.

Research on the relationship between the parental educational involvement and adolescent depressive symptoms has not yielded consistent conclusions. Some studies have found a negative correlation between parental educational involvement and adolescent depressive symptoms [ 26 , 41 ], with the suggestion that higher parental involvement might be associated with better outcomes in adolescents’ academic self-efficacy, self-esteem, and psychological resilience [ 42 , 43 ]. However, some studies have also found a positive correlation between parental educational involvement and adolescent depressive symptoms, where the demands, pressure, and psychological control exerted by parents regarding their children’s academic achievement could potentially be linked to negative mental health outcomes, especially when parental educational involvement manifests as excessive control over the child’s learning activities [ 30 ]. Furthermore, some studies have found no significant relationship between parental educational involvement and adolescent depressive symptoms, suggesting that depressive symptoms, as internalized issues, may not be directly associated with parental educational involvement [ 25 , 29 ]. Additionally, research on the relationship between the two has yielded effect sizes of varying degrees, ranging from small to medium to large [ 27 , 41 , 44 ].

Therefore, the question of whether and to what extent parental educational involvement is related to adolescent depressive symptoms remains unresolved and warrants further investigation.

Synthesizing previous meta-analyses, scholars have demonstrated that parent-based interventions are often associated with improved treatment outcomes for children with depressive disorders [ 45 , 46 ]. However, no meta-analysis has yet explored the relationship between parental educational involvement and the prevalence of depressive symptoms among typically developing adolescents, nor has there been an analysis of the reasons behind the inconsistent research findings in this area. This study conducts a meta-analysis of the existing literature on the association between parental educational involvement and adolescent depressive symptoms. Additionally, we seek to identify the factors influencing this relationship to explain discrepancies in current research.

Relationship between parental educational involvement and depressive symptoms in adolescence: theoretical framework

Numerous studies have highlighted the potential importance of parental educational behaviors in relation to adolescent depressive symptoms [ 34 , 47 ]. The “ecological systems theory” offers a framework for understanding this relationship.

Bronfenbrenner proposed the “ecological systems theory,” which explores how various levels of environmental systems (micro-, meso-, exo-, and macro-systems) and their interactions may be related to individual outcomes [ 48 ]. This theory suggests that parental educational involvement could play a role in adolescent psychological development. Parental engagement in educational activities has been associated with children’s academic development, socialization, and overall well-being [ 49 , 50 , 51 ]. Increased interaction between parents and children in family and school educational activities correlates with better psychological support [ 52 ].

Both families and schools play crucial roles as integral components of microsystems, serving as vital sources of social support for adolescents. Specifically, parental educational involvement at home, such as overseeing academic progress and taking children on museum visits, proves beneficial in enhancing children’s academic performance. Children who perceive more parental educational support tend to exhibit greater self-directed learning abilities [ 53 ], reporting stronger academic interest and learning motivation [ 54 ]. They also demonstrate higher academic commitment and achieve better grades [ 55 ]. Enhancing academic self-efficacy helps children gain a greater sense of self-worth and reduces the risk of depression [ 56 ].

The mutual influence between family and school constitutes a middle layer of the ecological system (e.g., school parental educational involvement), may also be important for children’s psychological well-being [ 57 , 58 ]. Parental educational involvement in school education, such as participating in school activities and communicating with teachers, allows parents to better understand their children’s interpersonal communication styles and the quality of their relationships [ 59 ]. It facilitates communication regarding interpersonal issues between parents and children [ 60 ], enabling parents to provide guidance, model behavior, or correct their child’s interpersonal norms and standards. This helps children acquire social skills and fosters positive interpersonal relationships within the school environment. Positive interpersonal relationships within the school environment are associated with higher life satisfaction and subjective well-being in adolescents [ 61 ], and these factors are inversely related to the likelihood of experiencing depressive symptoms [ 62 ].

Furthermore, through academic socialization, parents communicate educational expectations, convey educational philosophies, and discuss learning strategies with their children, potentially fostering positive attitudes toward learning [ 12 ]. When children receive a consistent educational approach from both family and school, it may contribute to a positive outlook on life during adolescence. This is particularly beneficial for adolescents during puberty, helping to strengthen their positive understanding of academics, reducing undesirable behaviors (such as dropping out), and discouraging their involvement in deviant peer relationships. As a result, this might help foster positive emotions and resilience when facing academic challenges, and could potentially reduce negative emotions [ 31 ].

