This episode is brought to you in part by the Keystone Purchasing Network and the PA School District Liquid Asset Fund (PSDLAF).
People are often surprised that it turns out that in the early ’90s, the rate of young people of their depression symptoms was similar to what it is now.
What’s concerning too is that the data shows that teens who are already vulnerable emotionally, they’re more likely to report that screen time, social media in particular, makes them feel worse.
The number one thing when I ask teens over the 10 years of doing this work, what is the one thing you want your parents to know? And they’ll say, “I want them to trust me.
The number one advice I give to any parent is really doing the work to create a support team.
When we can find purpose to our pain and help other people, that dual thing that comes from being able to talk about our mental struggles is one of the huge reasons I’m just thrilled to be a part of ongoing advocacy for so many people paving the way for years on these topics, of how do we completely normalize that it is normal to have a really hard emotional times for people of all ages.
Dr. Delaney Ruston: It’s great to be here. Thank you.
Annette Stevenson: In the film, Screenagers NEXT CHAPTER, you talk to students of different ages and with different life circumstances, but each student seems to struggle with some level of anxiety or depression. From your research, why have mental health concerns become more prevalent as the use of technology has increased?
Dr. Delaney Ruston: The work that I’ve been doing with Screenagers and Screenagers NEXT CHAPTER is a lot about understanding how do we talk with kids and teens in a way that they’re going to listen, because we’re in this tech revolution of this candy of technology, they can easily want to be doing their own thing. I really want to make sure we’re giving them information that they can respond to. What I’m worried about, and this is kind of getting to your question, is there’s been this idea that phones are ruining a generation and they are just the cause of any increase that we’re seeing. What I find is that young people immediately get defensive around screen time issues. So, let me get a little bit granular about what do we know about the data around mental health issues. These are the type of things that I share with teens to get them thinking deeply about these issues.
People are often surprised, it turns out, that in the early ’90s, the rate of young people of their depression symptoms was similar to what it is now. In fact, for boys it was actually a little bit higher. Not quite as high for girls. There’re many different factors that go into what is going on. In the ’90s it started to go down. Then, in the early 2000s we started to see for all age groups levels, for example, of depression rates to start to go up. In Screenagers NEXT CHAPTER, when my daughter developed depression and I just was at a loss what to do, even as a physician. I looked at the data of what you’re mentioning that from 2011 up to most recent of 2017, there’s been a 59% increase in teens reporting depression symptoms. So, why is that? Obviously, there are non-screen related reasons, such as increased focus on performance and competition that has me concerned and individualism.
So those that aren’t at that par can often feel less than. In terms of technology, and there is an association, so the more time if people are on, these young people are on a lot of screen times, there is an increased chance that they will report depression symptoms. I think there are three main reasons for that association. I think one is that, yes, things can happen on screens that can cause a young person to go into several weeks of feeling really low and blue and depressed, such as social cruelty or just feeling inundated with feeling left out or less than. What’s concerning too is that the data shows that teens who are already vulnerable emotionally, they’re more likely to report that screen time, social media in particular, makes them feel worse. So, the vulnerable are that much more of an area that we need to focus.
The second reason is really concerning about it displacing time that we know is valuable for emotional wellbeing. One huge example is sleep. We’re at basically a public health crisis around sleep and related to the fact that now 41% of teens report that they get less than seven hours of sleep most school nights. Right now, with COVID-19, when I’m talking with teens who are going to bed around two, they’re still sleeping in later, but this is a real problem, because they’re missing classes. They told me they really want help for getting more sleep – displacing time of course with friends and peers and other things that are really protective.
The third one is a really big one, is that this association with more time on screens and increased chance of reporting mental health challenge is that when teens are feeling low emotionally, where do they go? They tell me time and again their main coping skill now is going to a screen to not think about the issue or sometimes to get help. Ultimately, they’re no longer as often going to find a person or going to an afterschool program, or work, a job, where they might actually start to really do the types of engagement that will get them over and through their hard emotions as opposed to just mask it as they go day and day, and night and night, on screens.
Annette Stevenson: So sometimes, and that might even be the place where the problem started, is then where they’re returning back as their coping mechanism, from what you’re saying.
Dr. Delaney Ruston: Absolutely. One of the researchers in Screenagers NEXT CHAPTER says exactly that. That she’s particularly worried of those teens who say, “Social media is making me feel worse, but I can’t stop.”
Annette Stevenson: In one of the schools you visited in the film, high school students were talking to middle school students about how to navigate the experiences they’re likely to face as they get older and grow up. A middle school student expresses that they feel more comfortable talking to an older student instead of an adult. When students do talk to adults, how can the adults make students feel comfortable and allow them to open up? Or is that the answer, that they talk to maybe an older mentor student rather than an adult?
