This weekend I was hit hard by a disturbing article in The New York Times (NYT) about kids targeted by sexual predators via direct chats and in multiplayer video game chat rooms.

In a chat, people with bad intentions can pretend to be any age. They can say they are a friend-of-a-friend as a way to enter the chat. Children are susceptible because they are unsuspecting, and by the time they may realize something is not right, shame and threats may already be in place to keep them quiet and scared. 

People have been reporting problems much more frequently than just a few years ago. According to The New York Times article: “Six years ago, a little over 50 reports of the crimes, commonly known as “sextortion,” were referred to the federally designated clearinghouse in suburban Washington that tracks online child sexual abuse. Last year, the center received over 1,500. And the authorities believe that the vast majority of sextortion cases are never reported.”

These predators connect to kids who play games like Minecraft, Fortnite, and any game that has a chat function, slowly “grooming” their victims (“grooming” is such a creepy word—which is fitting— and refers to a perpetrator working to gain a child’s trust with the intent of doing sex related crimes).

 Things to know:

1. Criminals pretend to be teens and start conversations. I learned from the NYT article that often they pretend to have emotional hardships and use that as a way of building the relationship. I find this so disturbing. 
2. They might buy gaming currency, like Fortnite V-Bucks, for the kids.
3. Their goal is to try to get sexually explicit photos and videos to use as blackmail for more imagery.

This kind of extortion happens with many games. A Seattle man was convicted for posing as a teen and getting explicit photos from boys via Minecraft and League of Legends. 

The NYT article reports how Roblox, a game for small children, allows players to chat with others. Youth are socializing online through the chat functions on the games themselves but also on third-party chat sites like Discord and Omegle (whose tagline is Talk to Strangers), where interacting with strangers is the norm. Discord is a chat feature with text, video, and voice chat to meet up “live” while gaming. Once predators establish a “trusted-relationship” in an open space chat room, they will try to move these interactions to private conversations on platforms like Kik and Facebook Messenger. 

As parents, teachers, and counselors, let’s be proactive by having conversations about warning signs and red flag behaviors before our youth get targeted. It is critical to consider how we can engage our kids in productive conversations, without making them too anxious and without coming off as too anxious ourselves. 

1. Being strategic with our kids when we talk to them about these topics is vital. Start a conversation with the assumption that your child is doing the things you have asked, such as only interacting with people online that they know in real life. But then, verify, using a tone that assures them that your main goal is to reinforce safety, not impose punishment. (Yes, there may be consequences, but when they tell us the truth, praise them, rather than focus on the breaching of a rule. This way you will get more honesty in the future.) 
2. We don’t want them to think we think this is happening everywhere and all the time. It’s not. But it is about letting them know that this is a risk and we need to all work together to think deeply about how we prevent and stop suspicious activity.
3. These risks are serious, and can even be life-threatening. I spent time with Carol Todd whose daughter Amanda tragically died by suicide after ongoing, online sextortion. It was an awful story that you may have heard about. When I visited her in Canada, we talked for hours. She showed me her daughter’s room. We hugged and shed tears. She has done tremendous advocacy work for online safety and mental health and I was happy to be able to help in one of her advocacy activities years ago. She is a true hero of mine. (The adult man who was doing the sextortion is behind bars.)
4. Something I find helpful is to foster a discussion about these topics with your kid and someone they play video games with, and that person’s parent. Start a conversation about these topics, working to engage the youth. Try to shift the conversation from what they are playing to the more significant discussion around the issues, all the while weaving in the points you are trying to convey. You might say something like, “I imagine the parents of such and such kid were so glad their child told them what was going on. I know the parent might have wanted to throw away all their games, but hopefully, instead, they talked about how to find balance and safety so that safe gaming could still happen.” 
5. Talk to other parents. It’s so important to find out ways they are trying to promote safe video games too.
6. Take some time to learn about the games your kids are playing, and about the chatting apps. Then, let your kids know the type of info that you have gleaned and ask if what you learned sounds accurate or not. 
7. And SO IMPORTANT, occasionally play video games with your kids. Participating is a great way to see what is happening in chats. They might not want you to play because there can be swearing and such, but if you say to them, something like, “I know there may be language I don’t like, but I promise to hold my tongue. I want to look through a small window into your video game life because I know it means a lot to you.”

