An article in the April 13th edition of the Wall Street Journal revealed that The U.S. Preventive Services Task Force now recommends that all children as young as the age of 8 start being professionally screened for anxiety.
The task force, a panel of experts that make health recommendations on matters such as screening for diabetes and cancer, also reiterated its 2016 recommendation that children between the ages of 12 and 18 should be screened for major depressive disorder.
This follows the wake of the Covid-19 pandemic, which mental health professionals assert has led to a “mental health crisis” for young people.
The article states more than 1 in 3 high schoolers reported having poor mental health during the pandemic through June 2021, according to a CDC study of more than 7,700 students. About 44% said that they experienced persistent feelings of sadness and hopelessness within the 12 months preceding the survey (57% for females, 31% for males). 1 in 4 adolescent females reported having seriously considered suicide, while 1 in 7 adolescent males did.
Roughly 1 in 12 adolescents actually attempted suicide.
Federal data shows that drug overdose deaths among adolescents between 14 and 18 nearly doubled to 954 in 2020 compared to the year earlier, according to researchers from U.C. Los Angeles. The data from 2021 indicates that there were at least 20% more deaths than in 2020.
The article quotes Nasuh Malas, Director of Pediatric Consultation and Liaison Psychiatry at C.S. Mott Children’s Hospital in Ann Arbor, Michigan: “What the pandemic has done is exacerbate a pre-existing issue. These guidelines are a preliminary step to many, many steps that we need to take nationally as a community of people who are concerned about our youth.”
The article cites pre-pandemic statistics of the already poor mental health reported in children and adolescents: according to a study in the Journal of Developmental and Behavioral Pediatrics, children 6 to 17 were diagnosed with anxiety or depression at 5.4% in 2003 and 8.4% in 2011. By 2020, 9.2% of children aged 3-17 were diagnosed with anxiety or depression.
What the Wall Street Journal’s article didn’t get into are the potential causes for the “pre-existing” issue of poor child and adolescent mental health exacerbated by the pandemic’s isolation.
Most people probably don’t understand that, neurologically, anxiety and depression involve the same set of brain circuitry. This is the cortico-striatal-thalamic loop. Fancy wording, but what it really entails is simple: we take in information from our environment using our attention, process it emotionally by choosing what part of it is either rewarding or not, and then physically react to it – reinforcing the rewarding parts by focusing even more attention on them.
Anxiety is what happens when this circuitry loop is unnecessarily over-stimulated, and depression is what happens when it runs itself tired and short-circuits altogether, rendering an individual unable to find anything rewarding at all.
It’s a top-down positive-feedback loop, meaning that it starts with pre-frontal attention/focus, then moves to emotional/dopaminergic relevance, then to physiological response, which then loops back into determining what one pays attention to. Using Cognitive Behavioral Therapy (CBT), many therapists treat anxiety and depression by focusing on changing the pattern of a patient’s attention – the one thing they can consciously control- as doing so can then rewire the rest of the circuitry.
The brain is simply a bed of associations. These associations form a network, and the brain builds on the associations that feel most rewarding. It’s that simple.
At its core, the internet works similarly; all internet apps, especially social media, work to condition its users like the physiologist Ivan Pavlov did in his famous experiment with dogs: attach a physical stimulus (the ding of a notification) to a mental reward (other people saw your post and liked it!) and boom, users salivate for more.
The answer as to why more and more young people are exhibiting anxiety and depression is clear to me: the environment that dominates their pre-frontal attention has radically changed in the last two decades (coinciding with the statistics of worsening mental health), putting more reward on things that are unhealthy and unsustainable for brain function.
Look around: there are screens everywhere, constant voices, constant photos, and other peoples’ stories constantly being shared in real time. Look specifically at young people around you. They are most likely not fully there, because they’re simultaneously attending to all of this.
The attention of the average young person has become exponentially globalized compared to any generation that has come before it, and the results are in: the average U.S. college student can now only focus on a task for about 65 seconds at a time.
