What’s Behind the Decline in Teen Mental Health?

The past several weeks have seen somewhat widespread discussion of a truly upsetting trend in adolescent and teen mental health. In the most recent CDC data, 40% of high school students indicated that, during the previous year, they had experienced sadness severe enough that it impeded their ability to do their normal activities for at least two weeks. These issues seem worse for girls. The pandemic may have exacerbated mental health struggles, but the increase predates the most recent period. The upward trend looks like it began around 2012 (it’s always hard to precisely isolate the timing of a change in trend). The question is why. One focus of speculation has been screens. Others point to the election of Trump (although the timing doesn’t quite fit) or some general sense of doom (although it has been pointed out that existential global threats are not new to this generation). Last week, the Journal of Pediatrics released a commentary that makes a new argument. Specifically, the authors argue that a loss of independence for children is a significant contributor to these trends. In their words: “Our thesis is that a primary cause of the rise in mental disorders is a decline over decades in opportunities for children and teens to play, roam, and engage in other activities independent of direct oversight and control by adults.” What the authors of the piece do is try to pull together a case for this link based on a number of indirect pieces of evidence. It’s extremely hard to be fully convincing in this case (more on this at the end). But I found the data they talk about interesting, and maybe you will too. The first piece of evidence is the decline in mental health. We covered that above. The other key arguments: that child independence has declined, and that this is linked to happiness. Has independence declined over time? The argument that the physical independence of children has declined over time comes down to a bit of data and a lot of “look around, it’s obvious.” The authors draw on an academic book that analyzes changes in parenting advice over time and shows that earlier eras more often portray children as independent, going out and playing alone in early childhood, and having more adult responsibilities (like jobs) at the age of 11 or 12. You can see this even in something like The Baby-Sitters Club. The seventh graders in these books — published from 1986 to 2000 — are babysitting for young infants, including at night, making dinner, cleaning the house, and so on. The feel of the world is somewhat different than what many of us experience with our children now. For more concrete data, the authors draw on a survey in European countries that focused on how much independent mobility kids were given. For metrics like “Can children walk home from school alone?” independent mobility declined over the period 1990 to 2010. And this is Europe! The U.S. tends to be even more cautious. The authors seemingly worry here about both physical independence and free time. Kids are in school for more hours, and in extracurricular activities and homework for more hours. Their time is more structured and less free. They also comment specifically on the loss of ability to engage in slightly risky activities (climbing a big tree, for example) out of the sight of adults. It would be helpful to have even more precise data about this — and perhaps a better sense of when these changes really picked up — but it seems hard to argue with the conclusion that, relative to the 1980s, children have less physical freedom. (Notable: Last week one of the Q&A questions here was about whether sleepovers are bad. I see sleepovers as a classic example of the kind of independent activity that has declined.) What is the link between independence and happiness? If we acknowledge that independence has gone down, making the link to happiness would require knowing those factors are related. The evidence here is a lot more indirect. One argument is that children like to play (this seems obvious, but is also shown in data) and — this part is less obvious — that play often means without adults. There is some review data on this, and the authors point to one study in which kids between the ages of 4 and 6 were asked to classify pictures into play versus not play. The interesting finding is that when they see pictures where a teacher is involved, they are less likely to classify them as play. Play seems to be when it’s just kids. Other data presented would be consistent with this, but has multiple interpretations. Adolescent and teen mental health tends to improve in the summer; this is a time of more independence, but there are other changes too. It’s hard to link that directly to independence. The play evidence is on short-term happiness. When we turn to the longer-term links, the authors move quickly from data to theory. The authors link their ideas to theories about locus of control. It has been widely demonstrated that having low levels of internal locus of control — basically, feeling that you do not have a lot of control over your own life — leads to higher levels of depression and anxiety. Feelings of internal locus of control have declined over time. The authors hypothesize that independence at younger ages, with the associated need to problem-solve, could contribute to higher levels of internal locus of control. By extension, the loss of this time may contribute to the decline in these levels. This fits, but requires us to stretch beyond