Here are a few questions to get the conversation started:

1. Do you like to “chat” while you game?
2. How do you determine with whom you chat?
3. If you are in a group chat and someone invites someone you don’t know, how do you make sure they are who they say they are?
4. On social media, how much chatting happens with people that people don’t really know? 
5. Question for youth:  If you were leading a group of younger than you students in a discussion about this topic of online safety and chat situations, what would you say to them. ** If your teen would be willing to share this with me, I would love to hear it, and with permission, anonymously post.

Recent world events are causing a lot of anxiety – particularly with children and young adults. Screenagers posted an informative article, featured below, about how to determine what action should be taken in regards to anxiety.

If you have a loved one struggling with anxiety, please contact Tamara Ancona, MA, LPC at (678) 297-0708 for an evaluation, and to discuss the best treatment options available.

Anxious feelings are understandably very high right now in youth given COVID-19. My daughter is a senior in high school and gets waves of many emotions right now–such as anxious feelings related to deciding on a college or sad feelings thinking about all the things she will miss from not being able to go back to her school. All kids have stories right now of things they are fearing, regretting, missing out on, obsessing over, and much more.

As a physician, I thought it would be helpful to give insight into the difference between anxious feelings vs. clinical anxiety, and then to provide examples of skills and resources.

I have been talking with psychiatrists and psychologists who are finding that many teens who were experiencing a lot of anxious feelings related to things at school are doing overall emotionally better with school out. Yet they do talk about how this can change for them at any time, particularly as the days like this continue. 

Traditionally schools in our country do not teach about mental health challenges and skills. Fortunately, that is changing, as seen in Screenagers NEXT CHAPTER. 

No matter what has been taught at school, there is still so much that can be discussed with our kids now that will help them when they face anxious feelings and will help them in helping their friends and others. In surveys, teens report that they are more likely to tell a peer about hard emotions than adults. I say this only to point out that helping our youth gain skills can be a real asset to be able to help others in their lives, be it now or be it years from now. 

Anxious feelings

We often use the word “stressed” in our society, which can mean many different things to the person saying it, such as feeling that something in their life is out of control, or they feel overburdened, or irritated, or many other things.

In the same way, when a person says they are feeling “anxious”, it can mean many different things—similar to the word “stressed.”  This is where the skill of stopping to think about the core emotions behind these words is a great one to hone. Understanding leads to the most effective interventions. 

It can be helpful when thinking about anxious feelings to know that often the anxious feelings are actually fear. Fear of an uncertain future, fear that you did the wrong thing (regret is a type of anxiousness), fear of what will happen if you ask someone if they want to video chat, and then the fear of how that person will perceive you. 

In Washington State, there is a survey of high schoolers every two years. Here are the 2018 results regarding anxious feelings for teens in King County– where the city I live, Seattle, is located: 

8th-graders 

58% reported that they at least sometimes “felt nervous or anxious in the past two weeks.” 
46% reported that at least sometimes, they were “unable to stop or control worrying in the past two weeks.” 

12th-graders

69% felt nervous at least sometimes
59% were unable to stop or control worrying at least sometimes

Unfortunately, they only started asking these questions in 2018, so I cannot provide you with any data from past years. 

There is an incredible dearth of data in this country to be able to effectively compare data about anxious feelings of youth over past years. Often people cite two surveys of college students. 

For example, the American College Health Association surveys students from many colleges over many years. They have been asking if students “ever felt overwhelming anxiety in the past 12 months.” In 2011, roughly 50% reported yes, and in 2016 approximately 58% reported yes. 

The other study of U.S. freshmen asked if they ever “felt overwhelmed.”  

Clinical anxiety

The numbers here come from the main comprehensive study on youth mental health, called the National Comorbidity study-Adolescent Supplement. When any book or scientific paper references rates of adolescent clinical anxiety, this is the paper to which they are referring. 

(*Of note the numbers here were rounded to the nearest tenth.) 

• By age 18, 32% of youth will have met criteria for some type of clinical anxiety, ranging from very mild to very serious.
• By age 18, 19 % of youth will have met the criteria for severe clinical anxiety — meaning it caused severe impairment and/or distress.

The prevalence of the main specific types of clinical anxiety

By Age 18…

…19% of youth will have met criteria for having had a specific anxiety phobia (such as towards spiders). These were ranked from mild to severe, and the majority met criteria for “mild.”)

….9% met criteria for social anxiety (the majority met criteria for “mild.”)

