Addressing psychiatric and psychosocial issues related to children and adolescents
Psychiatric–mental health nurses (PMHNs) are well aware of the anxiety college students have over their grades and performance in academic and clinical courses. Many students claim to feel anxious and overwhelmed with the requirements for classes. Students express their worries about passing examinations and ask college faculty for increased levels of reassurance. They request detailed test blueprints, extensive test reviews, and access to faculty via e-mail and discussion boards. Course evaluations suggest that faculty choose easy-to-read textbooks that have short chapters. Current traditional age college students are part of the iGen generation.
The iGen generation, also known as Generation Z, comprises 74 million Americans born between 1995 and 2012 (Twenge, 2017). They have been called the iGen generation because students spend most of their time on the internet with devices such as smart-phones, in particular, the iPhone®, which was introduced in 2007 (Twenge, 2017). This generation has come of age with numerous technologies that shape their view of the world such as smart-phones, YouTube®, and social media platforms (e.g., Facebook®, Twitter®, Instagram®, Snapchat®). Students in this generation spend the majority of their free time on their digital devices. When asked how they solve their problems, many students state they call their parents before they make a decision.
Characteristics of the iGen Generation
iGen students are in no hurry to grow up. Many young adults delay getting a driver's license until age 18 or 19. They do not have part-time jobs, date less, are less likely to go out with friends, are less sexually active, have a lower crime rate, and do not experiment with alcohol or drugs compared to previous generations (Twenge, 2017). While attending college, they are more alcohol naïve and may be more prone to alcohol poisoning due to binge drinking, but tend to smoke marijuana (Hibbs & Rostain, 2019). As a cohort, these students appear more virtuous and better behaved, but are they more responsible?
Twenge (2017) explains that these young adults are maturing more slowly because they were raised in smaller families by parents who have kept a close watch over their children. Surveillance by parents began with the use of baby monitors and has continued with use of cell phones. This cohort of young adults uses technology excessively in their leisure time, fights less with their parents, and is seen as less rebellious than previous generations. This lack of rebellion against their parents' overprotection seems odd to older generations, but these college students have embraced the overprotection. This cocoon mentality is behind recent trends on college campuses such as trigger warnings to alert students that a reading or lecture material might be disturbing and safe spaces where students can go if they are emotionally upset by a campus speaker (Twenge, 2017). Overprotection by parents has led colleges and universities to create a protective culture, “the culture of safetyism” (Lukianoff & Haidt, 2018, p. 30).
Parents have grown to be more protective because in the 1980s, there was the trend of stranger danger, which started with the abduction and murder of Adam Walsh in 1981. Adam, a 6-year-old boy, became separated from his mother in a Sears store in Hollywood, Florida and was abducted and murdered by a stranger. This tragedy led to activism by his father, John Walsh; the television series, America's Most Wanted; and the creation of the National Center for Missing and Exploited Children in 1984 (Lukianoff & Haidt, 2018). As a result, parents were afraid to let their children out of sight. Parents planned play dates with other parents and their children. This parental protection became the norm versus allowing children to play freely outside without adult supervision. This was also the era of the self-esteem movement when all children got praise, a certificate, or a trophy for every activity. Children were rewarded for their achievements. Members of the iGen generation are the children of Generation X (born between 1965 and 1980) parents and the parenting style that began during the Millennial generation (born between 1981 and 1996).
Overparenting is a general term for a type of parenting style characterized by parental over-involvement, intrusiveness, and control in the lives of children, teens, and college students. Overparenting is coupled with high levels of parental warmth and responsiveness (Padilla-Walker & Nelson, 2012). Lareau (2011) states upper- and middle-class parents use this type of parental control of organized activities so as to cultivate student talents, which is described as “concerted cultivation” (Lareau, 2011, p 2). From this experience, a robust form of entitlement may take root. This sense of entitlement plays a role in college settings where students learn to question adults and address them as relative equals (Lareau, 2011).
