Why mental health is declining for teenage girls in the U.S.

Editor's Note: This story includes accounts of self-harm and suicide. The National Suicide Prevention Hotline number, a free and confidential service, is available in either English (1-800-273-8255) or Spanish (1-888-628-9454).

NSPH is also online and has representatives available to talk through chat at suicidepreventionlifeline.org.

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U.S. teen girls are experiencing record high levels of sadness and depression.

"Often, the parent or caregiver is the one who’s bringing us concerns. 'They’re more withdrawn. They’re not participating as much. They’re isolating,'" Dr. Gary Maslow, a pediatrician, says.

What’s going on?

The pressure of social media is often cited as a leading cause. But that’s not the full story behind the mental health of teenage girls in the U.S.

"These things have been designed specifically to grab our attention. And it’s hard for adults to resist, but it’s an order of magnitude harder for a teen to resist. And that’s because their self-control toolbox isn’t as well-developed as an adults."

Today, On Point: Teen girls and mental health.

Lisa Damour, psychologist. Author of The Emotional Lives of Teenagers: Raising Connected, Capable and Compassionate Adolescents and Under Pressure: Confronting the Epidemic of Stress and Anxiety in Girls. (@LDamour)

Dr. Moira Rynn, adult, child and adolescent psychiatrist. Chair for the department of Psychiatry and Behavioral Sciences at the Duke University School of Medicine.

Anastasia Vlasova, mental health activist and host of “Our Turn to Talk," a mental health podcast for teens and parents. Sophomore at New York University.

MARY: Hi. I would like to comment on your asking for comments on the teenagers that have depression. You wonder if the apps are an issue. I just want to say my daughter did have a depression severe enough that she was suicidal or actually needed to be hospitalized. A year ago, she was 15 years old.

MEGHNA CHAKRABARTI: This is Mary. It's not her real name because she wanted to share her story and protect her daughter.

MARY: I think it was triggered by the isolation of COVID, because right after COVID, when she started going back to school, you could tell that she was very stressed and at the intense needs of connecting and connection. And this boy came, and she jumped into that relationship with an unusual intensity, and he dropped her. And I think that was too much. And that triggered that depression on someone who was already anxious and stressed.

So I think that the fact that she was isolated and didn't have to connect with friends as much to negotiate, what do you do when there's a crush? When there's rejection? What do you do with girls that look at you ... the competition with girls and anything, all the negotiation, the social aspect of being with your peers, they did not have during COVID. And I could see in her behavior that it impacted her.

CHAKRABARTI: That's mom Mary. Again, we're not using her real name to protect her daughter. Now, this is Abbey Raphael. She lives in Port Angeles, Washington.

ABBEY RAPHAEL: I think that very much so. Instagram page played, Instagram, Facebook, MySpace, those all played a decent sized role in that. Because I was constantly comparing myself to, you know, all the girls that we see, you know, perfect lives, perfect body, airbrushed to heaven. And yeah, I mean, I was just sitting there feeling like I wasn't good enough and that I would never, you know, be worthy of, you know, being one of those perfect women in their perfect houses with a perfect body and a perfect family. And I have not been, since COVID hit, I have not been on social media, and I have never been happier.

CHAKRABARTI: This is on point. I'm Meghna Chakrabarti Abbey and Mary's daughter speaks to an ongoing trend in the lives of the lives of American teenage girls. They are struggling with their mental health. According to a recent report from the Centers for Disease Control and Prevention, in 2021, nearly three in five teenage girls felt persistent sadness. And one in three girls, one in three, seriously considered attempting suicide. But why? And what can be done to help them? That's what we're going to talk about today. And we'll begin with Dr. Moira Rynn. She's the chair of the Department of Psychiatry and Behavioral Sciences at Duke University School of Medicine. Dr. Rynn, welcome to On Point.

MOIRA RYNN: Thank you.