….5% will have met criteria for PTSD.

….8% will have met criteria for separation anxiety.

….2% will have met criteria for generalized anxiety (the majority met criteria for “severe.”)

…2% will have met criteria for a panic disorder (the majority met criteria for “severe.”)

…2% will have met criteria for agoraphobia (the majority met criteria for “severe.”)

Unfortunately, the data collected for this study was done in the early 2000s and published in 2010, and there has not been a follow-up study. I know this is shocking. I have spoken with the researchers, and they told me it had to do a lot with a lack of funding. 

Diagnosing Clinical Anxiety

Some anxious feelings are to be expected and are even helpful. For example, anxiousness in anticipation of a test in a few days can help a person to study for a test.

When anxious feelings are often out of proportion for the situation, and the feeling does not fit the fact, this may indicate the possibility of clinical anxiety. 

For example, these two scenarios would be cause for concern:

1. A teen worries all the time about tests. Long before it is even going to happen the student is so consumed by the fear. The teen loses sleep and has lots of intrusive thoughts about failing.

2. A youth experiences significant anxious feelings when they imagine talking to other people or raising their hands in class. This has resulted in them being extremely behind in school and not have any friends. While the student desperately wants to change, they can’t move past their anxious feelings. 

As a physician, I assess anxiety in teens and adults in my clinic. I ask everyone who comes into the clinic at some point in the visit, “Are you experiencing any anxiety or depression?” The incidence of anxiety and depression is significantly higher in a medical setting than in the general population, so it is important that I ask about these things. And, so often, I see how relieved they are that I asked. When I see people in my clinic, and I have identified a concern about anxiety, the number one question I then ask is, “Are you avoiding things?” Their eyes light up and often respond, “How did you guess that? 

The main questionnaire used in health settings to help diagnose clinical anxiety is called the GAD 7. I really recommend going over these questions with your kids or teens. 

It starts with these questions:

1. Over the last two weeks, how often have you been bothered by the following problems?

• Feeling nervous, anxious, or on edge
• Not being able to stop or control worrying

2. If the teen answers yes to either, then the following questions are asked if they have these symptoms:

• Worrying too much about different things?
• Trouble relaxing?
• So restless that it’s hard to sit still?
• Become easily annoyed or irritable?
• Felt afraid as if something awful might happen? 

3. Then the third part assesses how distressing and/or debilitating the symptoms are and asks:

If you checked off any problems: 

How difficult have these made it for you to do your work?  

Take care of things at home, or get along with other people? 

(Options are from “Not difficult at all” to “Extremely difficult”)

When symptoms are ongoing, there can be real suffering and can lead to avoidance of certain situations. So, while it is common for teens to feel a bit nervous about going up to talk with a peer, a more intense nervousness, would indicate a more severe problem. This might present by them starting to avoid most social interactions and becoming more isolated. 

When anxious feelings lead to a lot of suffering, via constant worrying, and a lot of negative consequences, such as avoiding situations often, these are signs that anxiety is a clinical problem and should be addressed with professional help such as counselors or therapists.

Skills to Help with Anxiety

These skills can be helpful even for youth who do not have clinical anxiety but for whom anxious feelings are getting in the way of doing things they would like doing, such as having more friends, worrying less often, and so on. 

Let’s start with a skill that can help with all types of anxious feelings—not just clinical anxiety.

The 3-Ex’s 

In Screenagers NEXT CHAPTER psychologist and author Lynn Lyons describes a skill she calls the 3 Ex’s:

1. “The 1st X is you will expect worry to show up. You would say something to yourself like, “Oh, there it is. So I’m about to take a test. I hear somebody else got into this school. You have to recognize that. That’s your worry. 
2. The 2nd X is you are going to externalize it. You pull it out, you give it a name, and say something like ‘Hi, Pete, nice to see you.”
3.  The 3rd ex is that you are going to experiment, so you do the opposite of what the worry is demanding. The worry demands attention. You decide not to get in a discussion with it and, instead, you are going to pivot. You pivot into getting started on your homework. Or if you’re falling asleep, pivot into thinking about something that is sort of mundane enough that doesn’t really matter to you.”

Exposure therapy (also referred to as exposure response prevention)

The goal of this therapy is to work towards no longer avoiding things that a person wishes they were not avoiding. It is about eventually doing the things the person is avoiding over and over, so they get used to the uncomfortable feelings and learn how to do actions despite anxious feelings. Meanwhile, the more the action is done, over time, the anxious feelings will go down to some degree.