Why specifically do young people seem to be affected most? Adolescence is a critical period in the brain’s development; the brains of adolescents need attention from their peers – textured, nuanced social interaction and validation – through which they form their own identity. In a world where this is now achieved primarily through an online presence, young people are lonelier than ever. Because trying to truly attend to the digital world while also balancing existing in the real-world is an attention overload. It has created a society of anxious young minds on the verge of tiring themselves out completely.
Their response: They double down, dedicating even more time to their escapism, whatever it takes to evade the uncomfortable dissonance of balancing these two realities- whether it’s by being on their phones even more, or by doing drugs, or whatever it takes to not have to live in the “real world” but instead preserve the reward they feel through their forged online identities.
A study by the National Library of Medicine found that anxiety is what modulates the relationship between attention-deficit/hyperactivity disorder (ADHD) severity and working memory-related brain activity. They found that at least 50% of individuals with ADHD have one or more comorbid anxiety disorders.
More times than not, anxiety becomes the precursor to depression. I argue that ADHD is the real underlying cause for the increase in anxiety and subsequent depression among young people. And it’s not that the brains of young people have gotten weaker or more inherently flawed, it’s that the landscape of our world has rapidly changed to no longer support proper human concentration and therefore connection – the kind of connection that these developing brains so desperately need.
As a result, these developing brains are being wired incorrectly, forming around an unsustainable pattern of attention, leading to anxiety and then to depression.
In 2017 (pre-pandemic), the daily mobile media usage among kids under eight was already nearly 10 times higher than it was in 2011, according to a Common Sense media usage survey.
According to Discover Magazine, one survey estimates that almost half of all American teenagers say they’re online nearly constantly.
According to a 2018 survey by the Pew Research Center, more than half of U.S. teens between 13 and 17 worry they spend too much time on their phones. And when they don’t have a smartphone in their pocket, nearly 60% of teens reported feeling either anxious, lonely or upset.
According to Statistica, Google’s parent company Alphabet reported $257 billion in revenue for 2021, a 41% increase from the year prior.
Instagram accumulated $17.4 billion in ad revenue in the United States in 2020. The social media platform, owned by Facebook, is projected to reach roughly $40 billion in annual ad sales in 2023.
In 2020, TikTok owner ByteDance’s revenue more than doubled from the previous year to $34.3 billion, as reported by the Wall Street Journal. In 2021, the company saw its total revenue grow by 70% year-on-year to around $58 billion.
According to Fortune Business Insights, the behavioral health services market grew 11.3% in 2020, and is projected to grow from $77.6 billion in 2021 to $99.4 billion in 2028.
Covid-19 boosted behavioral health service growth not only by exacerbating the prevalence of mental health issues, but also by using the pandemic as an opportunity to tout digital mental health care services, including virtual therapy, virtual neurological interventions, and digital diagnostic support and medication prescription. These “digital therapies” are slowly becoming the norm, and will continue to become so.
The truth is that anxiety is indeed higher among children and adolescents than it’s ever been. Anxiety is higher among all age groups still experiencing brain development while living in the age of technological addiction; human brain structure has been formed through thousands and thousands of years of evolutionarily-reinforced behavior that rewards itself through real, face-to-face, one-on-one interactions with other humans, not through shallowly connecting with thousands at once. It’s no surprise that dramatically shifting to this new social paradigm in a short time is yielding significant mental health problems among the population.
The anxiety problem starts with what we are paying attention to. In order to fix the anxiety problem, this needs to be where our solution starts.
Instead of screening 8 year olds for anxiety and depression, finding that it’s indeed there, and then trying to treat it by putting them through virtual therapy or pushing pills down their throat, we as a society should be limiting the external influences that are the cause of the problem.
To start? Limit screen time. Crucially, replace it with rewarding, in-person social experiences.
But achieving this on a national level involves a cultural reset – one that requires all hands on deck. This will be difficult, if not impossible to achieve, because the largest, most powerful companies in our economy are profiting off of robbing young people of their attention.
And now, mental health services have found a way to profit off of the anxiety this creates, by ironically contributing to the “screen time issue” even further.