CHAKRABARTI: So when the CDC first released this report in the middle of last month, it really was quite disturbing. What was your first reaction to these seemingly just shocking numbers?

RYNN: Yeah, no, I mean, of course, tremendous concern as a child and adolescent psychiatrist who works with teenagers, I have seen firsthand this level of distress in young people. And unfortunately, these numbers are not surprising me, just given the distress and the challenges that young people have had during the pandemic. But as we're seeing ... very much so for girls as well.

CHAKRABARTI: So can you tell me a little bit more about what you are seeing? You said you've seen it firsthand.

RYNN: So we have seen and we've seen this across the nation, just increased rates in general of teenagers and their families reaching out and seeking out help for mood disorders, anxiety disorders, substance use issues at a very high, high rate. And we all have probably noticed across the nation different states declaring youth mental health emergencies.

Young people presenting to the emergency departments with serious events of suicide attempts, mental health distress, difficulty managing and navigating their daily life. Certainly, those of us in the field of child mental health have seen these difficulties, even prior to the pandemic. We have seen a rise over time in these issues, but certainly the pandemic added an additional significant stressor. You'll see quotes, people saying it was fuel on a fire that was already occurring in youth mental health.

And that stems from just the ability to access treatment and get the needed treatment to access the type of supports parents and the young people need in terms of these issues and struggling with getting access. And then you have the pandemic that impacts adolescence where it's the most important time of their social development, where they are trying to understand themselves in relationship to their peer relationships, to their parents, their schools, what their future is going to mean for them.

And the pandemic in order ... to prevent the spread of the virus with this sort of complete lockdown. ... Certainly, that was important from a public health perspective in virus containment, but it had this impact for young people all of a sudden not having access to the relationships, their peers, the other adults in their life, like their teachers or their coaches that provide them support, and also those activities outside of the home that help them to continue to develop themselves interpersonally has been a signal. It has had a significant negative impact for young people during this time.

CHAKRABARTI:  Well, I will say, though, that the prolonged lockdown, especially of young people ... we ought to be asking ourselves maybe if that prolonged lockdown of particularly young people, if its costs outweighed its benefits. But you made a really important point, in that this latest CDC report is not just a discrete data point from 2021. It, in fact, is a decade long trend that they did analysis of, 2011 to 2021. And on some factors, they say that they're seeing actual positives.

RYNN: Well, they've shown to improve overall in terms of risky sexual behavior and also substance abuse and decrease in bullying at school. So those are positives. And I'm glad you brought that up. We do not want to ignore the positives that we have seen. Unfortunately, the negatives have been in the area of protective sexual health behavior, so such as condom use, seeking out sexually transmitted disease testing if needed, and HIV testing.

But of real concern that you can see in this survey is the experiences of violence and also unwanted ... sexual experiences that young girls are reporting. But I also want to mention for the LGBTQ+ youth, all of their parameters on this survey. I know we're focusing on girls, but this also impacts, you know, girls and young people and those that are identifying their sexual preferences. Showing great difficulty in terms of violence, lack of support at home and increase in suicidal thinking and suicide attempts as well.

And unfortunately, across all groups, we have seen a rise in hopelessness, sadness, but particularly in girls, Black youth and LGBTQ+ youth as well. And so I do think this level of isolation, the loss of supports young people have that they do depend on the school systems for in other types of outside social groups. And I really appreciated that young person that was talking about the impact of social media. Social media has a lot of positives and there can be a lot of information shared, but there's a lot of misinformation on social media as well.

And there's the visual aspects of this that's portrayed in terms of how we're expected, particularly for girls, how they're expected to look or be or dress. That became a major outlet and provided support across groups. But at the same time, certainly for more vulnerable individuals, it's had a negative impact in terms of how they see themselves.