This technique is done in graded steps. For example, a teen is too anxious to participate in class. They might not even be able to verbalize what they are afraid of, but they might be able to verbalize reasons, such as they are afraid people will judge them poorly, laugh at them and not want to associate with them.

Graded steps that might work for the student — and perhaps working with the teacher in the class to go through this:

1. Start by making time with a supportive teacher to practice outside of class to ask questions and to offer answers.

2. Making plans with a teacher before a class to have an answer ready, so when the teacher asks the question, the student will raise their hand and propose the answer.

3. Doing the same prep work to think of, and together, think of a question the student could ask in class. Then, the student is reassured that the teacher thinks this is a “good” question that is valid, reasonable.

4. Creating a goal of how many times in the class they will raise their hand regarding answering a question or asking a question. For instance, picking four times a week and having an accountability plan with a reward/ treat when they accomplish the goal.

5. Finally, starting to raise their hand and participate more in another class where the student has not been working with the teacher.

This is challenging to do, but the good news is it has a high success rate. As the teen does these exposures, as they step into the discomfort of getting scaffolding and support, you can actually see changes in the brain scans of the amygdala. It is no longer as hyperactive as it was before to that stimuli.

In Screenagers NEXT CHAPTER, Olivia, who is 15, had clinical social anxiety, and her therapeutic exposure task was to go to a shopping mall and ask for sushi at a pizza place. She needed to practice being embarrassed. When you do something like this, it makes real-life situations that much more tolerable. I’m not saying we have to do that for everyone, but sometimes it’s just calling that friend you don’t like to call, you practice doing that. You just do baby steps.

Parents and teens need support to do this. Asking youth to face the fear and feel anxiety is so hard as a parent and, of course, for the youth to do—if it were not hard, they would have been able to stop. 

For parents, finding other parents who are going through the same situation or have gone through it can be such a help–not only as a source of support but also as a way to find resources. 

Getting counseling for one’s child or teen is key, and for parents to be a part of that counseling at times, it is also important when appropriate. In addition, parents usually benefit from things like their own counseling, support groups or parent coaching. 

Building Brain Attention Skills with Mindfulness

In Screenagers NEXT CHAPTER, we learn that my college-age son, Chase uses the App, 10% Happier to learn mindfulness skills from George Mumford, an expert who has taught these skills to many athletes, including Michael Jordan. 

In the film, I say:

“My son, Chase, also found an online tool that has really helped him. He’s had chronic pain from an accident years ago and lots of stress because of it. From his favorite online teacher he’s been learning mindfulness. It’s all about getting more insight into one’s patterns of thinking and learning to direct attention to more helpful thoughts.”

In the film, Chase talks about it in this way: 

“There’s the sensation of pain, but then I add the stress of being in pain and the emotional baggage of the history of the pain and the uncertainty of the future of the pain. And I recognize that I actually have a lot more control over this than I thought. So in my day-to-day when I’m in physical or emotional pain, I can be mindful of the negative layers that are building up on top of it and intervene before they themselves cause unnecessary suffering.”

Here are some popular Apps that teach mindfulness 

(Myself, my husband and my teens have used all of these at different times)

1. Ten Percent Happier
2. Calm
3. Headspace

Dialectical Behavioral Therapy (DBT) has many useful skills for overcoming intense feelings, including anxiety. There are many websites with many skills.

The TIPP skill is one such example. If a person is suddenly overcome by anxiety or other strong emotions, doing one of these things changes a person’s physiology, which helps stop or lower the intense emotions. 

T– Temperature–the person applies ice in a bag to their face for a minute or two. Many teens also talk about how useful it is to put their faces into an ice bath of water for a few seconds. I have known many teens who find this temperature skill very helpful.

I– Intense exercise–the person takes the energy of the emotions and does some quick jumping jacks or other quick exercises.

P-Paced breathing–the person slows their breathing-such as breathing in for breathing for 5 seconds in and then 7 seconds out.

P-Paired muscle relaxation-the person breaths in and tenses a body part at the same time, such as the arms–they pay attention to the feeling of the contractions and then when they breathe out they release the contraction.

