Q&A: How good parenting can be the best way to treat youth depression, anxiety
Posted May 24
Dr. Leonard Sax, physician and psychologist, says American medicine has gotten turned around when it comes to treating children who are anxious, depressed or lack focus.
He tells the story of some parents whose daughter's grades started to slide. The doctor suspected attention deficit disorder and prescribed Aderall for the child. The medication helped, but the girl also develop palpitations and insomnia.
The parents consulted Sax after reading his article in the New York Times on over-prescribing medications and he discovered the girl was sleep deprived, spending hours chatting with friends through social media when her parents thought she was asleep in bed.
"There’s no easy way to distinguish between a child who’s inattentive because they’re sleep deprived and the child who is inattentive because they have ADD. You need a clinician to do a careful history," he said. "Instead, a physician says let's try (medication)."
He noted that American children are far more likely to be treated with medication than are peers elsewhere. They are also diagnosed as depressed and anxious at higher rates.
"There are more kids on medication for ADD in Salt Lake City than in all of France, he said. "Outside of the U.S., such medications are rarely used. In the U.S. they are widely used for depression and for behavior."
Sax, who graduated from the Massachusetts Institute of Technology before earning a Ph.D. in psychology and an MD from the University of Pennsylvania, is a public lecturer, practicing physician and the author of four books: "Girls on the Edge," "Boys Adrift," "Why Gender Matters" and "The Collapse of Parenting." In the latter, he argues that many of the challenges youths face, from obesity to depression and anxiety, are rooted in a lack of effective parenting.
In a recent interview sparked by the upcoming release of an updated version of "The Collapse of Parenting," Sax said in many cases parenting is the key to help tackle these challenges, not medication.
The interview has been edited for clarity and length.
You’ve said kids today struggle in unprecedented ways. Why is that?
Leonard Sax: I think one of the reasons is because parents are confused about their own role. A lot of parents think good parenting is letting kids decide everything. In some domains that may be true.
But I find that many parents are letting their kids go to bed with a mobile phone. … At 2 a.m., the daughter gets a text: “OMG, Jason and Emily broke up. This is really big news. We have to talk about it.” She’s up for an hour exchanging views. She comes down in the morning and she looks tired. You ask what is wrong. She says everything is fine.
This is a domain where parents need to make a decision. At 9 o’clock at the latest, you take the device, turn it off and put it on a charger that stays in the parents’ bedroom. She can have it back tomorrow morning. It is not reasonable to put that decision in the hands of a child.
She needs to be able to say, “My evil parents take my phone every night and won’t give it back until morning.”
Smartphones are everywhere. Is that a problem?
We now have a great deal of research showing that too many American kids are spending all their time looking at phones and screens. The more time on Instagram looking to see how many likes they have, etc., the more likely they are to become anxious and depressed over time. That effect is stronger for girls than it is for boys, but it’s a big effect for both.
Kids don’t require mobile phones that can take pictures, do texting and surf the web. Parents say, “My child goes to activities after school. What happens if her ride doesn’t show up? There are no phones anymore. I don’t want her to go up to strangers and borrow a phone.” OK. I get that. But it’s not an argument for a smartphone. That’s an argument for a dumb phone, a basic phone that can make and receive a phone call.
There are many such phones, but parents do not believe it because they aren't marketed to them. They are marketed to the elderly. It’s called a snap phone. It can make a phone call and receive a phone call and that’s it. That takes care of the safety concern. If your kid needs to have a phone, that’s a great choice.
It seems every teenager now is anxious. Is that a true picture?
That’s a major focus of especially my book "Girls on the Edge." We’ve seen an explosion in anxiety in the last 20 years, more pronounced for girls than boys, but big for boys as well. We know a couple of factors.
Screens clearly promote anxiety. There’s a good longitudinal cohort study showing that the more time spent on social media like Instagram, the more likely (a teen) is to become anxious. Kids are selective in terms of what they post. Kids tend to post happy stuff. Emily goes to a football game, takes pictures, then posts two or three where she’s having a good time. So imagine a kid sitting alone in her room, looking at all the other Instagrams of kids having a good time — there’s Emily at the football game, Madison at the party having a blast, there’s Annette with her new puppy. I am sitting here in my room not doing anything. My life sucks.
The more time kids spend on social media, the more likely they are to think all the others kids are having more fun than they are, that they’re missing out and it leads them to become more anxious and depressed.
How are boys and girls different?
Boys seem partially insulated for a couple of reasons. For one, boys use social media differently than girls do. A boy and a girl both go to a football game. The boy takes a picture of the game or the pretty cheerleader at the game.
The girl is taking pictures of herself. If you don’t like Jason’s picture of the pretty cheerleader, he doesn’t care. If you don’t like Susan’s photo of Susan, she’s going to take it more personally.
Boys and girls use social media very differently. A boy gets sick and throws up. He might post a photo of his own vomit. Girls never do that. … A boy looking at Brett’s vomit is less likely to want to be Brett.
Third, boys are spending more time on video games than on social media, and that’s a big effect. Boys are likely to spend many, many hours on video games compared to girls.
Is that good?
Many Americans are confused on this. They think video games are technology, technology is good, therefore video games are good. The research says that up to about six hours a week, video games don’t really have much effect in terms of academic achievement, for example. But beyond six hours a week, there is a roughly linear and negative effect.
(Video game researcher Craig Anderson from Iowa State) blames “displacement.” If you’re spending 20 hours a week playing video games, that’s 20 hours you’re not doing something else like studying or sleeping.
A lot of American kids are coming to school sleep-deprived and get 60-90 minutes less a night compared to most teenagers 20 years ago.
What else, besides sleep?
Prioritize family. The unintended consequence of overscheduling is the message that family time at home is the lowest priority, it takes a back seat to everything, including soccer practice and a play date. Cancel the play date and schedule family time together. Enjoy each other. Parents are so confused. You need to be spending at least several hours a week every week doing something fun. Not chauffeuring to something fun the child is doing with others. It means something fun they’re doing with you. You need to prioritize the parent-child relationship.
Do you have tips for together time?
Practical things: No earbuds, no headsets in the car. The car is a private setting where no one else is listening. You should be listening to each other.
No screens at the dinner table. You should be listening to your child; they should be listening to you.
I took my wife and child to dinner on Mother’s Day. Next to us was a family with a boy, about 7, parents and grandparents. The parents handed the boy a video game device. The entire time, he is looking at the screen, eating or both. I never saw him speak to the parents or the parents to him. The point of taking your child to a restaurant is to build bonds. You have a real chance to connect. The entire time, he’s playing video games.
At what age do you no longer control these things?
There are no guarantees, but if when your child’s a teenager you have not allowed them to develop bad habits, you have not allowed your son to spend hours a day in video games and looking at pornography; you have not allowed your daughter to spend hours a day uploading photographs to Instagram, you have instead inculcated good habits, virtuous habits, you have improved the odds.
There’s an old phrase in American culture: Virtue begets virtue and vice begets vice. That’s what the scholarly research — longitudinal cohort studies — shows. If parents are authoritative and help kids develop good habits, they improve the odds. If permissive and let kids do what they want, the odds are now against you. Your child is more likely to be depressed, disengaged. At what age do you step back? When kids leave the home. As long as they are under your roof and you pay bills, they follow your rules.
The other point is, you cannot teach a virtue which you yourself do not have. To become a better parent, you have to become a better person — and not spend hours a day uploading photos to Instagram or playing video games.
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