CHAKRABARTI: So we're going to talk about that more a little bit later in the show. ... I wanted to get your sense about why there seems to be, again, across this ten-year time span, this major disparity between teen girls and teen boys. Because I'm looking at the CDC data here and they say in 2011, 36% of teen girls reported feeling sad or hopeless, persistently so. 21% of boys. And then by 2021, it's 57% of girls and 29% of boys. Why?

RYNN: So one thing that we do see in adolescence is that girls start to outpace boys, if you will, in terms of developing symptoms of depression. Now, depression is a multifactorial illness, so it's never just one thing. It's multiple factors. So prior to the pandemic, it has always been, my whole career now as a child psychiatrist that girls for about 2 to 1 sort of represents increase in experiencing depression.

And it's ... to do with a lot of different factors. One is trauma. You know the trauma that girls some girls experience in terms of their safety, sexual or physical abuse is one. The other is in terms of family history of depression. So if there [are] parental mood disorders, that places them at a higher risk. And then there is lots of studies, although we don't know the full answer in terms of during that adolescent period, you have a lot of hormonal changes.

And so, there are researchers trying to better understand that in terms of how that may be to play. And then there's biological factors. You may have a genetic vulnerability, so there's a number of pathways to develop depression, but we do seek for girls there are higher risk factors. In terms of violence, there's lack of safety, sexual abuse, maltreatment, how they're treated in their families and the supports that they have. And then you add on the pandemic.

CHAKRABARTI: Today we're talking about why teen girls in the United States are reporting the highest levels of mental distress or mental health crisis in a decade. And that's according to the CDC Youth Risk Behavior Survey, which we'll talk much more about through the course of this program. ... And with us now in the studio is Lisa Damour. She's the author of several books on teen mental health, including Untangled: Guiding Teenage Girls Through the Seven Transitions into Adulthood. ... Welcome to On Point.

LISA DAMOUR: Thanks so much for having me.

CHAKRABARTI: So you've been paying attention to this for quite some time. Can you tell me what you think or how long this sort of mental health crisis amongst America's young girls has been going on? Is it hard to say?

DAMOUR: I think it's hard to say. We certainly saw concerns rising in the decade prior to the pandemic. We have always recognized, as was mentioned, that girls are much more likely than boys to suffer from depression. I don't think we were using crisis terms until around the pandemic, and I think those are warranted. I think we want to be mindful of what this means for parents today.

You know, the data that were collected and that the CDC reported were collected in the fall of 2021, and they were asking about mood over the previous year and asking about a period of low mood for two weeks over the previous year. And so that very much locates those data in time and do, in fact, map on to exactly what we were seeing clinically. Teens were miserable. Girls maybe in particular were miserable.

But I also know that in many ways, for students and teenagers, as things have returned to a more normal pattern, a lot of kids do feel better. And so we want to both be attentive to the fact that things are not good for teenagers and certainly were very bad for teenagers in the pandemic. And then think about what that means now.

CHAKRABARTI: Yeah, So this is important to try to understand because as we talked about with Dr. Rynn, there's this sort of adding fuel to the fire situation of the pandemic. But if I understand correctly, at least according to the data from the CDC survey, which they do every two years, it's gone up every two years, these levels of distress.

DAMOUR: It has been going up. And we did see a big spike around this time. And, you know, of course, what we're hoping is that it starts to go down a little bit, that we can end up putting an asterisk on these data because they were collected when they were. But we don't know that and we're waiting to find out. And we do think about the particular impact on girls in terms of social isolation, perhaps in terms of the impact of social media, where kids did spend a huge amount of time on that online when they were in the pandemic.

The other thing is these data are self-report about mood. And one rule in psychology is that when in distress, girls tend to collapse in on themselves, boys are more likely to act out. So we didn't have a question that asked boys, have you been hard on your family of late? Or they may not have reported it even as fatefully as a girl might have reported feeling sad. So some of this, I am sure, is picking up differential levels of distress. But again, I always want to be mindful of when were the data collected and how was the question asked. And, you know, what are we really looking at here?