Mental Health Organizations – Resources for Teens and Parents

The following are examples of mental health organizations

Anxiety and Depression Association of America

This organization has information on stress and many types of anxiety conditions as well as links to find help for children, teens, and adults.

NAMI

The National Alliance on Mental Illness has local branches across the country and offers support groups, online resources, programs in schools, and more.

Child Mind Institute

The site has many written materials and links to awareness campaigns. My Younger Self, for example, is 30 short interviews with actors, athletes, and other celebrities who discuss their past mental health challenges.

Youth Mental Health First Aid

These are free day-long courses designed to help parents learn how to understand youth mental health issues better and as a parent, things to do. On the website, you can find if there are classes near you.

Mental Health America

This organization has affiliates across the country. The website has links to information, and they also do important work in working to increase mental health access, locally and nationally. This page on their website is helpful for the nuts and bolts of finding mental health support.

6 seconds

The international emotional intelligence network researches and shares tools, methods, and training to create a kinder, more positive world.

BTWF

Born This Way Foundation – Started by Lady Gaga and her mother, the organization works to build a “braver, kinder world” for youth by creating safe-spaces and promoting self-care skills.

Psychology Today (link to https://www.psychologytoday.com/) 

This site is very well respected as a way to find a therapist, psychiatrist, or support group in one’s area. One puts in their zip code, and any indicators, such as “adolescent” and it will list many possible providers. Then the provider can be contacted, and a short call can be set up to see if there will be a good fit. 

Phone and Text Lines for Mental health

Crisis Text Line is free, 24/7 support for those in crisis. Text 741741 from anywhere in the US to text with a trained Crisis Counselor. Crisis Text Line trains volunteers to support people in crisis. This organization is a resource that many youth and adults report using and feeling helped. People who volunteer for CT receive 30 hours of training before they start, and they volunteer several hours a month.

My good friend is a volunteer, and we spent an afternoon together, where she showed me how their training works and examples of the work she does with people. It was powerful. A person can text about anything they are struggling with, and the volunteers are there and provide supportive interactions. Even though it is called Crisis Text, the texter does not have to have an imminent crisis; they get all sorts of people seeking support for things like eating issues, problems with peers, and just people dealing with hard emotions.

National Suicide Prevention Lifeline Call 1-800-273-8255

7 Cups – Connects you to caring listeners for free emotional support

Better Help – This is a fee-based service that provides online therapy via Skype and text

Boys Town National Hotline 1-800-448-3000. 24-hour, free, confidential hotline staffed by trained counselors for boys and girls to receive help with bullying, anger, abuse, depression, school issues, and more.

211.org is a free and confidential national hotline that connects callers with resources and support in their area. 

Ideas for conversation starters with youth in your life:

1. Clearly, there is a need for more research done around both anxious feelings and clinical anxiety of youth in this country. What type of research could you imagine doing?
2. If you were to study anxious feelings as they relate to screen time, what would be some interesting questions that you could see researching? 
3. What strategies do you find helpful when you are feeling anxious?
4. What skills mentioned here could you see ever using or telling a friend about?

Children and Screens cordially invites you, your friends and your network to join our series of three virtual workshops for parents featuring leading interdisciplinary experts on the topic of “Children and Screens During COVID-19” via Zoom. Parents can register through our website www.childrenandscreens.com. Hear from the country’s leading pediatricians, child psychiatrists, child psychologists, neuroscientists, educators, and parenting experts to learn:

The “Ask the Experts” series will focus on different developmental age groups, beginning with young children on April 28th at 12:00-1:30 EDT, moderated by Dimitri Christakis, pediatrician and editor in chief of the leading medical/science journal JAMA Pediatrics. Other panelists include: 

• John S. Hutton, Attending Pediatrician, Director of the Reading & Literacy Discovery Center at Cincinnati Children’s Hospital
• Brandon T. McDaniel, Research Scientist at Parkview Mirro Center for Research & Innovation
• Ellen Wartella, Professor of Communication Studies, Psychology, Human Development and Social Policy; and Medical Social Sciences at Northwestern University
• RSVP here

The second workshop for school-aged children (K-8) will take place on May 6th at 12:00-1:30 EDT, moderated by pediatrician Colleen Kraft, the immediate past president of the American Academy of Pediatrics. Experts include:

