So today we're going to talk about digital wellness in a social media world and navigating information and misinformation in mental health. And I'm Darlene King. I am the current chair of the APA Mental Health IT Committee. I'm an assistant professor at the University of Texas Southwestern in Dallas, Texas. I also am a behavioral health physician informaticist at Parkland Health Hospital System. And I mostly do outpatient work in our Parkland clinic. You want? Oh, maybe one. My name is Dr. Ashvin Sood. I am a child and adolescent psychiatrist who practices primarily outpatient in the telepsychiatry position, practices in New York, DC, and primarily in Wisconsin. I'm also a content creator on TikTok as well as an external consultant for TikTok and do primarily outpatient work. Good morning, everyone. I'm also deeply impressed by the depth of attendance this morning on the last day. So congrats on being here. I'm Howard Liu. I'm a child psychiatrist as well in a couple roles here at the APA. I'm chair of the Council on Communications. And then I'm also chair of psychiatry at University of Nebraska Medical Center. My preferred platform is actually a Twitter. Not TikTok, sorry. And just enjoy being here and look forward to chatting today. Thanks. Good morning. My name's Nicole Benson. I'm also a child psychiatrist. Here at the APA, I'm on the Council for Quality and also on Darlene's committee, the Mental Health IT Committee. At home, I'm the associate chief medical information officer at McLean Hospital. And I direct digital for psychiatry or I'm the medical director for digital for psychiatry across Mass General Brigham. Thanks so much for coming. Wonderful. Thank you so much. All right. And then these are our disclosures that we have. I'll leave these up for a second so you can read. And so today, I want to give you guys an overview of the talk that we're going to share with you today. So first, we're going to dive into exploring children's use and misuse of social media. And we're mostly going to be focusing on children in this talk. Part two, we're going to go into beneficial social media use, taking action, minimizing harm, and harnessing the benefits of social media. And then for part three, we're going to have a discussion activity followed by some question and answer and have it be a bit more interactive. So I thought I would start off by thinking about what was life like before the invention of Facebook? Like what are some things that I had to do when Facebook didn't exist? I think I had to talk to a friend in person. I had to use the phone to call someone. I had to actually hang out with someone in person to really get to know them. If I took any photos, I would show them my photo book or scrapbook and have to be there. I couldn't just scroll through pages of photos instantly. I remember sending physical letters to my grandma, chatting on AOL Instant Messenger. That was real fun and throwback. I think I had an embarrassing username, like Lime2222 or something. And then pass notes in class. I get in trouble for that sometimes. And then I'd had to sit idly with nothing to do at some points. And so I had to think about what was life like before Facebook was invented in 2004. And it became the most visited site in the world by 2008. Instagram came out in 2010. And taking photos of one's meal before eating it increased by like 10 billion percent. And then whatever happened to MySpace? So what exactly are social media? And this definition can vary depending on which source you cite. But for the purposes of our presentation, we'll be using the definition that's cited in the Surgeon General's Social Media and Youth Mental Health Advisory. And they say it includes internet-based channels that allow users to opportunistically interact and selectively self-present, either in real time or asynchronously, with both broad and narrow audiences who derive value from user-generated content and the perception of interaction with others. And I thought I would show the popularity of some top social media sites. And the middle column are monthly active users, which I'm not an expert on this. But I think it's the people who actively engage with the platform by posting, commenting, liking, or sharing. And then the organic traffic are those that come from a search engine. And they're the ones that are just kind of scrolling through and spying on everybody. And then what happened in 2007? Things changed with the invention of the first Apple iPhone came out onto the scene. And smartphones really changed a lot, because you can see the rate of uptake of the smartphone, the speed of adoption of this technology, was faster than a lot of other technologies that have come to be, as well as the uptake of social media. And Dr. Benson raised a really good question about this graph, saying, does every home now have a radio? We don't know the answer to that, but this graph thinks everyone has a radio. But with the smartphone, it allowed instant access to information, instant access to Facebook and scrolling and Instagram that before you had to get on your computer, go to your web browser. But now it was like right at hand, easy to use. And so especially social media apps have had many profound effects on our lives. And as time has gone on, more information has become known about the effects of social media use on our mental health. And so today, we are going to dive more into that, especially focusing on youth and adolescent use of social media and the ways you can help your patients utilize technology beneficially and how to minimize its harm. All right, I'll hand it off to Dr. Benson. Thank you. Thank you. OK, so I'm going to start just by talking about some background in children and adolescents. So we're going to start with an overview of social media use in children and adolescents and then get to some of the reasons to be cautious in this realm. So first, Dr. King touched on this a little bit about smartphones now being everywhere. And I want to start by noting that depending on age, the majority of children, basically around 11 or 12, have access