In American working class and poor families, however, childhood can look very different in that there is less structure and more freedom to play outside with other children or watch television in their spare time. These families do not focus on concerted cultivation. The crucial child-raising responsibilities of these parents do not lie in their children's feelings, opinions, and thoughts. Rather, these parents are more directive in that they tell their children what to do and do not discipline through the use of reasoning. In these families, there are clear boundaries between adults and children. Working class and poor families do not have a steady diet of adult-organized activities. Children might have one sport or activity instead of multiple ones. These students have more control over their leisure activities, which are separate from adults. This type of parenting is called “accomplishment of natural growth” (Lareau, 2011, p. 1). Children of working class and poor families also spend more time with extended family members.
Types of Overparenting
One type of overparenting has been described as helicopter parenting because parents hover above their children to protect them from harm or experiencing frustration, disappointment, or pain. With the advent of cell phones and social media, parents can monitor their children's whereabouts and be in immediate contact with them to intervene on their behalf (LeMoyne & Buchanan, 2011). Helicopter parents micromanage their college students' personal and professional lives. They are overly directive in advice giving and problem solving. Parents do things for their college students that they could do on their own. Anxious parents expect their young adult children to be ready to receive and immediately return phones calls, e-mails, and texts at any time to check in on their schedules, classes, and relationships. When a student does not communicate immediately, parents continue to call, e-mail, or text to be reassured that their student is safe. Parents have been known to come to campus to bring food, clean their student's dorm room, and collect laundry. Parents have contacted teachers, administrators, and coaches to advocate on behalf of their youth regarding academic work and grading disputes. This parental behavior began in high school and continues in the college years.
Parents also attempt to influence decisions by school authorities on behalf of their young adults. For example, at the end of a semester, faculty and academic administrators are often bombarded by family members who want to negotiate a final course grade on behalf of their college student. Some parents insist that the poor grade be changed, especially if a course has been failed and academic progression is threatened. To a parent, the stress of an academic failure presents an unacceptable situation. Requests by parents emphasize that an exception be made for their son or daughter versus a focus on academic standards. At times, safety and security officials must be kept on alert in case the interactions with parents escalate or become hostile in their attempts to eliminate any obstacle in their college student's academic trajectory. In this case, a more extreme form of overparenting, called snowplowing, lawn mowing, or bulldozing (Miller & Bromwich, 2019), goes further than helicopter parenting. These parents want to plow through any barrier in the way of a college student's path so to guarantee the student's academic success. All overparenting is behavior that is out of control (Nelson, 2010) and stems from parents' overwhelming anxiety. In today's society, there is extreme competition for admission into students' preferred college or university. Stress and pressure to be the best is expected because admission to a top tier university is perceived as a good investment that will lead directly to a high paying and prestigious job.
Consequences of Overparenting
Deresiewicz (2014) states that our educational system has made a race of childhood and that youth have become excellent sheep:
They have learned to be a student but not to use their minds…. They have been taught that education is doing your homework, getting the answers, acing the test…nothing in their training has endowed them with the sense that something larger is at stake.
Students are all striving to meet the high levels of academic expectations from elementary school through high school for the potential payoff of a college education at a prestigious institution. An expectation is that they are doing enough to impress college admission officers. Helicopter parenting becomes part of the strategy used by parents to reach the goal of meeting college admission standards. To meet these demands, parents become over-involved in their children's academic and extracurricular activities. Parents have been known to even write college application essays on behalf of their teens.
Given the intensity of competition for students to excel leaves little time for youth to relax, eat dinner, care for pets, or engage in chores. Therefore, adolescents do not learn key life skills that will help them in college, such as cleaning, cooking, doing laundry, managing money, and communicating with authority figures. Students' self-esteem is linked to their academic role. Such intense competition and a focus on achievement and performance results in less deep learning. According to Pope (2001), instead of a focus on deep learning, students learn to “do school,” that is, to do the work they need to do to accomplish the minimum to get the grade they want. As a result, Pope (2001) suggests that the educational system is creating a generation of stressed out, materialistic, and miseducated students who try to play by the rules to get ahead, but find that they compromise their values and manipulate the system by scheming, lying, and cheating, instead of being engaged with learning and committing to the values of integrity and community. A focus on achievement has a negative impact on the mental health of college students in particular because the college environment is more intense and does not have the parental scaffolding.