• Elizabeth Englander, Director of the Massachusetts Aggression Reduction Center at Bridgewater State University
• Catherine Steiner-Adair, Clinical Psychologist and Consultant, Author, and Speaker
• Moriah Thomason, Associate Professor of Child and Adolescent Psychiatry and  Associate Professor in the Department of Population Health at NYU Langone Health
• RSVP here

The final workshop on Adolescence is scheduled for May 12 from 12:00-1:30 EDT, moderated by child and adolescent psychiatrist Paul Weigle, chairman of the media committee of the American Academy of Child and Adolescent Psychiatrists. Speakers include:

• Tracy Asamoah, Child and Adolescent Psychiatrist 
• Jean Twenge, Professor of Psychology at San Diego State University and author of iGen
• Nicholas Kardaras, Author “Glow Kids”, Director of The National Institute for Digital Health & Wellness (NIDHW); Founder/CEO: Maui Recovery in Hawaii and Omega Recovery in Austin. 
• RSVP here

While we all learn to cope with living a digital life during this pandemic it brings up questions about the effects all the screen time will have on us and our futures. Screenagers explores the this in the article below:

Understandably most young people are on screens a ton right now. Thank goodness there are all sorts of great things made possible via screen time. 

But, what are the potential costs of loads of certain screen time activities on their brain health and mood? Are there ways to do changes in tech time that might help them feel better — even while keeping the same total amount of screen time?

Clifford Sussman, MD, is a psychiatrist for children and adolescents in Washington, DC, and he is well known for his work in treating those with problematic internet and video game use. He and I have presented together at the American Academy of Child and Adolescent Psychiatry Conference and have shared ideas over the years.  

Sussman and I were talking last week and I realized now would be a good time to share with you the brain model and action steps that he often teaches his clients. No matter if you put his suggestions into practice, this is a great science topic to discuss with youth in your life. 

Sussman talks about “digital binging” — many hours on end, without any real breaks doing things such as video games, social media, youtube, shows, etc.  This leads to what he calls the “residual effect” on the brain with prolonged use of such activities. 

The residual effect of the brain is caused by changes in the physiology of the brain. 

The brain has a reward center called the Nucleus Accumbens, where dopamine is the chemical released by one neuron to signal the adjacent neuron.  We can call the first neuron “Neuron A” and the second one, “Neuron B.” Neuron A will secrete dopamine in the small space between itself and Neuron B. Neuron B has specific receptors for dopamine. When dopamine attaches to the receptors, it causes feelings of pleasure and reward. Dopamine is what causes chocolate to taste good, etc. 

In instant gratification activities, such as social media, TV shows, and video games, dopamine is secreted non-stop. With ongoing dopamine release, the receiving neuron will eventually decrease its number of receptors for dopamine. This is because the body is always working to stay in homeostasis (balance).

If your brain gets bombarded continuously by dopamine, you start to develop a tolerance to it — meaning the intensity of good feelings decreases. The dopamine receptors have lessened, so even though there is dopamine present, the receiving neuron doesn’t fire off much of a signal because the receptors to the dopamine are less. 

Sussman says that this can lead to a higher sense of boredom. Boredom is not a pleasant state.

When the person stops doing social media or playing video games after several hours, they may feel cranky or just not very happy. They may think it is only because they want to be on screens more, but part of these lower feelings can be due to having fewer dopamine receptors.

Non-screen activities may just not be that appealing because the receptors are less (downgraded) so things, like reading a book or being with family, might not be as enjoyable as could be. 

The person may not be consciously aware of any lower feelings from normal daily activities, but they are experiencing this state. 

Solutions Dr. Sussman Suggests:

Know this key point

With time off of screens the dopamine receptors start to regenerate themselves. This is why Sussman does a lot of work with his clients to get them to take many breaks between engaging screen time activities to let the brain receptors get back to equilibrium. 

Change the conversation

Rather than parents talking about activities as “work vs. play,” consider talking about activities as high dopamine and low dopamine activities. High dopamine activities are ones where there is a constant, high flow of dopamine, such as video games, web surfing, and watching shows. Low dopamine activities are ones with delayed gratification — they can be enjoyable, or can lead to a sense of well being by eventually achieving things like completing a homework assignment. Some examples include exercising or playing board games, which are still fun but have a slower pace. Another good example is baking, which is enjoyable, and then there is a short high from the reward of eating the baked good. 