to smartphones. But even as we look towards younger kids, more and more have access to smartphones. So the idea of how screens and social media are used is really relevant across childhood and adolescence. And we can see that the vast majority of teens, probably not surprisingly, report using a social media platform, with about a third saying they're using it constantly. And this is not just limited to teens. Even 8 to 12-year-olds are using social media with around 40% reporting use, which I find to be very high. You can also see in the figure on the left that children really are using screens for entertainment purposes a lot. And even in the last two-year interval on the graph, this is increasing by about 17%. So when we think about social media and entertainment sites, teens report that almost all have used YouTube. This is the most frequent site that teens report as not being able to live without. And you can see in the figure on the right what platforms are increasing in usage, so like Instagram, Snapchat, and what platforms are really falling behind. And here we see it's Facebook, which Dr. King said was the most visited site in 2008, falling down for kids, and Twitter. It's also interesting to note that about 40% of Gen Z members, so that's people born between 1997 and 2012, use TikTok and prefer TikTok for online searching. So a lot of people are getting answers to questions, getting their news, and other things in addition to just entertainment on these platforms. But lately, many have expressed concerns about how social media is impacting children and adolescents. And as you may have seen, in 2023, the US Surgeon General issued an advisory on social media and youth mental health. And while in the advisory, they recognized that there are certainly benefits for social media use in youth, they highlighted that there are clear indicators that social media can have a profound risk of harm to children and adolescents. And it's true. There are studies showing that adolescent social media use is predictive of subsequent decrease in life satisfaction for girls aged 11 to 13 and boys 14 to 15. And longitudinal studies suggest that adolescents aged 12 to 15 who spend more than three hours on social media face double the risk of experiencing poor mental health outcomes. And some of the specific areas for concern around social media use are body image concerns and eating disorders with social comparison as a potentially contributing factor. So I think that the concerns about the impact on mental health are just one of the reasons to be cautious about children using social media. We're going to go through some of the other issues. Major concern when using social media is the concept of privacy. And I sort of think about this in a few ways. The first is the privacy with respect to the platform and what it's doing. And second is privacy with respect to the child or parents and what they may be sharing. So when we think about platform privacy, there's a law called COPPA, or Children's Online Privacy Protection Rule. And I think a panelist is going to go into this more detail. But it basically says that for platforms who are directed at children under 13, the platform has to obtain parental permission before collecting or sharing information about these kids. And one way that apps have gotten away with this is to just prohibit anyone under 13 from creating accounts. And we'll talk about the logistics about that in a minute. But with respect to the users themselves, kids also should know about privacy and safety. And without meaning to, they can share more online than they should. So many kids post photos of themselves or use their real names and profiles. They could reveal things like birth dates, interests, their school name, the town where they live. And sharing this can really make them an easy target for online predators and others who might mean harm. And in fact, many kids actually say that they've been contacted online by someone they didn't know in a way that made them feel scared or uncomfortable. There's also the platform that can automatically reveal a user's location and tell anyone where to find that person, which is a whole different problem. And I think also parents. It's also true when parents post about their kids. And we'll get into that soon. So in our last slide, we started talking about how platforms can protect children, either to comply with laws or to restrict kids from getting access to harmful content. And one way to restrict kids from getting access to harmful content is to identify minors who are using social media platforms. We could do this in several ways. For example, asking someone who's signing up whether they're a minor. And while many sites do ask for a birth date or ask the user to attest they're older than 13, we can probably all imagine how well that actually works. Another way is to implement an age verification process. So this could prompt a requirement for parental consent as well. And actually, in general, teens and adults both support these types of measures, with adults supporting them to a higher degree, which probably is not surprising. And so you can see in the figure that about 81% of adults versus just under half of teens support requiring parental consent. And 71% of adults and about 56% of teens think that age verification should be required. And there have actually been several states that have passed laws requiring parental consent and age verifications in order to allow a minor to access social media accounts. There is also a flip side of this age verification process where some have expressed concerns that the process for age verification may not preserve user privacy. And so some use third party age verification And this is sort of a little bit outside the scope of our talk today, but when we're thinking about apps specifically designed for mental health purposes, not just social media, the privacy issues can be even more concerning. Because we've seen concerns that apps that suggest they're protecting privacy, particularly around your health data, may still have