Building on this theoretical framework, this study hypothesizes a negative correlation between parental educational involvement and adolescent depressive symptoms, with the hypothesis that parental educational involvement may be associated with a reduction in depressive symptoms (H1). The inconsistent findings regarding the relationship between the two may be influenced by various moderating variables.

Factors that may moderate the relationship

Participants’ characteristics and measurement factors may influence the relationship between parental educational involvement and adolescent depressive symptoms.

Participant characteristics

Age and grade level may influence the relationship between parental educational involvement and adolescent depressive symptoms. The dynamics of parent–child relationships and academic interactions undergo continuous changes over time. For adolescents entering middle school, this marks the initial phase of a “storm” characterized by a strong pursuit of autonomy and independence, leading to decreased attachment to parents during this stage [ 63 ]. Parental interference in academic matters may undermine adolescents’ autonomy-seeking efforts, leading to conflict. Furthermore, parents who are more involved in education often have higher academic expectations and demands for their children, which may increase academic pressure on their children to some extent [ 30 ]. For middle school students with insufficient emotional regulation and weaker resilience, parental involvement in education might have some negative effects and may not always significantly alleviate depressive symptoms. As adolescents age, they tend to place greater importance on their relationship with their parents, because this symbolizes their level of significance in their parents’ hearts [ 64 ]. During the high school stage, adolescents commonly face increased academic pressure. For those who have passed through the rebellious phase and have matured mentally, parental support and assistance might be associated with reduced academic anxiety. Research focused on high school students suggests that parental academic guidance may help alleviate depressive symptoms in this age group [ 41 ]. This study hypothesizes that age (H2) and grade level (H3) will moderate the relationship between parental educational involvement and adolescent depressive symptoms.

Gender ratio may be associated with variations in the relationship between parental educational involvement and adolescent depressive symptoms. According to social role theory [ 65 ], adolescent boys tend to seek more autonomy and independence and are inclined to conceal emotional issues. Conversely, adolescent girls during puberty are more likely to discuss educational and emotional matters with their parents and display emotions more openly, often relying on their parents for emotional support. Adolescent girls are more prone to experiencing and expressing depressive symptoms compared to boys. It has been suggested that positive emotional experiences gained through parental interactions may be linked to the alleviation of depressive symptoms in adolescent girls [ 41 ]. Some scholars have demonstrated that the relationship between parental educational involvement and adolescent mental health is stronger among females than males. This study hypothesizes that the gender ratio (female ratio) moderates the relationship between parental educational involvement and adolescent depressive symptoms (H4).

Measurement factors

Differences in the reporters of parental educational involvement may influence the relationship between parental educational involvement and adolescent depressive symptoms. One possible reason for this discrepancy is that previous measurements of parental educational involvement did not distinguish between parents’ actual involvement and their children’s perceptions of parental educational involvement. Paulson and Sputa found significant discrepancies between children’s perceptions of family and school parental educational involvement and the levels reported by parents [ 66 ]. Parents tended to report higher levels of involvement than their children did. This finding was confirmed by subsequent studies [ 30 , 67 ]. Research indicates that, compared with parental reports, the level of involvement perceived by children has a greater correlation with depressive symptoms [ 30 ]. Epstein (1995) suggested that school, family, and social relationships all influence academic performance and a child’s psychological well-being, with the child themselves being the primary actor in academic achievement and personal development [ 68 ]. Therefore, understanding how children perceive their parents’ educational involvement, compared to parental reports, is crucial. This may help explain why children’s perceived parental educational involvement is more closely associated with their psychological well-being than parental self-reports. Therefore, this study hypothesizes that the reporter of parental educational involvement moderates the relationship between parental educational involvement and adolescent depressive symptoms (H5).