CHAKRABARTI: Okay, that's interesting and important. Dr. Rynn, what do you what do you think about that?

RYNN: Yeah, no, I agree. There's always challenges with survey data. But ... we have to see. However, I do think that there's a broader issue in terms of access to psychological and psychiatric services for young people. And I feel in the field we have been seeing this progressive rise, just given the lack of help that there is, when parents and a young person think that they do require the help. And then I think the pandemic has just added to that.

CHAKRABARTI: Okay. So I'm going to ask for both of you to give me your forgiveness in advance and all listeners here, because I'm just about to ask you just a dumb question. Because, you know, I'm in my mid-forties and I'm thinking back to when I was in my teens, which was a long time ago granted. The late 80s and early 90s, and I can't actually imagine that mental health support for young people was tremendously better back then.

And at the same time, I don't recall or, you know, I can go back and look at studies. I don't recall seeing the same levels of self-reported distress. So I guess what I'm trying to get a handle on is do teens, especially teen girls, are they really actually feeling more or less mentally healthy now than they were a generation or two ago. Is that true, Lisa?

DAMOUR: It is true. And it was true before the pandemic. We have been seeing rising rates of distress and we've been calling the question about what is this about? And the kinds of things we consider are sleep reduction. Teenagers sleep much less now than they used to. That is very, very closely aligned to mental health. And then what might be causing that might be academic pressure, might be technology. In the bedroom, we are seeing teens telling us that they are greatly stressed by things like climate change, school shootings, political polarization. They are aware of these things.

They are appropriately anxious about these things. So this is real. It has been growing. And something else that Moira mentioned that I think is really important in terms of where this arrives at a level of a crisis is that as the needs of teenagers grow, the workforce to care for them does not grow at the same rate. Taking care of teenagers is a fairly specialized area. Not a whole lot of us do it. And so then, especially in the pandemic, when there was this huge surge in need, it's not like you can instantly create a seasoned workforce to meet that need. So the two together really put us in a jam.

CHAKRABARTI: Dr. Rynn, your thoughts?

RYNN: I totally agree with Lisa, and I think when you get other data, another data point that's concerning along with the CDC, again, albeit a survey is a recent publication from the JAMA network that is showing the mortality data for young people from 1999 to 2020. All-cause mortality rate has been up significantly by 10%, and homicide rates since 2013 of young people in this group has also increased and it is evolving and felt to be caused by certainly what Lisa mentioned, sort of shootings of firearms, access to more potent opioid substances like fentanyl and the mental health crisis that we're in and the number of adverse life experiences children are having, such as trauma, neglect.

And so, you know, we are seeing different indices suggesting that, you know, this is concerning, and this is serious. And we really need to have an organized approach for girls, but also for other young people and who are showing this. And to Lisa's point, boys will not report in the same way. It comes out in other ways of different risky, risky behaviors that also puts them at great risk, a great risk for physical harm.

CHAKRABARTI: Yeah, that's an important point. And we have seen an increase in those behaviors if we're going to sort of say that there's a correlation between the boys' mental health and those risky behaviors.

CHAKRABARTI: ... I want to bring in someone who's sort of living this life right now. And her name is Anastasia Vlasova, and she's joining us from New York and she's a mental health activist and host of Our Turn to Talk. It's a mental health podcast for teens and parents, and she's currently a sophomore at New York University. Anastasia, welcome to On Point.

ANASTASIA VLASOVA: Hello. Thank you for having me.

CHAKRABARTI: Okay. So first of all, tell us are you still in your teen years or you just exited them?

VLASOVA: I actually just turned 20 a few weeks ago, so I officially exited.

CHAKRABARTI: Well, happy birthday. Happy belated birthday. But that means that you were still, I mean, technically a teenager at the onset of the pandemic. So I'd first like to ask you, honestly, how was your experience of those early COVID years?