vulnerabilities and there are a bunch of issues that can be raised about privacy. And so we're thinking about apps that are specifically designed for mental health purposes, may still have vulnerabilities, and there are a bunch of examples of this, a few are up here. But when we think about user privacy, one prominent area of concern is not even about children themselves using social media, but rather this idea of sharenting, which is basically when parents use social media to share content or pictures about their children with or without the child's consent. And it's complicated because a sizable proportion, almost one third, of pre-teens report wanting to be an influencer. And this could actually be a really good way to get started. That being said, there have been a lot of concerns about this practice, suggesting that children can be exploited. And it's been estimated that within the next five, 10 years, sharenting could play a role in 2 thirds of identity fraud cases facing this younger generation. And I think increasingly, there's also a recognition from young adults who experience this as a child that they feel their privacy was violated with so much posting by their parents. And in the last few years, some states have started thinking through how to protect these individuals as they come into adulthood. For example, mandating that kids can request that content be taken down after a certain age. This is definitely an evolving area. And then there's the related idea of kidfluencers, or actually children whose social media presence is followed and monetized. Kids can make a lot of money through social media. And one example is Jojo Siwa here. And there's really very little regulation or even child labor laws around this. There are some regulations in other countries that limit how much time a child can spend on social media content generating content, but not much in the US, though this may change. And one example in the US is a child labor law passed in Illinois that's designed to protect kids featured in online content, and basically mandates that earnings have to be shared with children if they're featured significantly in the content. And I mention this because it's just one rather unique example of how children can get into trouble when using apps or the internet. All right, we also know that young people use social media as a resource. We talked about 40% of Gen Z members prefer TikTok for online searches. And in fact, on TikTok alone, the hashtag mental health has been searched more than 67 billion times. And there can actually be a lot of benefits to finding people on these platforms who talk about mental health, can provide support and reduce stigma. But it also means that teens and children and adolescents are increasingly using social media to self-diagnose, with more than half saying that they've used it this way. This becomes a little bit problematic because the information might not be accurate and the users may not know. And there have been some studies looking at this. So one study looked at popular TikTok videos about ADHD and found that more than half were misleading. Another looked at 500 videos with mental health related hashtags and found 84% of them had misleading advice or even inaccurate and potentially damaging information. So while there's not a lot of information out there, or while there is a lot of information out there, it can be really hard to know what's true or not. And so some of this is helping children and adolescents, and even adults, try to find the reliable and accurate sources. This is just a review of some of the terms we've talked about. And that's it for me. Thanks so much for your time today. I'm looking forward to the discussion. Thank you. Now that Dr. Benz has told you all about the risks, I'm gonna go into the lion's den and say there are some benefits for kids, and I'm not just a child psychiatrist, I'm also a dad of four, and my kids are currently in high school, middle school, and elementary school, so I have some real world experience of what it's like, parenting, and just thinking about things from a pros and cons perspective. I will say that all these things are really valid, all these areas, but I guess the premise I want us to think about is just, first I need to figure out, arrows, okay, let's do a quick poll here, so thinking about just who's in the room. Raise your hand if you have a kid or teen in your life outside of work, raise your hand. All right, so roughly two thirds of us. Those of you that have a kid or are involved with a kid in some way, aunt, uncle, adopted family, whatever it is, have you allowed that person to go to camp or a sleepover? Raise your hand. A few brave souls, okay. Those of you that may be traveling, going to see relatives, those kind of things, have you allowed your child less than 18 years old to fly alone? Raise your hand. All right, a couple of you. And then how many of you have taught a teenager how to drive? Anybody here? So, all right. So, all those things involve some inherent risk, right? And I'm currently in the throes of teaching my teens how to drive, and it's an interesting experience, but also profound in some ways, because it can be very dangerous, right? And you try to choose less populated times when you're out there on the road for the general public's good as well. But at the same time, there's some benefits, right? Largely, that they'll be independent. We don't have to ferry them around everywhere, but also just for their own self-actualization, right? So they can feel confident, they can feel some agency, they can choose where to go, make some mistakes on their own, come back, lay it for curfew, all these different things that are part of the rite of passage for just growing up, right? And we've all been through it. So, as you look at all these things for driving, we know there's a risk-reward. And then, even though our kids by no means are a carbon copy of ourselves, they do take a lot of their cues, not just during your explicit, I'm gonna teach you to driving era, but throughout your life, ferrying them around by