A few are as young as 12, most in their late teens. But recently, his final appointment of the day was an 8-year-old boy whose parents brought him in, horrified to discover his pornography habit.
"No longer can we do the 'birds and bees' talk at age 12 and then not talk about it again," says Bulkley, who practices in St. George, Utah. "This has to become something that kids and parents can talk about on a regular basis."
In an article published in Pediatrics in 2007, researchers found that 42 percent of youths had been exposed to pornography online in the last year and 66 percent of that group didn't want to see it.
Data from the "Youth Internet Safety Survey" conducted in 2000, 2005 and 2010 show that the prevalence of seeing unwanted pornography went from 25 percent to 34 percent and then dropped back down to 23 percent.
"This does not mean that young people who are voluntarily accessing pornography are having a hard time finding it," the authors point out. Rather, it might reflect an increased use of filtering on networks and individual computers, as well as more educated young Internet users. They know enough not to click on unidentified links or email.
But when filters don't work and pornography pops up, or when it's sought out intentionally, it's no longer static Playboy or Penthouse images. Instead, today's Internet porn is high-speed, high-definition and increasingly filled with violent acts.
One content analysis of the top pornography movies from 2005 found that 88 percent of scenes showed violence against the performers, including slapping, spanking, gagging, choking, kicking or hair-pulling, and 94 percent of the time the violence was directed at women.
Seeing scenes like this makes an impact on adolescents. Researchers at the Center for Innovative Public Health Research (CiPHR) in San Clemente, Calif., found that youths who watched violent pornography were six times more likely to engage in sexually aggressive behavior compared to non-viewers. These behaviors include in-person sexual assault, or technology-based sexual harassment or solicitation.
This connection persisted even when other important factors like substance abuse, prior sexual victimization and aggressive behavior in general were taken into account. On the other hand, youths who viewed non-violent pornography were no more likely than non-viewers to act out aggressively.
"Not all porn is equal," said CiPHR president and research director Michele Ybarra. "We expected to see a difference, but not to this magnitude."
Viewing non-violent pornography may present its own concerns. According to a 2009 study on “Sexual Attitudes and Behaviors Associated With U.S. Early Adolescents’ Exposure to Sexually Explicit Media,” by Jane Brown, 13- to 14-year-old males who watched Internet pornography, X-rated videos and read pornographic magazines were nearly three times more likely than their non-viewing peers to have engaged in oral sex (59 percent versus 20 percent), and 10 times more likely to have engaged in sexual intercourse (38 percent versus 4 percent) two years later as 15- and 16-year-olds.
But watching non-violent pornography doesn't rise to the alarming public health crisis that violent pornography is creating, said Ybarra.
"How you feel from a moral perspective is valid, but separate, from a public health perspective," she said, "and violent pornography is qualitatively different than non-violent."
The adolescent brain is not simply a smaller, newer version of the adult brain. Instead, it's more of a "work in progress," where connections are constantly being made as systems continue to develop.
"Their brains are not fully developed," said Bertha K. Madras, a professor of psychobiology in the department of psychiatry at Harvard Medical School, speaking of adolescents. "Their executive part, the frontal lobe that puts the brakes on impulses, is involved in sizing up situations, assigning a rational response to emotional situations, all of that is simply underdeveloped in the adolescent."
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