Alternate high and low dopamine activities

Dr. Sussmansays that the issue is not so much the total number of hours of high dopamine activities on screens, but instead, there need to be many breaks from those high dopamine activities so that dopamine receptors can return to more normal levels.

He suggests that for teens, only about one hour at a time of a high dopamine screen activity be done before taking a break. And for younger kids, it should be more like 30 minutes. And then whatever the time spent on a high dopamine activity should be followed by that same amount of time for low dopamine activity (on or off-screens — but ideally many times off screens). So if a teen girl played an hour of Fortnite, she would do a low dopamine activity for an hour before going back to do high dopamine screen activities. If a teen spends two hours on social media, they should then be off of high dopamine screen activities for two hours. 

More concrete suggestions from Sussman:

1. Make a list of high and low dopamine activities with the family.
2. Don’t abandon some routines now with COVID-19, such as having a certain time at night when screens are put away. He told me how this will help facilitate a “commuter instinct.” This is the instinct where the brain adapts to repeated habits. For example, if a person takes the bus home each afternoon and has a habit of falling asleep on the bus, they find that they naturally wake up a stop before their stop. Brains get in sync with our routines.
3. Work with kids to plan in advance how they will get off their screens when the allotted time is up. For example, if a kid enjoys playing Fortnite and they know one game takes at least 40 minutes, and they have an hour of allotted screen time, then they should be self aware that they should not start a second game. Instead they can do something else during the remaining 20 minutes of their high dopamine screen time.

Ideas for conversation starters:

1. What do you think about the concept of high and low dopamine activities?
2. Do you think taking more breaks between screen time fun activities could improve your mood?
3. Do you recall a time you binged on screen time and felt particularly low afterwards? Maybe sad, or angry or perhaps you had a headache?
4. You can visit Dr. Sussman’s website as a family and watch some videos he created that show animations of the science. 
5. I think it can be interesting to talk about how one feels during the day doing certain screen time activities vs. at night. Personally at some point in my early 20s, I realized that I could not watch TV or movies during the day, unless I was home sick, because afterwards I would just unexplainably feel blue. It was not from binging. I still have that to this day. I don’t see how Sussman’s ideas would explain this, but it has me wondering.

If you have a loved one struggling with the effects of screen time, please contact Tamara Ancona, MA, LPC at (678) 297-0708 for an evaluation, and to discuss the best treatment options available.

As adults we frequently discuss the things we’re stressed about. But what about our kids? Particularly teens and tweens? Screenagers tackles how to talk to this age group about their stress and ways to help them cope.

Teens and tweens often tell me how they talk with each other about their stress levels.

The other day I passed out an anonymous survey for reactions from teens to Screenagers NEXT CHAPTER, and one high schooler wrote: “It was really helpful to hear someone other than teens talk about teen stress.”

When people get asked to rank their level of perceived stress, teens on average report higher levels than adults. There are many reasons teens report stress, including academic-related stress and stress from relationships with peers and family. There is also the stress of trying to feel “good enough,” or trying to belong to a peer group, just to name a few.

Screen time and stress can be intertwined.  

Youth tell me many positive ways screen time helps them to cope with stress, such as contacting a good friend to get advice, or using it to make a song. Both of these uses help them relax and feel more competent. Many talk about YouTubers they turn to for insights on “How to cope on a bad day?” or “How to approach a friend who is ignoring them?” Others tell me that they achieve instant stress reduction from watching funny YouTube videos. 

On the flip side, there are many ways screen time can promote feelings of stress. 

One of the big ones is managing social media – both the relationship issues that emerge and the sheer volume of things that demand their attention. I interviewed a 15 year-old girl in Screenagers NEXT CHAPTER who talked about the stress she feels from social media and all the “Snaps” (i.e., messages) she gets.

“I’ll send Streaks. At eight o’clock I’ll put my phone down, I’ll go eat breakfast. I’d come back, and I’ll have like 17 different Snaps from people. I have to make sure I’m not ignoring them. And they know I’m not ignoring them. It’s just a lot.”