how you drive, right? By what you do when somebody cuts you off, right? How patient you are when you roll up to a stop sign and there's nobody there on Sunday, you know, do you, you know, keep going or not, you know? And all these things, they kind of drink in. And the annoying thing is, once they read the driver's manual, then they start pointing out the things that you are not doing according to the law, right? And so, it's kind of this interesting, you know, definitely bi-directional process as you're teaching them independence. And I would say it's very similar as you think about this with social media, but only if we are on the road as well, right? And so, this is kind of the challenge because oftentimes, they're on way more, they're on different apps as we heard from Dr. Benson, right? So, there might be on TikTok, I'm still stuck on Twitter, you know, plodding along. So, you know, it's a little bit different. We did see that piece, right? They are on different platforms and they will continue to do so. And in fact, the big tech companies are not looking at, where are the professors, you know, for social media? They're looking at where are the tweens, right? And the tweens keep changing. And even the millennials, you know, who were the vanguard are now no longer so, right? Gen Z and Gen Alpha and so on, and they wanna see that's where the revenue is gonna be. And now really the currency is time eyeballs, right? Three plus more hours, those kinds of things, continuous scrolling on TikTok, all these different things. That's really where people are. So, I'm gonna make a case that there are some possible benefits, not for every child or teen, and definitely there are teens and children that have more vulnerabilities, right? But there are some possible benefits. And I've experienced this among my own kids and I've seen this among my patients as well, and just folks that I mentor. And I think there are some pros and cons, but just like driving, it helps if we're there alongside them, right? And in a humble way as well, willing to recognize and we also mess up. So I'm just gonna go through these. So connection is the first one. And I have difficulty remembering things so I just grouped them into these five Cs. So, you know, who are you following? And that's a really interesting thing. And if you wanna go without judgment alongside the teen or child in your life who happens to be on social media, or just online, ask them that question, right? And in my child interviews, when I do an intakes, I try to ask a little bit of a media biopsy as well. You know, tell me what you like to watch or are you on social media? What platform do you, you know, who do you follow, right? And it's quite interesting, right? Because, you know, they might be following someone that you had no idea they had an interest in. It might be peripherally related to some TV show or something on Netflix or something they're seeing or it might be something entirely different. If they have a passion area, you know, it could be their musical or the athletic or whatever it is, they're often looking for role models, right, and they might not be the ones that you chose, but, you know, and they're just trying to follow them in a different way, right? Just as we did growing up, but maybe less synchronously, but at this time, they can see things almost all the time from their favorite influencers, right? So, it's an interesting piece to see who they follow and I've seen my teens as they've grown up follow different people, most of whom I did not prompt them to follow and it's just interesting and we talk about it at dinner. Curiosity, I think, is another piece that can be whetted by social media and I am a foodie and so I guess that is one thing that I have successfully transmitted to my kids, but they follow a lot of different food people, mostly my daughter, and she's learned a number of skills that I definitely did not teach her, but this is just one where she, you know, made some tabbouleh and, you know, we never sat down to go through a cookbook or those kind of things, but she watched enough YouTube, you know, like the perennially on YouTube and saw it and she learned many things on there and, you know, and I've actually learned, I've tried to learn from TikTok, I'm kind of a late adapter, but I mostly scroll through food videos there and I'm kind of learning to do some Sichuanese Chinese cooking on there and those kind of things and there are some actual skills you can learn on these platforms, but it's helpful to kind of learn side by side, but it's surprising sometimes what they can learn and pick up and then learn and if you need to fix something in your house, as you know, it's very helpful. Collaboration is tricky, right? And, you know, we heard that from Dr. Benson that, of course, you don't want people preying on your kids, you don't know who they're contacting, some of these multiplayer video games, you don't know who their friends are, right? What country they're in, all these different things, so you can also do it asynchronously and so, you know, I do have a elementary school child and we try to also side by side play video games on his Nintendo Switch and so, you know, like one example is you can just kind of follow along these guides, right? Which used to be in magazines back when I was a kid, but Nintendo Power and those kind of things, but now, there are all these extensive guides that walk you through these games and I'm not very good at solving these Zelda riddles, I'm just gonna tell you that. So, whenever he gets stuck, I'll try it for a bit, but then I'll look for these guides, you know, and they save you time, they keep you going and it kind of helps the momentum and I think for any skill that you're learning, if you're curating, particularly for that school age child, it's helpful for you to kind of do that piece with them and it does not have to be synchronous, you don't need to expose them to other people, but just, you know, kind of side by side learning along with them and I think that is helpful to kind of give them just some additional