Different cultural backgrounds may influence this relationship. Collectivist cultures emphasize interpersonal belonging and emotional support, while individualist cultures highlight individual independence, uniqueness, and autonomy [ 69 ]. Various studies on parental educational involvement across different countries have found that the nature of parental educational involvement in a Chinese cultural context is unique [ 31 , 67 ]. In collectivist cultures, family relationships are tightly knit, and children exhibit greater emotional dependence on their parents and obtain more emotional support. This study hypothesizes that cultural background moderates the relationship between parental educational involvement and adolescent depressive symptoms (H6) .

The present study

In summary, this study aims to address the following objectives:

Q1: Conduct a meta-analysis on the relationship between parental educational involvement and adolescent depressive symptoms, exploring whether they are correlated and determining the overall effect size.

Q2: Investigate in depth whether relevant participant characteristics (mean age, grade level, and gender ratio) and measurement factors (reporter of PEI and cultural background) moderate the relationship between parental educational involvement and adolescent depressive symptoms.

Literature search and selection

A comprehensive search was performed for both Chinese and English literature related to research on parental educational involvement and adolescent depressive symptoms. Chinese literature was retrieved primarily from databases such as CNKI, VIP Journal Full-text Database, Wan Fang Database, and the China Master’s Theses Full-text Database. The English databases included in the search were the Web of Science Core Collection, Medline, ProQuest Dissertations and Theses, PsycInfo, and PubMed. The search was conducted on September 22, 2023, with no restrictions on the publication date.

The search terms used were: "parent* involvement," "parent* educational involvement," "parent* participation," "family involvement," "family participation," "depress*," "mental health," "internalizing problem," and "negative mood." These search terms were determined based on relevant theories and existing research [ 2 , 19 , 23 , 70 , 71 , 72 , 73 ]. The search strategy in both Chinese and English databases involved keyword combinations in (a) titles, (b) keywords, and (c) abstracts. For example, in the Web of Science Core Collection database, the search strategy was: TS = ("parent* involvement" OR "parent* participation" OR "parent* educational involvement" OR "family involvement" OR "family participation") AND TS = (depress* OR "internalizing problem" OR "negative mood" OR "mental health"). In addition to database searches, this study also manually searched the reference lists of articles for additional literature retrieval to ensure comprehensiveness.

Eligibility criteria

Inclusion criteria.

The inclusion criteria for the studies in this research were as follows: (1) Empirical studies focusing on the relationship between parental educational involvement and adolescent depressive symptoms. (2) Report the age or schooling level of adolescents, with the age range needing to be between 10–18 years, or specify as middle school or high school students. (3) Studies measuring both parental educational involvement and adolescent depressive symptoms, and reporting at least one correlation coefficient ( r ) between the dimensions or total scores of parental educational involvement and depressive symptoms. (4) Including adolescents attending school as participants. (5) Reporting the sample size of the participants. (6) Using unique datasets, with only one study included if the same dataset was used in multiple publications.

Exclusion criteria

The exclusion criteria for the literature were established based on the inclusion criteria mentioned above. Additionally, exclusions were made for studies in which: (1) The participants were clinical subjects, as they did not appear in a natural background. (2) The language used in the literature was neither Chinese nor English. (3) The literature was inaccessible for download.

Literature was imported using EndNote X9 and screened according to the inclusion and exclusion criteria. This study ultimately included 22 articles, comprising 36 effect sizes. The detailed literature selection process is shown in Fig.  1 .

The PRISMA search strategy flow chart of included and excluded studies

Coding of study characteristics and effect sizes

For the literature included in the meta-analysis, the following data were extracted: (1) literature information (author names and publication year), sample size, effect sizes; (2) mean age of participants, grade level, female ratio; (3) reporter of parental educational involvement (PEI), type of PEI; (4) sampling location, cultural background; (5) study design (cross-sectional, longitudinal), literature type. This systematic data extraction served as a foundation for subsequent meta-analyses.

The effect sizes from the literature were coded based on the correlation coefficient r between parental educational involvement and adolescent depressive symptoms. The coding principles were as follows: (1) Each independent sample was coded once. (2) If a single article included multiple independent samples, each was coded separately. (3) If an article reported the relationship between different types of parental educational involvement and depressive symptoms, each type was coded separately, resulting in multiple effect sizes. (4) If an article simultaneously measured parental and child-reported levels of involvement and their relationship with depressive symptoms, different reporters were coded separately. (5) For longitudinal studies, the baseline coefficient between parental educational involvement and adolescent depressive symptoms was used for coding.

