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Teens in Crisis 

Social media, the pandemic and cultural changes left a generation on shaky ground 

Teens in Crisis - pressures are too great
Dan Bejar

Gabrielle Carlson was ready to pull the fire alarm. It was October 2021, and Carlson, then president of the American Academy of Child and Adolescent Psychiatry, saw a world of kids in crisis: Soaring rates of depression and anxiety. Families under siege by pandemic-fueled disruptions. Dramatic increases in emergency room visits for childhood psychiatric crises.

And then there were the suicides.

Nearly 1 in 10 high school students admitted they had tried to take their own life in the previous 12 months, according to a survey published by the Centers for Disease Control and Prevention, and 1 in 5 had seriously considered it.

Suicide rates among adolescents had risen nearly 53 percent between 2010 and 2020; it was now the second-leading cause of death for people ages 10 to 18. Then came the pandemic, and the lockdowns, and the isolation, and the increased reliance on virtual schooling and socializing. And everything got worse.

“I said to my executive committee, ‘We need to do something,’ ” recalls Carlson, a professor of psychiatry and pediatrics at Stony Brook University’s Renaissance School of Medicine. “ ‘We need to declare a national emergency.’ ”

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Today, organizations from the CDC to the American Academy of Pediatrics and the U.S. Surgeon General’s office agree: We’re in the throes of a mental health crisis for young people ages 10 and up.

More than ever, the nation’s children are at risk.

More than ever, we seem powerless to help.

teen crisis image

Teens in Crisis: A Guide for Parents

Help your kids navigate online threats, skyrocketing anxiety, sexual pressure

Resources and Tips

Social Media

Kids can easily navigate digital spaces

To really understand the crisis facing today’s teens and tweens, start with this one fact: They have superpowers that most older adults can only begin to understand. Superpowers granted to them by an array of social media apps on their smartphones.

Snapchat gives them the power to see where their friends are, to see who is hanging out with whom, and to know if and when they’ve been excluded. Instagram gives them the power to compare their lives with those of others who post filtered, idealized portraits of themselves. TikTok allows them to scroll endlessly through posts that cater to their current obsessions, no matter how dark or damaging those interests may be. All of these smartphone apps and more give them the power to communicate with others anywhere, at any hour of the day, anonymously if they’d like — and often against the wishes of adults.

But as social media allows kids to reach out, it also allows others to reach them. Bullies, once limited to playgrounds and schoolyards, can now harass vulnerable children anywhere, at any time. Algorithms dictate what kids see on social media, feeding them a daily diet of content about their deepest passions, fears and insecurities. Scammers and sexual predators find it easy to access children: The National Center for Missing & Exploited Children (NCMEC) reported a 97.5 percent increase in “online enticement”— essentially adults trying to lure children into sexual acts from 2019 to 2020.

“A lot of parents still think: Not my kid, not in my house, not in my neighborhood,” says Titania Jordan, chief parenting officer at Bark Technologies, which makes digital monitoring systems for parents to track their kids’ online activities. But Jordan recently demonstrated how, using a widely available photo filter, “I was able, at 41, to make myself look like a fifth grade girl and post images online. Within moments there were predators trying to message me on Instagram,” she says.

As adults, we already know that technology makes this generation of kids uniquely vulnerable, even to their own missteps. “Think about what it was like when we were young,” says Lauren Coffren, executive director of NCMEC’s exploited children division. “There was spin the bottle, there was streaking. Except that we don’t have videos of these acts following us around for the rest of our lives.”

Mental health crisis

Cyberbullying and constant demands from smartphones
Dan Bejar

Jonathan Haidt is one of several researchers who draw a direct line between social media and the increase in mood disorders in children and teens. “When you compare rates in 2009 — before most teens were daily users of social media — to 2019 — the last full year before COVID-19 made things even worse — the increases are generally between 50 percent and 150 percent,” Haidt wrote in testimony before the Senate Judiciary Committee in May. Self-harm among young teen girls, in particular, is up about 180 percent, says Haidt, a professor of ethical leadership at New York University. Boys and girls both have higher rates of anxiety and depression, but girls have suffered the greater impact.