VLASOVA: Honestly, I enjoyed the experience. Mainly because when the pandemic first hit, I was in my second semester of junior year of high school, and that was an incredibly academic, intense period of time in preparation for college. And there were exams and lots of deadlines and important assignments do. And I was also incredibly busy with extracurriculars and tennis.

And so to have the freedom to actually relax and engage in self-care instead of maintaining this go, go, go crazy busy schedule was quite a gift. And I feel like that sentiment was shared among a lot of my friends because we were finally given an actual break. However, as the pandemic progressed, obviously there are moments in time when I felt incredibly socially isolated. Luckily, though, two of my close friends and I started a podcast, which we hold virtually every week. And so that was an opportunity to bond with each other. And then by the time I actually attended university, we were back in person. So yeah, it was fine, but still had my ups and downs.

CHAKRABARTI: There's a variation there and it's a really interesting one. Lisa, what Anastasia saying is reminding me of a show that we did early on when everything was getting locked down. It was with two education professors from the University of Georgia and they were they were saying that they hoped that this would be a moment of pause, their words were to allow kids to decompress a little bit. And it sounds like Anastasia actually had a chance to experience that.

DAMOUR: I have heard this from other teenagers, too. And, you know, for teenagers in very demanding academic situations and who are very ambitious themselves, high school is ridiculously intense. We ask a huge amount of young people. And actually, I had a daughter who was a sophomore in high school when the pandemic began, and suddenly her AP exams were a 45 minute online multiple choice. You know, I mean, it was like maybe they were always multiple choice, but it changed the game entirely.

And we were all sort of standing around, stupefied by how little was in the end asked, which was entirely appropriate given the circumstances. I think so. It does raise a question about whether or not we could push the reset button on what is actually fair and reasonable to ask of our most ambitious students who are in a position to really load up their plates academically. On the flip side, there also were a lot of teenagers who had no access to school, who went to work for their families, who had an experience that was as far away as possible from one of relief. And so, there's a whole picture here, but everybody had a different pandemic.

CHAKRABARTI: And Lisa, I totally agree with you, because there were many, many children who essentially got no education, who were lost to their school systems entirely, just disappeared, in fact.

DAMOUR: And are still lost. Actually, one of the stories were not telling is the level of school truancy and absence that has continued. That is a major ongoing force from the pandemic.

CHAKRABARTI: So Anastasia, though, I'd still like to hear more from you about, you know, this picture that the data are presenting about how teenage girls in this country are feeling the distresses that they're feeling. Can you tell me from, you know, your own life and ongoing conversations with your friends? Like what are the things that you think are triggering this? Or how is it that this perpetual mental and emotional pain is happening in girls in this country?

VLASOVA: I think one of the main drivers is definitely social media use. I mean, people are accessing social media daily, if not hourly basis, and they're forced to engage in self-comparison and a whole host of other things that don't make them feel good about themselves. And I also think that there's an increased pressure for young people to exhibit perfection. Basically, were expected to get straight A's, we're expected to go to a top university to obtain a job that is high paying and also passion and purpose driven. And there's just a lot of expectations.

And I think that's largely the result of an increase in information that's spread around. So people are just consuming more content, which means that basically they're being overstimulated and almost feeling over inspired, but also just overwhelmed with all that is possible and is expected of them. And also, having hosted Our Turn To Talk, the podcast and documentary series about young people's mental health, I learned that there's also just a lot of disconnection socially. So a lot of people are feeling socially isolated in their real life relationships.

So even though social media is providing some sort of connection, when they turn off their phone and they go back to real life, a lot of people are realizing that their in-person connections are not as strong and fulfilling as they thought. And so I think that is definitely a contributing factor to their negative mental health experiences.