The literature coding was conducted using two methods: (1) The first author independently coded all the literature at different time points (with a 1-month interval). Analysis of the two coding sessions revealed minimal discrepancies in a few data points, while the majority of the codes showed no significant differences. (2) The third author, who received training, independently coded the literature. A comparison of the coding showed a high level of consistency (97%). This ensured a certain degree of accuracy in the literature coding. In cases of coding discrepancies, the two individuals engaged in discussions to make corrections. Eligible studies and data reports were screened based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement [ 74 ].

Data analysis

In the process of effect size aggregation, two methods were employed: the fixed effects and random effects models. The fixed effects model assumes homogeneity among different studies, attributes differences to random errors, and posits that the true effect is the same across studies. In contrast, the random effects model considers that the effects among different studies are influenced not only by random error but also by sample characteristics, acknowledging substantial heterogeneity among studies [ 75 ]. This study hypothesized that participant characteristics and measurement factors would impact the relationship between parental educational involvement and adolescent depressive symptoms. Therefore, a random effects model was used to aggregate the correlation coefficients. Additionally, the model selection was evaluated using the Q test and I 2 value. The I 2 value represents the proportion of the total variance due to heterogeneity, with values of 25%, 50%, and 75% indicating low, moderate, and high heterogeneity, respectively. If the Q test is significant or the I 2 value exceeds 75%, exploring the sources of heterogeneity is crucial [ 76 ], and employing a random effects model for data processing is recommended.

This study utilized correlation coefficients r as effect sizes and employed the Comprehensive Meta-Analysis (CMA) software (version 3.0) to aggregate effect sizes and analyze moderation effects. The correlation coefficients r were transformed into Fisher’s Z using the method introduced by Coryn to ensure comparability between effect sizes [ 77 ]. Subsequently, Fisher’s Z values were converted back to r using the appropriate formulas for result interpretation.

Conducting tests for moderation effects primarily involves:

The moderation effect of continuous variables, including adolescent mean age and female ratio.

The moderation effect of categorical variables, including adolescent grade level, PEI reporter and cultural background.

For continuous variables, the significance of the results was examined using meta-regression analysis. For categorical variables, the significance of the results was tested through subgroup analysis. To ensure the representativeness of subgroups, the number of effect size observations at each subgroup level should be no less than three.

Risk of publication bias

Publication bias refers to the preference for positive results, leading to a higher prevalence of positive results in the published literature [ 77 ]. Focusing solely on results in published journals may skew the meta-analysis findings; therefore, this study also searched for and included unpublished theses and dissertations, controlling for publication bias to some extent.

Furthermore, to ensure the reliability of the meta-analysis results, this study utilized a funnel plot and trim-and-fill method to assess publication bias. In the funnel plot, if the distribution of effect sizes shows an inverted symmetry, it suggests that publication bias is not significant. The trim-and-fill method involves estimating the effect size after trimming potentially biased studies and comparing them with the original estimates. A minimal difference between the effect sizes before and after trimming suggests low publication bias [ 78 ].

Study characteristics

Based on the literature search and selection, 22 studies comprising 36 effect sizes and involving 390,094 participants were included in the meta-analysis. Among them, six studies were in Chinese and 16 were in English. Three were theses, one was a conference paper, and the remaining 18 were journal articles. The time span of these studies ranged from 2006 to 2023. Table 1 provides a detailed overview of the study characteristics identified in each original publication.

Heterogeneity test

The results (Table  2 ) showed that the Q value was 2674.75 ( p  < 0.001) and I 2 was 98.69, surpassing the 75% threshold suggested by Higgins. This indicates substantial heterogeneity among the included studies, and the differences may have been influenced by various study characteristics. Therefore, it was appropriate to employ a random effects model to explore the moderating variables that affect the relationship between parental educational involvement and adolescent depressive symptoms [ 76 ].