When kids have access to social media one to two hours per day, there is often no correlated increase in poor mental health, Haidt wrote. But as daily usage increases to three or more hours, increases in mental illness “often become quite sharp.”

“I do not believe that social media is the only cause of the crisis,” he wrote to the committee. “But there is no alternative hypothesis that can explain the suddenness, enormity and international similarity” of the spike in mental health disorders.

Clinicians treating kids on the ground report the same thing: young people exhibiting exploding rates of depression, anxiety and self-harm, right about the time that digital media became a daily part of their lives.

“What I’ve seen clinically matches with what the literature is saying — that somewhere around 2010 is that inflection point, where you really start to see diagnoses going up, you start to see hospitalizations going up,” says Megan Moreno, M.D., professor of pediatrics at the University of Wisconsin–Madison and principal investigator with the university’s social media and adolescent health research team. “The question is, ‘What caused the numbers to go from that to this?’

“And you want me to answer: [smartphones]. That’s the easy answer that people reach for,” Moreno continues. “It’s the question of the day: Have we essentially given every kid a self-destruct-o device?”

The answer is, of course, more complicated.

“Between about 2008 and 2011, there was an incredibly rapid uptake of electronic medical records for huge institutions across the country,” Moreno says. And electronic medical records prompt physicians to screen routinely for mental health issues. “We started asking everybody—not just kids who looked sad or who had purple hair.” As a result, teens who seemed to be functioning quite well started testing positive for anxiety and depression.

But while that might have played a role in the timing of the spike, the reality of the crisis is undeniable.

“There are so many things that are weakening support systems for kids,” says Amanda Lenhart, a researcher at the Data & Society Research Institute in New York City who studies how adolescents and families use technology. “If you just focused on cellphones, you would be missing part of the story.” Teacher burnout and overcrowding in schools mean less support for kids who are vulnerable. Meanwhile, the country feels just a little less safe. Fistfights on airplanes. Political rallies that turn violent. Volatile confrontations over race. America is filled with angry adults. And angry adults lead to skittish children.

Another factor that weighs on children’s minds: mass shootings.

The active-shooter drills that today’s students practice resemble the “duck and cover” procedures of boomer childhoods. But there’s a difference: While prepping for nuclear war was scary, “how many times was the mainland United States attacked by a bomb?” asks Nusheen Ameenuddin, M.D., chair of the American Academy of Pediatrics Council on Communications and Media. “It’s a different story for kids. There are shootings at theaters, shootings at events, shootings at school; there really isn’t a place where they feel safe.”

Social media amplifies all of these anxieties. Moreno, for one, sees a near normalization of suicide on social media that may be playing a role in what’s happening in real life. “There’s a contagion effect. If someone in their very remote social network attempted suicide, that information is going to feed back and show that youth that there’s tons of people out there doing this,” she says. “It presents suicide as an option, and that’s the unique power that social media has that other types of media have not had before.”

Yet, at the same time, social media also offers young people an outlet for their emotional challenges. In a 2020 study, 43 percent of people ages 14 to 22 said that when they felt depressed, stressed or anxious, using social media usually made them feel better, compared with just 17 percent who said it made them feel worse. Young people with moderate to severe depressive symptoms are nearly twice as likely as those without depression to say they use social media “almost constantly.”

“Much to many people’s surprise, social media became a very OK place to talk about mental health,” Moreno says. “I think it’s had a huge impact on stigma. It’s more acceptable. It’s OK to ask for help.”

But asking for help and getting it are two different things.

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Lack of resources

While it’s undeniable that we have a mental health crisis among American kids, it’s also undeniable that we don’t have the resources to cope with it. Not even close.