Dr. Delaney Ruston: I think it is important that all of us know, because I wasn’t aware as much as I should have been that research continuously shows us that the number one place that teens go is to their peers when they’re dealing with a hard emotion. A high percentage still will say that they go to their parents, but obviously a higher percentage go to teens. I got really interested in how do we help, and I’ll get to how adults can help, but I was really interested in how do we help teens get better at using effective evidence-based language and techniques that they can use when their friends are going through hard times. Knowing full well that would help them to feel more confident and gain skills that they teach their friends, they would be learning themselves. In Screenagers NEXT CHAPTER, you see this incredible program where teens in high school are teaching middle school kids about specific language using I statements.
Really what does active listening and validation really mean? It’s programs I’d love to see all across the country, because when it comes particularly to this kind of touchy-feely stuff, social emotional skills, the last thing we want to do is to kind of talk down to teens and just tell them the obvious, as opposed to have them teach it. I see it constantly how engaged they get. In terms of adults, personally, I can tell you that’s such a big reason I made this film, because when Tessa was going through hard emotional times, even though I have been a doctor for 25 years and I take care of, at times, teenagers and young adults with depression, I felt as a parent completely at a loss of what to do. I needed a lot of help to learn how to support her better, because I kept just going in and problem solving.
We got to the point, I would just start to say maybe like one word and she would just be like, “There you go again.” And the last thing I wanted to do is make her leave at the moment I thought I maybe would have a connection with her. In Screenagers NEXT CHAPTER, when you follow, one of the stories is our story. You follow that journey as I’m struggling of what to do. I really began to appreciate what’s called the art of validation. So many parents who’ve had kids go through this hard time say, “Why didn’t someone teach me about validation before?” And it’s really active listening and empathy. It’s not necessarily saying you’re agreeing with what they’re saying. It’s just truly listening in a way that lets them say their emotions.
Even though you have such this desire to say, “Okay, have you tried this? Have you tried that?” I have a huge list of reasons that teens tell me why that doesn’t work and makes it worse. And I’ll give just two right now.
One of the big ones is they feel like you don’t trust that they can come up with solutions. That’s a huge issue that they want autonomy and to feel trusted. In fact, the number one thing when I ask teens over the 10 years of doing this work, what is the one thing you want your parents to know? And they’ll say, “I want them to trust me.” They don’t mean, trust me that I’m not going to cheat and kind of steal more screen time, because five minutes later they tell me about the way they’re sneaking screen time. It’s just like we’re the number one group in their lives, people in their lives, that they need us to believe in them because so often they’re not believing in themselves. I mean, it’s a rocky road growing up, boy. So, that’s one.
Another big one is by not jumping into problem solve, is that it shows them that we know that hard emotions are a part of life. That we’re not trying to just get rid of them. Okay, you have that emotion, but let’s get to here to there. It’s like, yep, that’s hard. And that acceptance is a really wonderful thing. Actually, if you’ve ever tried it, because I’ve had some really hard times in my life. As I’ve learned to, at moments, just accept it and not be fighting. I actually can literally feel the tension and the sadness just decrease a little bit.
It’s similar for teens. So ultimately, to wrap this part up, and I could talk forever about this. Is I went to a scientist, because I was in my research in the film, learned that she had actually done physiologic studies of parents and their teens. When a teen is given a puzzle on a computer that they’re not able to solve, and the parent is told whatever you do, don’t go in and try to solve it. Just watch and see what happens. Time after time the parent steps in and tries to help. And she’s actually measuring the physiology of the teens and the parents at the same time.
The moment that the parents steps into problem solve, basically, literally you can see the parents’ stress level go down, and that of the teen go up. What I’ve learned to do in response, knowing this science is to realize how important it is for them to feel a sense of control. I’ll say to both my teens, if they’re having a hard time and it’s hard for me, I still work on it. I’ll say, “That sounds really hard. I’m curious what solutions you’re thinking of.” Or I’ll say, “Let me know if you want help in trying to problem solve things.” That goes really well.
Annette Stevenson: Because you’re putting that control back on them to say, “Yes, I’d like help.” Or, “No, I would not like help.”
Dr. Delaney Ruston: Exactly.
Annette Stevenson: So hard. And as you mentioned, the parent’s stress level goes up. So that’s like the parent urge, the parent has to fight that urge to step in.
Dr. Delaney Ruston: Exactly. Annette, let me say, because you were actually specifically just saying adults, but I think it’s the same thing for teachers. It’s interesting. This didn’t make it into Screenagers NEXT CHAPTER, but I was, as an outsider, going in and talking to, interviewing and filming a lot of teachers, I would say, “What do you learn in education school about relationships and communications with students?” They would look at me like I was kind of silly to even ask. They go, “No, no, no. We don’t learn anything about that.” I was shocked. Then I thought to myself, well, as a doctor when I was in medical school, how much do we learn about communication techniques in what we’re doing as doing really important interface with families and our patients?