sense of mastery while they're struggling at times rather than abandoning some of these quests. The other piece that's really important and just good for mental health is depending on where you live, it's a really difficult time out there, right? So, and we know that all the time, there's things in the news that are disturbing for us as adults and definitely hard for teens and for kids to see and hear about and sometimes they wanna reach out, right? And all sorts of coming of age, coming out, all sorts of things that they're experiencing, you need a community and, you know, I've practiced in different states, Michigan, Massachusetts, now in Nebraska and I'll tell you, there's different communities, right? Easily accessible in your local school district, but online, sometimes you can find other communities that, you know, you really feel connected to and so that can be really important for some kids and teens to really feel seen and heard, especially if they have conflict with their parents, right? And they don't feel like they share the same values or some of these challenges. So, I think that is something as well, just finding that sense of connection and being seen and heard. The last thing I'll say is just that, you know, it is important just to think about communication as well, right, and even though I would say that there's a different pattern of communication on each social media platform, it's probably not what you want them to spit out in their eighth grade English essay. At the same time, they are learning how to communicate, sometimes how to stand up for themselves, you know, just, you know, what is some of that flow back and forth and it is interesting and I think that, you know, in general, we're seeing that some of this is translating as people are using AI and chat GPT to write their essays as well, but, you know, just a different style of communication and it's interesting just for them to see that from other people, particularly people they admire as well. I saw this recent example, I'll just put out there, that was one of the top 10 conversations on Twitter ever, which was this back and forth between this environmental activist, right, Greta Thunberg and someone that was trolling her about consuming a lot of, you know, cars and other things and so they went this back and forth, you know, kind of tit for tat piece and, you know, he's trolling her and then she responded, you know, and then this response actually became one of the top 10 tweets of all time and it kind of went back and forth so you can kind of see and there are a couple more discussions, but, you know, the moral of the story is that you really don't want to mess with these teenagers online because he ended up in jail and she ended up with two of the top 10 tweets ever, but you really can learn some of this back and forth and just kind of standing up for yourself, right, when people are trolling you, bullying you, that kind of thing, it is interesting to see that as well. So, you know, a next poll piece I'll just ask here, just thinking about skills and benefits, have you ever here asked a child or teen the meaning of a slang term you saw on social media did not understand, raise your hand if that has happened, all right, just about everybody, right, so we were in a session yesterday and the term Doolooloo was trending on social media, that kind of thing, what does it mean? A lot of people still didn't know, right, because those kind of, the language is being defined on these platforms and then filtering out in the Oxford English Dictionary. How about seeing your child or teen exhibit a new skill which they learned on YouTube, has anyone done that? Yes, so, you know, it happens and it's interesting, sometimes surprising, right? The next thing, how about learn about a useful new app from a child or teen because they heard about it on social media, does that happen in the back, yes? Happens to me frequently, they give me unprompted suggestions, and then the last is if you are on social media, received unsolicited feedback from a child or teen on how to improve your social media game and they were right, has that ever happened to you? It's happened to me and they are merciless, let me tell you, so, but it is important because they are, you know, native to these platforms, right, they really are on it a lot, they consume a lot of content, so they're very fine filters for what will go and, you know, kind of what the nuances are, so it is helpful to think about those things. So, you know, we're gonna move towards a case and, you know, I would say that very few parents and I would say a few child psychiatrists really feel super comfortable with social media, right? It's kind of something where, you know, okay, you know, what we'll talk about a little bit, I'm not sure I'm a master of this domain, you know, but tell me what your interests are and, you know, I'll try to come along, but there are some tools that we can give out to our, you know, parents out there, if you are working with them or if you are a parent or your aunt or uncle or something like that, a foster parent, so the AAP, American Head of Pediatrics, does have a formal family media plan and so if you are someone that likes to really have an organized, you know, kind of flowchart of different things, you can go to that site and find some resources there and just talk through it, it's kind of like a social contract about what you do want to use, that kind of thing. So that's one resource, if you're kind of a formal kind of person and organized, I must admit that that is not me. I did learn, and I think we share a family therapy professor, Dr. Ann Fischel, over at Mass General, who really emphasized the importance of family meals, right, and there's a lot of data suggesting that that is, in fact, where a lot of these discussions can happen and it doesn't have to be dinner, it can be whenever, but just trying to have that at least once a week, I think that's probably the best venue, at least in my family, because it's free-flowing and something happens or whatever, you know, and that's