the data in the link between independence and these feelings. A second theoretical link is with self-determination theory, which suggests that people are happier if they feel like they are living in accordance with their own desires, rather than being driven from the outside. The authors again hypothesize — although this isn’t something we see directly in data — that independence might play a role in increasing these feelings of self-determination. A final point relates to our evolutionary background. For most of human history, and still in many societies today, children had more freedom (and more was expected of them in terms of contribution to the larger group). The common setup we have today, with the combination of scaffolding and expectation, is counter to this. So perhaps kids are not adapted to it. (I’d recommend Hunt, Gather, Parent for a different type of perspective on this.) The authors make a few other points — looking at correlations between parenting styles and child outcomes, and reflecting on what adults say about their formative life experiences. These sections are both the most interesting and — the authors acknowledge this — the most under-evidenced claims. The argument “things were different in paleolithic times” can be both true and also not responsible for an increase in mental health issues. It seems like an area that would be ripe for more research, which would probably have a more significant experimental component. The paper spends less time on the “how” of making this work. Our built and social environment isn’t necessarily set up for kids to play outside all day until dark. The answer is probably: baby steps. Could a child walk themselves home from school or the bus stop? Could you work with another neighborhood family to let the kids do some unsupervised play in a way that you were both comfortable with? Summer can be a good opportunity here. The authors of the paper are writing for pediatricians, and arguing that providers should talk to families about what might be possible for them. The role of risk in childhood The authors start the paper as I started this post — with a discussion of trends in mental health over time. This is a hard claim to strongly support in the data. For one thing, many of the changes they discuss are taking place over decades, not in the past 10 years. The trends in mental health are long-standing, but it does seem like in the period since 2012 there has been a significant trend change. These data do not provide an explanation there. (More generally: It is extremely difficult, not to say impossible, to imagine nailing an answer to this question. We are looking to explain a broad trend shift from sometime around 2012. A lot of things happened in 2012. Hasbro reintroduced the Furby. The Avengers came out. Of course, it’s not likely that a creepy fuzzy toy or a blockbuster movie franchise drives teen mental health, but the evidence for it isn’t a lot weaker than some of the other theories.) However: I think these issues bear thinking about even if they do not explain this particular trend, or only partially relate. A key point made in the paper is that many parents right now spend a lot of time protecting their children from exploring slightly risky situations — things that would stretch their problem-solving just a bit, or even scare them a little. When I reflect on my childhood, experiences like those did stick with me, but they were also very formative. I spent a fair amount of my childhood playing unsupervised in the parking lot of the church down the street. One game, “elimination,” involved trying to catch a tennis ball thrown against the wall, with the loser having to stand on the wall while other people tried to throw the ball to hit them. I do not remember this especially fondly, but I cannot help but wonder whether experiences like that better prepared me for the metaphorical ball-throwing that is part of talking in the public eye. The point is not that our children need to play elimination in a parking lot. But I was compelled by this piece to some reflection on scaffolding, and perhaps a greater need to look at where we are comfortable introducing independence to our kids. We have a strong and appropriate parental instinct to protect our children. The point here is that letting them go a little freer is actually part of that protection. Resources I started today’s newsletter with some alarming statistics around mental health in adolescents and teens. Some of you may have children in this age group who are struggling. So I want to end with resources that could help. I’ve asked Miranda Featherstone, a writer and social worker who has talked to us about sex and death, to jump in. Here’s what she says: If you’re looking for a therapist, there is always the Psychology Today provider search, which allows you to filter by age. I would also encourage you to talk to your pediatrician (and be persistent if necessary) if you would like a referral for mental health support for your child, or are looking for a therapist who will help parents better support a child who is struggling. Another resource is your school counselor and social worker: they not only provide support but are also generally well-positioned to make thoughtful referrals to local therapists. The same is often true of directors of child care centers, in the case of younger children. Finally, NAMI is a great organization — and a good place to start is “What to do if your child is in crisis.”

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