Main effect

The random effects model was used to estimate the strength of the correlation between parental educational involvement and depressive symptoms. The results (Table  3 ) indicate an overall correlation coefficient of r  = -0.200, (95% CI [-0.26, -0.14], p  < 0.001). According to Wilson’s perspective in meta-analysis, when r  ≤ 0.10, it is considered low correlation; when 0.10 <  r  < 0.40, it is considered a moderate correlation; and when r  ≥ 0.40, it is considered a high correlation [ 79 ]. The correlation strength falls between 0.10 and 0.40, indicating a moderate negative correlation.

Furthermore, a sensitivity analysis was conducted to eliminate the interference caused by extreme values from individual studies on the meta-analysis results. The sensitivity analysis results indicate that, by excluding any single effect size, the correlation coefficient fluctuates between -0.181 and -0.209. This finding suggests a high level of stability in the meta-analysis results.

Moderating effect test

The results of the meta-regression analysis for the continuous variables revealed that the moderating effect of mean age (slope = -0.07, Z  = -2.52, p  = 0.01, k = 24) was significant, while the moderating effect of female ratio (slope = 0.41, Z  = 1.30, p  = 0.19, k = 34) was insignificant (Table  4 ).

The results of the subgroup analysis of the categorical variables revealed that the moderating effects of grade level ( Q B (2) = 11.757, p  = 0.003) was significant. Table 5 shows that the relation between the two variables was significantly higher in senior high school ( r  = -0.40, 95% CI [-0.58, -0.18]) than junior high school ( r  = -0.18, 95% CI [-0.25, -0.11]) or mixed group ( r  = -0.05, 95% CI [-0.13, 0.03]).

The moderating effect of the PEI reporter was significant ( Q B (1) = 7.22, p  = 0.007), whereas the moderating effect of cultural background ( Q B (1) = 2.937, p  = 0.052) was not. Table 5 shows that the relation was significantly higher when PEI was reported by children ( r  = -0.26, 95% CI [-0.34, -0.19]) compared to parents ( r  = -0.12, 95% CI [-0.19, -0.05]).

Publication bias test

The funnel plot (Fig.  2 ) illustrates that the effect sizes were concentrated above the plot and evenly distributed on both sides of the overall effect, indicating an absence of substantial publication bias. However, recognizing that a funnel plot allows for a preliminary, subjective assessment of publication bias, we conducted further testing by employing a trim-and-fill approach to re-estimate the effect sizes and identified ten studies on the left side to be trimmed. The recalculated effect size after trimming was -0.279, with a 95% CI [-0.33, -0.23]. Despite this adjustment, the effect size remained indicative of a moderate negative correlation, closely resembling the original pooled effect size ( r  = -0.200, 95% CI [-0.26, -0.14], p  < 0.001), with only a marginal difference of 0.079. These findings suggest that this study did not exhibit a severe degree of publication bias, and that the results are reasonably reliable.

Funnel plot

Parental educational involvement and adolescent depressive symptoms

This study conducted a meta-analysis of empirical research on the relationship between parental educational involvement and adolescent depressive symptoms. The results indicate a significant, moderately negative correlation, confirming H1. This clarification resolves the controversy regarding the direction and magnitude of the correlation between both items. Parental educational involvement is associated with a reduction in depressive symptoms in adolescents, which aligns with findings from previous studies [ 31 , 32 , 80 ]. When parents engage in academic interactions with their children, providing increased academic support and positive guidance, this is associated with improvements in their children’s emotional well-being [ 81 ]. This result also supports the theory of “ecological systems.” For adolescents, families and schools serve as the primary living environments. When parents engage in academic activities with their children, such as assisting with homework, inquiring about their learning progress, and discussing the importance of education for personal development, children may perceive their parents’ care and support, potentially enhancing family happiness [ 82 ]. This perception may contribute to positive emotional development in children and is associated with a lower likelihood of depressive symptoms. Furthermore, active parental participation in school activities and communication with teachers helps increase teachers’ attention to students and enhances interpersonal trust. A positive school interpersonal environment, including teacher-student and peer relationships, can elevate children’s life satisfaction and significantly decrease the likelihood of bullying within the school [ 83 ]. This supportive environment could, in turn, help mitigate the emergence of maladaptive behaviors and emotions in children.