So that was another impetus for doing this documentary. I ended up after my residency in primary care doing a research fellowship. I started doing research on interpersonal communication science, because there are actual specific things we can be teaching people. While I know we talk a lot about kids and teens are losing their communication skills. I often think about the fact that, gosh, I know a lot of people who didn’t grow up with much screen time and they’re not really good communicators.
So I feel like this is really a moment in time that we can really be teaching specific skills more and I would love to see that more and obviously in all realms of education as the adults, physicians, and us parents, all of us can get better. I’m on a constant journey to get more effective in my communication skills with colleagues and family members and all of that. I’m talking about when there’s emotions at stake and relationships.
Annette Stevenson: I’m going to jump ahead a little bit, because we’re talking about screen time of course as part of this. Students and parents are spending more time together as families. We’re isolated right now due to the spread, or the prevention rather, of the spreading of the COVID-19 pandemic. So what symptoms can parents look for that could give them a signal that their children might be experiencing mental health concerns, or maybe anxiety, or issues stemming from maybe the isolation, or maybe from the additional screen time? All of these circumstances that we’re caught up in right now, what are things that parents can really look for?
Dr. Delaney Ruston: Let me put on a clinical hat, just to make it very simple for a moment. For depression, we start out with two main screening questions. If either of these are positive to enough of a degree, and I’ll explain that, then we go into finding out more. I will say the same for anxiety. So for depression, the two main things that we look at is, first we ask, are they’ve been feeling down, depressed or hopeless? It really needs to be on several days of the week. The other thing is little interest or pleasure in doing things. They can have both of those or one of those and they need to have it several days a week that that’s going on. Here’s the interesting thing about depression symptoms though. Is we often say, “Well, if there is a reason for it,” my daughter won’t have graduation and prom, because she’s a senior in high school, or others that had planned for their sports.
I mean, there are so many reasons for disappointment. It’s even with that background, if a teen is having some, or a child, really seems to no longer have interest in anything, or just very little, and seems sad or hopeless for several weeks. The goal is actually to get them support. You as a parent to not just say, “Well, there’s a clear reason.” It’s a great time to be giving them skills and to lower their suffering. Not to have this idea, there’s a reason, you just got to keep suffering.
The other one for anxiety, you asked. Again, two main questions to start with. Are they feeling nervous, anxious, on edge most days, a lot of it? And the second one is, are they not being able to stop or control their worrying? For anxious feelings, usually that’s if it’s going to become a clinical or really a problem.
Usually that person will have already had symptoms before this COVID crisis. But, related to what to do after that. If they are having hard times. There’s a lot of things that we still can do even in isolation. One of the big ones is, is there a way that that kid or teen can feel needed? In Screenagers NEXT CHAPTER, for example, I was able to ask my friend who Tessa babysat for, if she could ask Tessa to babysit more for her. Right now obviously kids and teens can’t play with other little kids. But they could, for example, if the parents said, “You know what, our friends or our cousin, your younger cousins having a hard time with math, can you give them a call on FaceTime and help them?” It’s really healing. That’s just one small example of things that we can be doing to try to help them with hard emotions
I’ll give one other skill, but just to say that, this is the whole point of Screenagers NEXT CHAPTER. Was in the different stories is skills that parents and kids and teens learn through the stories and the science through the film. The website, Screenagers Movie, has all sorts of more tips around anxious, depression, symptoms, stress and really actionable steps. That’s what I really wanted to make happen. I just would say one other one is parents to be talking more about their emotions right now. It seems obvious on one level if you’re already prone to do that as a parent, but I can’t tell you the number of parents that I interviewed for this film who, I’ll give an example. One father, I said, “Do you talk to your three kids at all about your emotional state, what’s going on in your day, and how you get through hard times?”
And he looked up and he said, “Talk about my emotions? You mean other than get mad at them?” And he goes, “I really don’t that much.” And what’s so great is it’s not about bombarding them or flooding them, but it gives them such permission to talk more when we talk about, it was a hard day for this reason, or I’m feeling worried about this, or a little upset or disappointed. The other thing I think is so great, particularly when we talk about whether it’s times now or in the past, what we did, what worked, what didn’t, the different strategies we had. Maybe we went to counseling, maybe we had this great friend that we would ask for help, and that friend was so happy we asked for help. There’re all these ways that we’re seeping into their brains of resiliency skills when we talk about our emotional experiences.