CHAKRABARTI: Oh, wow. You are saying so much. Honestly. There's like a PhD thesis in each part of your answer there. I'm so grateful. Dr. Rynn, I have seen some analysis that suggests, and please correct me if I'm wrong, that prior to roughly 2010, let's say, that while we were seeing an increase in negative mental health reporting from young girls, in particular from teen girls in particular, that around the roughly 2010 period, the rate of increase gets much, much, much higher. And again, like we can't pin everything on smartphones and social media. But that's just a very peculiar year to start seeing things rise higher. And I just wanted to know what you thought about that.

RYNN: Yeah, no, I think it's a really good point and I really do appreciate what was brought up. I mean, I see it in my practice, young people that will come and say, you know, presenting with a host of symptoms around their depression and anxiety and we will spend a lot of time where some of the causes, like seeing what they see online or via the social media or what other friends, and the amount of energy that goes into trying to present a certain side of yourself. That may not be the reality, that you feel you need to do. And that's exhausting.

And to the point where it's just taking up so much time that's interfering with school and other relationships. So the social media is a significant issue. It can be helpful, but it can be harmful. And so, it's how do we get to the balance and how do we build more education around this for young people so that they can empower themselves to use it for good, but manage the negative sides to it?

And, you know, we're seeing more of that in the school curriculums, trying to build that kind of education about how to use it in a positive way and then how to turn it off. Are the things that actually make you end up feeling bad. And you can imagine for young people that don't have the resources to do the things that other young people are doing, or get the kinds of things that they have, how challenging that can be, and very difficult and demoralizing.

CHAKRABARTI: Now, we started talking about social media and the role that it plays. And it just reminded me, of course, that Facebook slash Meta, I mean, when Facebook whistleblower Francis Hogan sort of brought all that data and internal studies that Facebook has been doing about the impact of their product on teens, seems like they know very well about the mental health impacts of lots of Facebook and Instagram use.

So we just reached out to the parent company media for an interview. They declined that request, but they did send us this statement from their head of their global head of safety, who says:

We want teens to be safe online. We developed more than 30 tools to support teens and families, including supervision tools that let parents limit the amount of time their teens spend on Instagram.

And they also have age verification technology that helps teens have age-appropriate experiences. That's the part of Meta's statement. Now, Anastasia, I'd love to actually hear a little bit more detail like your early use of social media. What how old were you and what exactly were you doing? ... Were you even like an early influencer?

VLASOVA: I always laugh when people say that word, but you can call me whatever you want. I just say that I had a fitness tennis health blog, but I downloaded Instagram summer before seventh grade, so I think I was around 12 at that time. And I at first just downloaded it to create a personal account like any other account that my friends had. And then a few months into having it, they launched this additional Fitness Health tennis blog because I was getting really into playing tennis competitively and I just started to cook healthy recipes.

And basically, I was just exploring the fitness fanatic side of myself, and I wanted to share that with other young people on the platform and hopefully inspire others to also start thinking about discipline and work ethic and how to live an active lifestyle. Because I saw how beneficial doing that was for me. And I soon started to get really entrenched in the fitness industry on Instagram, which was largely unregulated. I mean, it's still pretty much isn't today. And I started to experience some toxic relationships with my food intake and also with fitness.

And so that led me to eventually start doing digital detoxes where I would take breaks from social media for an extended period of time. And I went back and forth, back and forth. And then around the middle of high school, I stopped doing that account and took a pretty extensive break from social media, particularly Instagram. But then re-started an account. But it was at that point for the organization, This Is My Brave, which works to save lives through storytelling and it's all about mental health. And I was put in charge of their team division and running their team Mental Health blog, where I interviewed different psychologists. I posted my own experiences.

CHAKRABARTI: I'm so sorry to interrupt here, but I want to jump in because, first of all, thank you for sharing your story. I mean, we always ask people to be vulnerable in a way that I think most people wouldn't really be willing to when they come on a show like this. So I do appreciate it. But I'm wondering if you could share just a couple more details about when you talked about this, you developed this unhealthy relationship with eating, because from what I understand, you were following those fitness influencers and you were like, what, 13, 14? And they looked strong and healthy, so you thought they must be doing something right. So you would try what they were doing. And then ... you told our producer was leading to binge eating for you, is that right?