Helicopter Parenting and the Effects on Learning and Motivation
Schiffrin, Yost, Power, Saldanha, and Sendrick (2019) found that when viewed as having a failure-as-debilitating mindset, young adults reported their fathers were more likely to participate in helicopter parenting behaviors, which was associated with fixed mindsets. People with fixed mind-sets have been found to have decreased motivation, avoid challenges, and have less perseverance (Reed, Duncan, Lucier-Greer, & Fixelle, 2016).
Schiffrin et al. (2017) studied the comparison of students' and mothers' reports of helicopter parenting on academic motivation. Using a survey of 192 college students, their findings concluded that children's report of maternal helicopter parenting was related to extrinsic motivation to learn, a focus on perfectionism, and avoidance goals for learning, which have been associated with lower academic performance. Mothers' report of helicopter parenting was related to maladaptive academic motivations that may have negative implications for academic achievement. Children may expect or feel entitled to parental over-involvement. Parents may over-value their children, and these sentiments and narcissistic traits may be internalized by children. When students perceive that their mothers engage in helicopter behaviors, their academic motivations shift in that they care more about grades and avoiding failure rather than learning the information. This mindset continues as the student enters college.
Reed et al. (2016) examined the factor structure of the Helicopter Parenting Behaviors measure using confirmatory factor analysis. They examined self-efficacy as a mechanism for helicopter parenting and autonomy-supportive parenting in emerging young adults' mental and physical health. Both autonomy-supportive parenting and helicopter parenting had indirect effects on anxiety, depression, life satisfaction, and physical health through self-efficacy. Autonomy-supportive parenting was directly related to life satisfaction and physical health. Helicopter parenting was not related to well-being. Autonomy-supportive parents are involved in their child's life but consider the child's perspective and act in ways that encourage the child's independence and ability to solve his or her own problems (Deci & Ryan, 1985). Chirkov and Ryan (2001) suggest that young adults who perceive their parents as engaging in autonomy-supportive parenting behaviors tend to experience a smoother transition to adulthood.
Mental Health Issues of iGen College Students
The stress experienced by college students continues after they are accepted into college or university. In the book, The Stressed Years of Their Lives: Helping Your Kid Survive During Their College Years (Hibbs & Rostrain, 2019), two mental health professionals from student health services at the University of Pennsylvania explore students' abilities to cope in college once the structure of parental support at home has been lifted. Campus hazards include hazing, binge drinking, drug use, sexual assault, and feelings of not fitting in or feeling less than in their academic roles (Hibbs & Rostain, 2019).
According to the American College Health Association's (ACHA; 2017) national survey, one in four college students were either diagnosed or treated for anxiety in the prior year. More than one half of these students reported being overwhelmed with anxiety during the prior school year. One third reported depression symptoms that significantly affected their academic performance (ACHA, 2017).
The National Academies of Sciences, Engineering, and Medicine (2013) reported that only one fourth of affected students received counseling for mental health conditions, and many who did receive counseling prematurely dropped out of treatment. Active Minds (2019) lists anxiety as the most common mental health disorder. One third of all college students with depression had symptoms severe enough that they had trouble functioning in the past 12 months. Mental health issues such as depression, anxiety, and eating disorders were associated with lower grade point average (GPA) and higher probability of dropping out of college. More than 80% of college students felt overwhelmed by all they had to do in the past 1 year, with 45% having felt hopeless (Active Minds, 2019). Minority students were less likely to seek treatment. Suicide is the leading cause of death among college students (Active Minds, 2019). More than one half of college students have had suicidal thoughts and one in 10 students has seriously considered attempting suicide. Eighty to ninety percent of students who die by suicide were not receiving help from college counseling services (Active Minds, 2019).
The suicide of Madison Holleran, a talented female student athlete from the University of Pennsylvania, described in the book, What Made Maddy Run? (Fagan, 2017), gives an account of a stunning academic student and track star who did not fit in and had difficulty coping with her academic life and athletic training. She eventually died after jumping from a skyscraper in downtown Philadelphia, several blocks from campus. The book described that Maddy had what many students have, the Penn Face, where everything on the surface, including what is posted to social media sites, texts, and e-mails, appears to be perfect, while the student is silently struggling in private. The Penn Face has been compared to a duck's face, where the duck's face is calm, but the feet are paddling frantically under the water. No matter what is going on, the student tries to uphold a pleasing, perfect public persona to friends, family, peers, and faculty as well as on social media (Fagan, 2017). Students do not want to disappoint others, yet they are anxious, depressed, alienated, and suffering.