Annette Stevenson: It sounds like some of these are really just an easy thing. Not an easy fix, but it’s an easy thing to kind of think of and implement in some of these instances. Like you mentioned the homework help or giving some sort of purposeful responsibility. So they feel a responsibility to something, and purposeful and feel needed. If it could be as simple as that in some of these instances, that’s very actionable, as you mentioned.
Dr. Delaney Ruston: Once we get out of this crisis, I would say as a parent who’s gone through this for quite a while with my daughter, I can’t say enough how emotionally painful it is as a parent to see your child or a teen go through an emotional hard time. It doesn’t have to be clinical. It can just be, we all know, a break up, whatever they’re going through. It is so much, the number one advice I give to any parent is really doing the work to create a support team. I couldn’t have gotten through Tessa’s in and out depression long journey without about four moms that were going through it. In fact, it wasn’t easy to find them, actually. Doing that work was great, as well as reaching out to friends like I mentioned, one who would, because Tessa couldn’t self-advocate to babysit, because of the depression symptoms. Once she was there, it’s called behavioral activation. Her brain started to enjoy the behavior, but the anticipation just wasn’t there. The dopamine levels are lower. The reward center, we can see it on MRIs is actually less active. So I needed a support team as well as family counseling. You even see that in the film, when I get to go with her a little bit to her counseling. All of these things I really just wanted to demystify in the film and was so happy that the teens themselves are so happy to be in the film, including Tessa, who I wanted to really make sure did she want to be in the film.
I said to her over and over, “Do you really want to be in it?” She finally, she watched the rough cut a few times. She said, “Mom, when I see those other teens talking about all the different things they do, it helps me so much that I really want to make sure that I get to help others. I absolutely want to be in this film.”
Annette Stevenson: That’s courageous and that’s awesome. I kind of wondered about that just in knowing that it’s your daughter.
Dr. Delaney Ruston: Exactly. Right. I mean, in terms of how much autonomy does she have. I said, “Hun, this film has so many stories, so much science, it could absolutely work without you.” And there was a family member who was worried. She lives on the East coast, we’re on the West coast. She’s like, “Delaney, the East coast mental health problems are still much more stigmatized. Are you sure you want to do that?” Now, Tessa goes and does Q&A appearances all over. She loves talking to people. Overall, it’s human nature when we can find purpose to our pain and help other people, that dual thing that comes from being able to talk about our mental struggles is one of the huge reasons I’m just thrilled to be a part of ongoing advocacy for so many people paving the way for years on these topics, of how do we completely normalize that it is normal to have a really hard emotional times for people of all ages. The last thing you want to do is make them feel like they can’t talk about it.
Annette Stevenson: A couple things, I want to ask if there’s additional resources that you might suggest for parents, students and children even? Also the school leadership audience? Is there additional resources? Secondly, your film as a resource. Where can our listeners find out more about your film and find a way to view it?
Dr. Delaney Ruston: Yeah, absolutely. As I mentioned at the top of the hour is I have been really focused on the science of communication. How do we engage young people? Because I was finding that I wasn’t doing such a great job with my kids. I was doing a really kind of a scare tactic around screen time issues. I realized I really wanted to do a share tactic. I really wanted to have calm conversations. So I created something, Tech Talk Tuesdays with my family. For over four years I’ve been writing a weekly article that looks at all sorts of topics we’ve been discussing around sleep, screen time, depression, anxiousness, stress, all these things. So first and foremost is at the Screenagers Movie website, has both films. If you go to Tech Talk Tuesday and just put it in any topic, there are literally hundreds of things that I’ve written. As well as a resource page that has all sorts of actionables around these topics on the website.
In terms of seeing Screenagers or Screenagers NEXT CHAPTER, in making the films, what I found was that we are in this technology revolution that is so intense and growing rapidly. The intensity by which it pulls our young people to want to be on screens. So many wonderful reasons and some risks. We can’t just say, “They just need to learn by themselves.” They need us. I realized we need each other in this. Just to be a parent alone or just to be a teacher alone. No, we really needed to come together as adults and kids and students and everyone together. So for this reason now, for both films, it’s been community screenings with parents and kids and teachers.
Now with COVID, what we’ve been doing is there’s online community events happening. People can organize them. Schools are organizing them, we’ve had dozens, and that’s been great with moderated discussion afterwards with the schools, counselors, teens and others. Also there’s individual event screening options as well. So all of that is that screenagersmovie.com.
Annette Stevenson: That sounds fantastic. For this particular time we’re in, completely doable.
Dr. Delaney Ruston: Yes.
Annette Stevenson: Be able to screen it online, so that’s awesome. Well, I sure want to thank you for joining us today. I’m sure there is so much more that we could go on about. We’ve scratched the surface here, but I think just to continue talking and learning and knowing more about this subject is just hugely important. So, I appreciate you joining us.
Dr. Delaney Ruston: It’s been wonderful. Thank you so much.