VLASOVA: Yeah, because I was seeing all of these fad fitness diets. Basically, a lot of them revolved around restricting your food intake. And so I was being incredibly restrictive with my food intake, and that eventually led to me depriving myself basically of foods that I deemed were not solely I, but society deemed unhealthy and not a part of a healthy lifestyle. And so I started to develop this restrict and binge cycle. And that was definitely a difficult thing to deal with because it prolonged for years and years all the way through the beginning of university.

CHAKRABARTI: ... The images on social media, many of them are actually false, first of all. But they're presenting this ideal of perfection that young people just can't turn off really anymore. And Anastasia had this experience where, you know, she would try the kind of diets or lifestyles that the influencers were advancing. It may not have worked for her in the way she wanted. And then she would actually feel like she had to punish herself for failing to live up to that ideal.

DAMOUR: So let's take two things and put them together. One is that teens are extremely vulnerable to norms more than children are, more than adults are in terms of what's happening around them. The other is that the social media platforms they use are largely driven by algorithms. Those algorithms will quickly detect what it is you're looking for, searching for, looking at spending time on liking and serve up a huge volume of those things.

So one of the things I worry about when I worry about social media is a young person who goes looking for anything related to fitness or diet or appearance or improvement, and then has a lot of that content take over their social media universe. And then if they're spending a lot of time in that social media universe, maybe because they're not going to school or because they're not seeing people in real life, that starts to change behavior, Their sense of what is normal changes. And that sense can be ultra thin, ultra fit. There's other dangerous versions of norms that get established in social media environments, but that's what we want to be attentive to.

What are the norms in the social media environments where any young person is hanging out? We saw an explosion of eating disorders in the pandemic. I will largely lay that at the feet of social media, that was what kids were looking at. They were searching. They were trying to make good use of their time and energy and get into good shape, as many of them were telling me. And then it just takes a turn because there's nothing that's working against those norms. And it's really leaving kids with the impression that an ultra-thin and ultra fit body is the standard.

CHAKRABARTI: So body image being one of the things that can lead to profound upset. Are there other things on social media that you would look out for?

DAMOUR: You know, there's all sorts of sides, as they say, to TikTok, and that's the language kids use to describe what the algorithm is serving them on TikTok. There are horrible sides of TikTok. There are white supremacy sides of TikTok. There are incredibly dangerous things. So one thing that we want parents to be attentive to is the norms in the digital environments where kids are hanging out because ... there's also upside. So I mean, there's goofy dance video sides of TikTok, right? I mean, it's not all bad, but if kids find themselves trapped in an algorithm that is taking them down a road we would never want them on. Adults need to know. We need to help them change course.

CHAKRABARTI: Okay. That is very arresting language, Lisa, about kids finding themselves trapped in an algorithm. So, Dr. Rynn, how would we do what Lisa suggests? How do we know when kids are like that and how do we untangle them from it?

RYNN: Pretty early on before that very first phone that you provide to your teenager or middle school age child is to really just set up the parameters of how you're going to support them in learning how to use that technology in a way that's going to be helpful to them and having that conversation and checking in with them periodically. And so there's a whole range of options parents can decide to do in terms of, you know, in discussion with the young person. And I always recommend parents to have a full discussion of how they'd like to be informed, to be able to check, see what they're looking at as a way to support them and just to ensure that they're not going down a path that could be dangerous to them. So it takes a lot of monitoring.

And a lot of discussions with your child and that young person into when they get independent on their own, where they're going to be making those choices. And it's not easy. I think it's really challenging to do these things and to really, really have that dialog and to help them. And I think the hard part for parents is that, particularly speaking, I'm going to share my age, but you know, my technical literacy compared to my two adolescents is just vastly different.