From another perspective, meeting basic psychological needs is associated with a child’s psychological well-being and may be linked to a lower incidence of adolescent depressive symptoms [ 84 ]. Parental educational involvement can elevate a child’s emphasis on academics, significantly increasing their sense of academic self-efficacy, helping them achieve better grades, and fulfilling their competence needs [ 85 ]. Compared to families with low parental educational involvement, those with high educational involvement may foster intimate relationships between parents and children. This not only sets a positive example for children in building interpersonal relationships but also contributes to their development of relationships within the school setting, meeting the children’s relational needs [ 41 ].

Adolescence, characterized by rapid physical and psychological growth, requires adaptation to new learning environments and tasks. Parental educational involvement can be beneficial in navigating the adaptation process, potentially helping to mitigate the development of depressive symptoms [ 86 ]. Most studies on parental educational involvement have explored its correlation with adolescents’ academic performance. However, this study highlights its relevance to depressive symptoms in adolescents based on meta-analysis findings. This suggests that parents should not rely solely on schools for their children’s mental health but should recognize the possible role of the family system.

Analysis of moderating effects

For the first time, this study systematically explored the moderating variables influencing the relationship between parental educational involvement and adolescent depressive symptoms. It preliminarily revealed the reasons for the inconsistency in the direction and magnitude of this relationship observed in existing research. The results indicate that adolescent mean age (H2), grade level (H3) and reporter of parental educational involvement (H5) significantly influence the relationship between parental educational involvement and adolescent depressive symptoms. However, female ratio (H4) and cultural background (H6) do not significantly moderate this relationship.

One of the most significant findings of our study was the confirmation of the moderating effects of age and grade level, supporting H2 and H3. This result indicates that the correlation between parental educational involvement and adolescent depressive symptoms varies across different academic stages, which aligns with previous research findings [ 87 ]. As adolescents progress in age and academic stages, the association between parental educational involvement and adolescent depressive symptoms becomes more pronounced. Specifically, during early adolescence, there is a growing self-awareness characterized by a desire for independence and a tendency to think for oneself, as well as an increased focus on the influence of peers. Consequently, parental educational involvement in academics may be perceived as interference and psychological control [ 84 ]. However, as adolescent age and progress through educational stages, they gradually move beyond the rebellious phase, becoming more mentally mature and recognizing the assistance parents provide in their education. The transition from middle to high school, in particular, brings about a significant increase in academic tasks and stress, elevating the likelihood of adolescent depressive symptoms. Parental support may help adolescents manage academic challenges, receive emotional backing, and address academic stress. For parents facing adolescents who have just transitioned from elementary to middle school, their involvement in education may not align well with the learning patterns of the middle school stage. Parents may experience pressure in understanding the difficulties of the curriculum and may not be adept at handling their child’s emotional development, resulting in a lower quality involvement [ 29 ]. As children progress through different grade levels, parents continuously accumulate experience in interacting with their child academically, gradually mastering more reasonable and effective methods of academic interaction to provide effective assistance. Simultaneously, they become more familiar with adolescents’ psychological developmental status and place a greater emphasis on providing psychological support to their child [ 41 ]. Therefore, the increase in the quality of parental educational involvement may be attributed to the moderating effects of age and academic stage.

Furthermore, another crucial finding confirmed the moderating effects of PEI reporter, validating H5. The correlation between the level of parental educational involvement reported by children and depressive symptoms was significantly greater than that reported by the parents. This suggests that children’s perceptions of parental educational involvement might be more closely associated with depressive symptoms [ 30 , 88 ]. This difference indicated that the level of parental educational involvement that children genuinely perceive should be considered. The importance of parental educational involvement has been extensively substantiated by educators and psychologists [ 89 , 90 ]. However, this result suggests that while emphasizing parental involvement, we should also consider it from the perspective of the child, contemplating how parental involvement behaviors effectively influence and are genuinely perceived by the child. Moreover, significant disparities in the perceived level of involvement between parents and children may indicate potential issues in parent–child interactions that warrant attention. However, it should be noted that this result may be influenced by method variance. In all the studies included, the measurement of depressive symptoms was based on children’s self-reports. This reliance on self-reports may lead to a stronger correlation between child-reported parental involvement and depressive symptoms due to method variance. This is an important factor to consider when interpreting these results.