Nursing Interventions to Improve the Mental Health of iGen College Students
Goals to improve the mental health of iGen college students include goals for students, anxious parents, college professors, and nursing faculty. The goals for students include: (a) establishing a healthy focus on self-discovery, identity, self-reliance, and grit; and (b) setting limits on technological distractions including how to cope with a constant deluge of e-mails, texts, and posts on social media. A goal that addresses anxious parents includes developing parenting strategies that stress autonomy and independence versus dependence. Students and parents should work on ways to reduce reliance on parents for problem solving and tasks that college students can handle on their own. Parents should let go or get out of the way of their young adults so as to allow their college students to develop healthy coping behaviors and life skills.
Goals for college professors and nursing faculty include managing boundaries in the faculty–student relationship, recognizing students' mental distress, and referring students with anxiety to university counseling centers or mental health providers. Nursing faculty in particular often struggle with navigating relationships with students with mental health issues (Kucirka, 2017). This struggle leads to role confusion and concern in managing the dual role of nurse and faculty. When students present with anxiety, nursing faculty instinctively adopt a nursing approach, focusing on caring for students rather than conveying the belief that students can manage their anxiety.
Kucirka (2013) noted faculty angst occurred when encountering distressed students, which in turn tapped into maternal/paternal desires to provide nurturing among those faculty who were also parents. This begs the question: Are nursing faculty becoming helicopter faculty? In addition, the administrative pressure to retain nursing students lends itself to overfunctioning faculty behaviors in addition to making exceptions for students' behaviors rather than holding students accountable for their education. These behaviors send the message that students need caretaking rather than the belief that they can manage and demonstrate self-efficacy.
Kucirka (2017) also discovered a dichotomy of panic and desensitization among faculty when students exhibited moderate to severe levels of anxiety. Psychiatric–mental health nursing faculty were frequently called on to be interventionalists. Overwhelmed nursing faculty members often sought counsel from psychiatric–mental health faculty in addressing student issues and concerns. Another response to an anxious student is desensitization to the student's mental health issue. For example, some participants expressed the belief that all nursing students are anxious and failed to recognize students with psychopathology who required intervention. It is imperative that faculty recognize and refer students to the counseling center or mental health provider in this situation. Providing therapy is not the role of faculty. It would be beneficial to provide all college faculty with education on recognizing the signs and symptoms of mental illness, boundary management, and the importance of using available resources for assessment and treatment of mental health issues. Psychiatric–mental health nursing faculty should also be included on university Behavioral Intervention Teams and advocate for the inclusion in peer support groups for students on campus.
Self-Discovery, Self-Reliance, and Grit
College is a time for young adults to continue on their developmental journey toward identity and preparation for a life of purpose plus engagement with others toward meeting intimacy in relationships. College students are developing habits that can serve them well in college and life. PMHNs can be instrumental in assisting young adults in their everyday lives by suggesting a framework for success, such as The 7 Habits of Highly Effective People (Covey, 2004). Key ideas in this book include being proactive, developing empathetic communication with others with a focus on win-win in relationships, listening and understanding others, keeping the overall goal of one's life in mind at all times, prioritizing actions to meet one's life goals, and self-care activities. Levine (2012) focuses on development of resilience and seven essential coping skills: resourcefulness, enthusiasm, creativity, a good work ethic, self-control, self-esteem, and self-efficacy. In her book, Grit, The Power of Passion and Perseverance, Duckworth (2016) also puts forth the argument that young people can learn to persevere and stick with a problem or project and develop a sense of agency and competence as a result. To do the work of a young adult to achieve a sense of separation and individuation, there needs to be clear boundaries established between college students and their parents.