While adults talk a lot about their fear that cyberbullying is a significant issue on social media platforms, far more often tw/teens tell me other ways that screen time leads them to feel stress. Here are a few of the many other examples they give: 

• Seeing others out without them on a Snapchat story
• Seeing the guy they like in photos with his new girlfriend
• Seeing one image after another of the popular girls looking their best
• Having someone open their Snapchat, so they know their message has been seen but then they don’t respond
• Not being invited to be in a group video game or an ongoing chat group

• Having someone not respond to a text message
• Having someone post something snarky about a post they made
• Having a guy repeatedly ask them for a photo, or meet them somewhere
• Having a friend going through a hard time and they keep texting, and they feel bad saying they have to go to bed
• Arguing with family about screen time

So often, youth tell me that immediately turning to a screen for escape is their go-to when they are feeling stressed. One 12-year-old boy said, “When I’m feeling stressed, I go on my phone, Snapchat, YouTube.”

Teens are fully aware of how using screen time to cope with stress can help in the short run but often only makes things worse. For example, when they feel stress if they have to write a paper – how easy it is to escape the feeling by watching YouTube videos, only to feel greater stress as the night gets later. They have not done work on the paper and then it just spirals, with less sleep and so forth. 

Things parents can do to help youth develop skills for stress:

1. Help them stop and define “stress”
   We all know that “stress” is the word of the day. It gets thrown around all the time. It can be helpful to do the following when your child (or yourself) says they are feeling stressed. 
   Stop and ask:
   “Hey, I just said stress, or hey, you just said stress, what emotion is it really?”
   See what the person who said “stressed” comes up with. Maybe it is actually tired, or overscheduled, or angry about something, or perhaps even sad?
   Just doing this one step, like identifying the core emotion, gives us the ability to address it with more skill and forethought.
2. Help them identify Challenge Stress vs. Overwhelming Stress
   How we help them to see stress in new, more helpful ways. Some degree of stress is healthy and desirable – this is often called challenge stress. But feeling overwhelmed by stressful feelings is not desirable.
   Talking about “challenge stress” vs. “overwhelming stress” is key.
   You might start by asking, “What is happening in your life that is challenging?” And then say, “There is some good stress. For example, a cross country runner might be feeling stressed about a meet on Saturday, and that keeps her making sure to practice all week. And frankly, she is excited about Saturday’s race. So the stress is a good thing – motivating her to work hard, to step into a risky situation.”
   Overwhelming stress might look like this example, a student is in three clubs, two that meet on different days before school, one after. They have several challenging classes. Meanwhile, peer issues are happening. So now they find themselves having a hard time falling asleep.
   Once they have identified what type of stress they have, challenge vs. overwhelming, then problem-solving is warranted.
3. Let teens lead when it comes to problem-solving
   When it is overwhelming stress, ask them if they have any ideas to solve the problem. When we jump in and solve, science shows that for teens, this often can increase their level of stress. This is what I did so often with my teens, but I learned much more effective communication techniques along the way. I have learned to say these two things that have made all the difference:
   “Do you have any ideas for facing this stressful situation?”
   “I am here to brainstorm solutions whenever you want me to — just let me know.”
   If they do want your insights, still let them lead, and perhaps they will come up with answers themselves. For example, the situation above about the teen with the overwhelming stress, some solutions may include getting help in how to address the peer conflict, taking a break from one of the morning clubs, or seeing if they can swap one of the classes for one that is more enjoyable. 
4. Show them the ways you handle your stress
   Parents have told me how surprised they were when they stopped to think about it – that they realized they rarely share their coping strategies for stress with their kids.
   My teens know that exercise is my number one stress reliever. I am not an Iron Woman athlete, but I rely on my daily dose of movement of some kind. It makes all the difference in the world for my stress levels.
   Another example is that they know that other than for texts, I have no notifications that come to me on my phone. They know that I don’t bring screens into my bedroom when going to sleep because sleep is so important to me.
5. Ensure they have “stopping points”
   Gone are the days of “natural stopping points” because videos, online games, social platforms are all specifically designed to be an endless chain of events. That means as families, we need to create the stopping points. 
   If a 13-year-old knows that screens get put away at 9 pm, they have to learn to not keep postponing work. Having times when they need to be off social media and video games ensures they have time to recharge – such as playing with a younger sibling or helping chop vegetables at dinner time. 
6. Teach them about Growth Mindset of Personality
   Studies have shown that teens do better with stress when they learn about how personalities are not fixed but change over time. Researchers measure their stress response during social situations after getting lessons on a growth mindset, and their stress hormones are lower than teens who did not get the lessons.

If you have a loved one struggling with stress, please contact Tamara Ancona, MA, LPC at (678) 297-0708 for an evaluation, and to discuss the best treatment options available.