The number of residential treatment centers serving people under the age of 18 dropped by 30 percent between 2012 and 2020, according to the most recent National Mental Health Services Survey. Outpatient treatment for mental health is in a similar state of crisis. In Massachusetts, for example, the average wait time for a troubled youth to see a therapist for an initial assessment is 13.6 weeks; to see a prescribing psychiatrist, 9.7 weeks, according to a 2022 report from the Association for Behavioral Health (ABH). Meanwhile, only 8 percent of U.S. school districts staff enough school psychologists to meet the recommended guideline of one counselor per 500 students.

As a result, of the estimated 4.1 million adolescents who suffered an episode of major depression in 2020, 58.4 percent received no treatment. Among the 2.9 million whose depression resulted in “severe impairment,” 53.1 percent went untreated.

Earlier this year, in the wake of the elementary school shooting in Uvalde, Texas, Congress passed bipartisan legislation that made a significant investment in mental health for young people, dedicating $1 billion in funding for school-based psychological support over five years, as well as other resources. But it will take time to make even a dent in this ongoing crisis: For every 10 mental health professionals entering the field each year, 13 leave, according to the ABH’s Massachusetts report. Ninety-five percent of outpatient mental health providers surveyed last year said their waiting lists were growing longer.

And when there’s nowhere else to go for help, you go to the ER. Psychiatric emergency room visits among kids under 18 jumped by 60 percent between 2007 and 2016. The typical pediatric emergency room now boards a median of four kids every night who are awaiting mental health treatment.

Pandemic

And then the pandemic arrived...

Adolescence has always been a time of anxiety about who we are and where we fit in. And we have a time-tested method for treating kids’ social anxiety: We send them to school, to camp, to sports. We socialize them.

Then, in March 2020, we stopped.

“The pandemic in many ways facilitated social anxiety for many kids,” says Jennifer Katzenstein, codirector of the Center for Behavioral Health at Johns Hopkins All Children’s Hospital in St. Petersburg, Florida. “They were going out and doing things that potentially made them feel uncomfortable, and then we said, ‘You have to stay home now.’ ” That did several things: It sparked uncertainty about their health and safety; it disrupted family routines around school and work; it shifted almost all social interaction online, fueling isolation and digital insecurities. As a result, many kids are just more awkward interacting with the world today than they might have been a few years ago.

The pandemic hit some communities especially hard: Black and Hispanic kids lost a parent or caregiver at more than twice the rate of white children; Native American kids, at nearly four times that rate. And COVID’s social and economic consequences were especially difficult for LGBTQ+ children, those with disabilities, and the financially disadvantaged. Carlson likens the effects of the pandemic on our kids to that of a famine. “You’ve got people who had two years of [psychological] malnutrition,” she says. “Now the crops are growing, and we can just resume eating. Well, some people will just spring back, and others will take longer to recover. But it’s one thing to be malnourished when you’re 35 and another thing when you’re 12—and how those two years are going to influence long-term development, we don’t know.”

Tech-driven generation gap

“Vault” apps allow kids to hide compromising photos and videos behind what appear to be calculators or music libraries.
Dan Bejar

In many ways, today’s children are natives to the culture and language of social media, while we, as adults, are more like first generation immigrants in this world. As savvy as we may be, as much as we may study and learn, we can’t fully understand the role that social media is playing in the lives of young people. It’s easy for kids to create hidden social media accounts that allow them to post innocuous content for their parents to see but hide their darker interactions from prying parental eyes. “Vault” apps such as Hide It Pro allow kids to hide photos and videos behind what appears to be a music app. Another, Calculator#, looks like — you guessed it — a calculator. Some apps come with two sets of passwords — one leads to a benign function you can show your parents; the other, to a whole new media landscape.

“We, as parents and grandparents, have been asked to stay ahead of the curve, especially from a technology standpoint, and that’s incredibly challenging,” Katzenstein says. “I tell parents you need to know everything that’s on that device. You need to know how every app works. You need to be following your kids, and other trusted adults need to follow them as well for any signs of concern.”