Letting Go of Young Adults: Creating Healthy Boundaries
Parents are understandably concerned about their college student's success because of the personal and financial investment they have made in sending their young adult to college. The high cost of a college education, an uncertain economy, and the need for employment after college to pay back student debt are all realistic worries for parents. PMHNs will need to create an alliance with parents to help them negotiate their own developmental transition to allow their young adults to figure things out on their own, take calculated healthy risks, and cope with failure. Reducing helicopter parents from hovering and protecting their college students and focusing on autonomy will increase self-esteem and self-efficacy instead of a constant dependence on parents, which leads to anxiety and helplessness. Families can be offered a parenting toolkit that includes many of the references, especially the books recently authored by Levine (2012), Duckworth (2016), Lukianoff and Haidt (2018), Hibbs and Rostain (2019), and Lythcott-Haims (2015), on how to raise young adults and prepare them not only for college but for life. Universities could use new student orientation sessions not only for students but for parents to talk about this transition period for the family and ways to promote autonomy, responsibility, and independence in their freshman college students. One crucial topic to be addressed is appropriate use of technology.
Untether Yourself from the Internet and Social Media
The internet is a crucial aspect of everyday life in the 21st century, but excessive use of e-mail, texts, and posts to social media can contribute to a college student's problems with time management unless the student puts limits on online activities. Technology's impact on everyone has been documented thoroughly by Turkle (2011, 2015). The reliance on technology puts demands on everyone to be available on an around-the-clock basis. This constant availability creates the illusion of connectedness; however, it lacks the personal intimacy of face-to-face contact. In many respects, technology can make a person feel more alone. Deep friendships cannot be forged through texting, e-mail, and social media; they require personal interactions and communication with others. Social media platforms support public pseudo-personas as students use social media platforms (e.g., Facebook) as a way to project and brand themselves to others. Internet use can take time away from college students' engagement with course material as well as with peers, faculty, coaches, and other supportive adults on campus.
Sales (2016) describes the impact social media can have on teenage girls in particular. Extensive use of social media can lead to sexting, pornography, and accelerated romantic online relationships. Although there are no official psychiatric diagnoses for behavioral addictions (with the exception of gambling disorder) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2013), discussions about behavioral addictions are becoming more prevalent in the literature and pose problems for students due to their intense use of technology. Examples of behavioral addictions include internet addiction, online gaming, online gambling, and online pornography as a behavior typical of sex addiction (Wieland, 2015). As a society, there must be a balance in the use of technology with other required daily activities. College students will need to find this balance to prioritize their coursework and academic and social engagement with others to feel genuinely connected. This prioritization includes setting limits on with whom, when, and how long to be online, including connecting by cell phone with their parents.
Helicopter parenting robs college students of their growth and development, hampering their sense of identity, individuation, autonomy, and self-efficacy. When parents make decisions, problem solve, and do for their young adults what they can do for themselves, parents give the message that college students cannot be trusted to take care of themselves. This style of parenting results in college students who cannot make decisions without parental input or approval, which leads to learned helplessness, anxiety, depression, eating disorders, and for some students, hopelessness, suicidal ideation, and suicide attempts. Helicopter parenting can result in students' poor coping skills when confronted with failure as well as under-developed life skills.
In this era of surveillance and always being turned on to technology 24 hours per day, 7 days per week, technology can become intrusive and a poor substitute for face-to-face interpersonal interactions and relationships with others. College students and parents need to partner in their mutual goals to develop young adults who can take healthy risks to become engaged with their education and peers, learn creative and innovative ways to solve problems, and cope with the stress of college life, including failure.
Technology needs to be used to enhance learning, not as a 21st century digital umbilical cord between college students and their parents. PMHNs in their practice and educational roles must lead the way to promote an autonomy-supportive type of parenting style instead of helicopter parenting. Nursing faculty should take the lead in educating faculty and academic nurse administrators about mental health issues and the process for appropriate referrals to professional counseling staff within the Student Health Services Department on campus. Students can be taught stress management techniques, mindful meditation, and other self-care measures to promote their own mental health and well-being. They should also know how to access mental health services and not feel stigmatized to do so. Students can also engage in mental health activism by participating in college and university chapters of Active Minds.
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