Surprisingly, this study did not find moderating effects of adolescent gender ratio and cultural background, refuting H4 and H6. There were no significant gender or cultural differences in the relationship between parental educational involvement and adolescent depressive symptoms. One possible explanation for this is that, although girls may have more academic interactions with their parents than boys, excessive parental educational involvement in academics could also deprive girls of their need for autonomy. This leads to more experiences of psychological control and negative emotions [ 91 ]. Another possible explanation is that the majority of studies had included in this meta-analysis had a relatively balanced female ratio of approximately 0.5, with a ratio close to 1:1. The limited overall literature included may also contribute significantly to the lack of moderating effects observed in gender ratios. This finding suggests the need for further analysis. The results indicate that cultural background did not significantly moderate this relationship. However, the effect sizes showed marginal significance ( p  = 0.087). Previous research has indicated that cultural background is a crucial factor influencing the relationship between parental educational involvement and depressive symptoms. Compared to individualistic cultures, collectivist cultures emphasize emotional interdependence among individuals rather than independence and autonomy [ 31 ]. The inconsistency between our findings and previous research conclusions may be attributed to the fact that our study was based on multiple research results rather than a single study. Despite refuting H6, these results have significant practical implications. They suggest that in collectivist cultures, parental educational behaviors may exhibit a stronger correlation with adolescent depressive symptoms. However, the impact of parental educational involvement on adolescent depressive symptoms demonstrates cross-cultural consistency and lacks significant differences.

Limitations

This study has several limitations. First, the cross-sectional nature of the reviewed studies limits causal inferences, we can only conclude from the meta-analysis results that there is a negative correlation between parental educational involvement and adolescent depression, but we cannot infer a causal relationship between the two. Second, this meta-analysis included a relatively small number of studies, restricted to Chinese and English publications, which may have led to data omissions. Third, half of the samples are from China, potentially limiting the generalizability of the findings. Future research should aim to include more diverse cultural backgrounds to enhance universality. Fourth, high heterogeneity in effect sizes suggests caution in interpreting the overall effect size, and further analysis of other moderating variables is needed. Finally, uneven distribution of effect sizes across subgroups may have influenced the results, warranting careful interpretation.

This meta-analysis aims to quantifies the correlations between parental educational involvement and adolescent depressive symptoms. The results revealed a moderately negative correlation between parental educational involvement and adolescent depressive symptoms. Furthermore, meta-regression analysis and subgroup analysis indicated that participant characteristics (mean age and grade level) and PEI reporter significantly moderate the relationship. Specifically, as adolescents mature and enter higher grade levels, parental educational involvement is associated with lower depressive symptoms. Moreover, compared to parental reports of involvement, adolescents’ perceptions of parental educational involvement show a stronger correlation with their depressive symptoms. The results of the study help us better understand the relationship between parental educational behavior and adolescent depressive symptoms.

Availability of data and materials

All data generated or analyzed during this study are included in this article.

Data availability

No datasets were generated or analysed during the current study.

Abbreviations

Academic socialization

Comprehensive meta-analysis

Home parental educational involvement

School parental educational involvement

• Parental educational involvement

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

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Ying Liu, Yidan Song, Yanlin Wu, Hongbo Lu, Yu Gao, Jing Tang & Xifu Zheng

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Ying Liu proposed the research topic, conducted data analysis, and completed the initial draft; Yidan Song carried out initial draft revisions; Yanlin Wu participated in data coding; and Hongbo Lu, Yu Gao, and Jing Tang were involved in literature screening and verification. Xifu Zheng provided guidance and suggestions for the article and made final revisions. All authors contributed significantly to this study. All authors have read and agreed to the final version of this manuscript.

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Liu, Y., Song, Y., Wu, Y. et al. Association between parental educational involvement and adolescent depressive symptoms: a systematic review and meta-analysis. BMC Psychol 12 , 538 (2024). https://doi.org/10.1186/s40359-024-02039-3

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Received : 06 March 2024

Accepted : 26 September 2024

Published : 07 October 2024

DOI : https://doi.org/10.1186/s40359-024-02039-3

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