But as grownups, we’re simply outmatched.

“Kids are exposed to so much at a more frequent rate and at an earlier age than parents have been able to process,” says Jordan, of Bark Technologies. “They’re so technically savvy, they’re able to navigate landscapes in a smartphone that parents don’t even realize are there.”

And when faced with inappropriate content or contact, “as a child your first instinct is probably not to tell your parents,” Jordan adds. “You’re scared. You’re ashamed. You don’t want to lose your phone. You don’t want to lose your social media. It’s a tough spot.”

Don't panic

River, 16, has experimented with gender identity and pronouns but now identifies as he/him.”
Annie Tritt

Mention the word “smartphone” to parents of teens, and you’ll almost certainly get an earful about how the device is ruining their relationship with their kids. “It’s the devil,” one parent recently told me.

But how do we know we’re not just in one of those moral panics that rock society every few decades? How do we know we’re not afraid of social media the way our parents were afraid of Dungeons & Dragons and our grandparents were afraid of Elvis?

“History suggests that this is a place we’ve been before,” Lenhart says. “The obvious parallel is TV, but before that it was comic books, radio, movies ... all of these technologies have at one time or another provoked a deep discomfort.” What’s different about this moment, she says, is that “we took a growth in technology and a change in society, and we shot it up with steroids in March of 2020.”

It’s easy to look at social media as the source of all evil. But, especially during the pandemic, it was an undeniable lifeline for tens of millions of kids, and it continues to play that role today — even more so as social and sexual identities have become more fluid.

“If you’re a kid who has an identity that’s not very represented in your offline world — say, you’re the only Goth kid, you’re the only violin player, you’re the only gay kid — then your social network is probably critically important to your mental health,” Moreno says. “There are kids out there for whom social media has probably saved their lives.”

One thing we need to be cautious about, Moreno adds, is blaming every problem in our family on smartphone use. “[Social media use] intersects with supernormal adolescent development — pulling away from their parents, being rude to their parents, wanting to be with their friends, but also knowing it’s awkward with their friends. We have to avoid the temptation to think that, for us, it was all so much better or different.”

Quick tips for parents

A new school year is underway. That means a return to the academic and social pressures that so many children have difficulty managing today. On the other hand, schools are often the first line of defense when it comes to detecting problems, providing support and giving kids the socialization tools they need to prosper in adulthood.

In the meantime, there are a few things we can do to help kids navigate the strange new world they’re growing up in.

If you’re interacting with a child in any way, put your phone away. You may be answering a critical email or paying an important bill. But what the child sees is a distracted adult. “Parents who are spending more time online will have children who spend more time online,” Ameenuddin says.

Insist on full access to a child’s phone and all social media apps, including passwords. If you don’t know what an app is, look it up and become familiar with all of its functions.

— Become a devoted follower of your kids’ or grandkids’ social media accounts. Understand that it’s not uncommon for kids to create more than one account on each platform.

— Instruct all children to keep their social media settings on “private” and, when they are at home, to turn their location services off.

— Dial in to support groups. Facebook groups like Parenting in a Digital World and Raising Teenage Girls Is Hard allow caregivers to share tips on navigating a changing world.

— If a child in your family has been approached in a way that’s inappropriate, contact law enforcement first, Jordan recommends. “Wait to report it to the platform; sometimes they’ll just take it down and the evidence is gone. Law enforcement will want to prosecute and prevent this from happening to another child.”

Above all, just be there. “What children are looking for is love and attention,” Coffren says. “And if they’re not getting love and attention from the places they need it, it’s readily available online — even if it’s not authentic, even if it’s misplaced, even if it’s duplicitous.”

Stephen Perrine is executive editor for special projects at AARP, where he oversees health coverage for the AARP Bulletin and AARP The Magazine. He is editor in chief of The Arrow newsletter and the author of the New York Times bestseller The Whole Body Reset.