And they can outmaneuver me in every way. But we have that. And I think that's a hard thing for parents, you know, for young people who start at three and four seeing iPads and so forth. But it gets to how being involved with your young person and having that conversation and telling them what you're worried about and that you're not trying to keep them from being able to connect with their friends in a positive, healthy way.

DAMOUR: I agree completely. And just a real practical point. Kids often want technology because they want to start to connect with their friends over it. And usually for younger tweens and teens, texting gets them very, very far. You know, one of the kind of inflection points we're trying to manage as parents is, you know, we don't want them to have a whole lot of social media, but we also don't want them to end up socially isolated because that does its own harm.

So one thing I often recommend to parents when they do feel that their tween or teen does need technology to stay connected is see if texting alone will do it. If you give them a phone, it does not need to have a browser. It does not need to have social media apps at the point when you give them the phone, make it clear that it does not ever go in their bedroom. And one of the beautiful things about young tweens, teens and young tweens teens, is that at the point when they want a phone, they will agree to anything.

So I really encourage parents to make the most of that moment to lay down pretty strict parameters and then to very, very slowly move into the digital waters, because we do have data showing that the impact of social media on older teenagers is not nearly as concerning as it is on younger teenagers. And this comes as no surprise because older teenagers are more savvy, they are more easily able to see things from lots of perspective. They're less concrete in their understanding, they're more cynical, and that's actually a real value around social media use. So delay, delay, delay. See how far you can get on texting.

CHAKRABARTI: Anastasia. You know, you said something a little earlier that I thought was so interesting and it kind of brings all of these issues together. That people wanted to spend less time on their phones and on social media. But then when they did, they found out that their in-person relationships were challenging as well, even though they wanted to have that connection. So I'm wondering if you could just talk for a second about how you navigated that and how have you tried to make both worlds online connection and in-person connections as healthy for you as possible now?

VLASOVA: Yeah, I think a lot of it revolved around realizing that taking time off of social media is time that I'd be gaining to reinvest in myself and my own personal development and basically grow into the person that I want to be and present to the world. And that way I'd be able to attract people into my life who basically I align with in terms of energy, aspirations, values, interests, all of that.

I think that time off of social media is an opportunity for young people to engage in self-discovery and self inquiry and self-reflection, which are all things that using social media on an hourly basis can really get in the way of. And if we don't engage in all of those practices, then we don't really know ourselves and therefore we don't really know what we want to look for in life, whether that's in friendships or perhaps careers or just hobbies or anything.

And so I literally sat down, I think, when I deleted my social media account and listed the pros and cons, and I realized that the cons of using it simply outweighed the pros. I mean, I was a way more anxious person. I was way more concerned with external validation, and my self-confidence was very volatile, I would say when I was using social media regularly.

But once I deleted it and I was without it for about six months at first and then a year in the new year and a half, I mean, within the first three months, I considered perhaps I should get it again or at some point down the line I will download it. But the longer that the time went by of not having it, I realized that I simply was just creating a life that I truly felt content and calm about. And so, yeah, I would say engaging in self-reflection and investing time and just getting out of your comfort zone and truly talking to people is one of the first steps.

CHAKRABARTI: Lisa, if you could make a little checklist for parents about what to look for in terms of if their particular their girls are feeling distress.

DAMOUR: It's hard at times to tease apart typical adolescent distress from mental health concerns because normally developing teenagers have lots of ups and downs. Here's what we do not want to see. We do not want to see mood that goes to a concerning place and stays there. Mood should go up and down in teenagers, but if your teenager is so low or so anxious that it's getting in the way of their life, that is grounds for concern.

We do not want to see teenagers who are using what I call costly coping. So they're managing their mood with things that have a cost. They're using substances. They are incredibly hard on the people around them. They are turning against themselves in terms of their own care. They're not taking good care of themselves. None of those things are under the umbrella of healthy development. We would definitely want help for young people if any of those things came up.