where I bring up, oh, did you read that thing about these people getting scammed, you know, there's a lot of teenage boys right now that are getting scammed, to send in a nude picture, that kind of thing, and then being extorted, right, to such an extent that the FBI's put out warnings, that kind of thing. So I like to casually bring those stories to dinner and say, you know, what do you think about that, you know, and they roll their eyes, but, you know, at least I try to make sure they're aware of it and we have a little back and forth, but, you know, so there's, and there's pros and cons, right, and then, you know, if they're proud of something and they post it on there, then, you know, they tell me about it as well, but I think that's a good free-flowing place to have that discussion. The third piece, which I think is probably the best, too, is just being on it, you know, I mostly, I did a mothball my Facebook page because I found it too difficult to really have a barrier between work and life, and then I mostly just use X, which is Twitter, professionally, and then LinkedIn, which is even drier than Twitter, and so those two things I use to try to show that, you know, I use it often, but, you know, I try to just keep it within certain bounds, and then the sharenting discussion is important because I have these kids, and so I try not to use their names or, you know, and I don't put their pictures on, that kind of thing. I have a lot of colleagues that are frequently on social media that do the opposite, right, and so, you know, everyone's got their own rules and boundaries, but, you know, you can always decide, it's always easier to kind of put more rules in, but you can't take things back, right, so that's the kind of the myth is that, oh, you know, just delete it, but people can snapshot anything, right, and or record any video, and things kind of have a life of their own, so just, you know, I think less is more, right, but just still get out there because it's important, there is some data shown just about the amount of misinformation that's on the newer social media platforms where most of the kids live, right, so we need to have child psychiatrists that are consulting with TikTok. We need to have, you know, a psychiatrist that are on Instagram, right, are on the places where the teenagers are because that's where they're getting the information. They are not, by and large, always going to our, you know, Facts for Families and other pages that we put out professionally because they just, you know, that's not where they float and hang out, right, so just thinking about getting it to the people. So, you know, I do have, these are my fast rules, just about thinking about before I post, I always think about my patients seeing every post because oftentimes they are following, if you are on, if you are working for institutions and as a PR professional, they might see that as well, and then your peers, which are everybody in this room as well. For youth, you know, I just translate that a little bit, thinking about the principal, you know, what would your principal think if they saw this post out of context or this TikTok, whatever it is, Instagram posts, and then, you know, your parents as well, and your peers, and that's the same kind of thing, but oftentimes they don't pause before they post. So, you know, again, there are some benefits if you think about it, but you have to be careful, and definitely not for everybody, and different kids and teens have different risk profiles as well, and so you just have to roll with it, right, so it does not have to be synchronous, it could be asynchronous, but they can demonstrate some new skills that can sometimes surprise you, and also, you know, change how you practice as well. So what we're gonna do here is that we have a remarkably robust attendance, and what I'm gonna ask you to do is do a little pairing, talking, introducing yourself to the person next to you. I'm gonna read this scenario, and we'll give you five minutes just to talk through with your colleague that you're sitting next to, and then we'll get back to the next segment. So here's the segment. So, a live streaming event. Your teenage daughter is a freshman in high school. She's inspired by celebrity influencers who tell their mental health stories online, and she starts a wellness club at school. This club is planning a live streaming event, which means it goes out in real time, right, not edited later, that kind of thing, for high school students in May. For Mental Health Awareness Month, your daughter explains that her classmates will tell their own unscripted stories about depression, anxiety, self-injurious behavior, et cetera, to address stigma. You hear about this event at dinner just before you head to the APA meeting. How should you advise her? So take a minute, introduce yourself to your neighbor, talk for a couple minutes, and then if a couple of you wanna share, we can do so. So go ahead and talk, and then we'll bring you back in. Okay, we're gonna bring you back, and thank you for the robust discussion. I think there's a mic here. Does anyone wanna share any insights that you have from your group? And you don't have to, please, if you do, come up and just introduce yourself and share your insights as to how should you advise this teenage daughter about this live streaming event. Well, I don't have any kids, but. Please introduce yourself. My name is David, and I'm the director of the APA. I don't have any kids, but. Please introduce yourself. My name is Matt Majeski. I work in New York City at Mount Sinai. And I think what I would tell my daughter is sounds like a great idea, but just remember there are two sides, sometimes three sides to every story. And so what you're hearing just from the patient may not be entirely the entire picture because there's the perspective of parents and relatives, loved ones, and the clinicians that are taking care of the patient. Yeah, that's great. Well done. A round of applause. Thank you. So all these different dimensions for each story. Well said. Please introduce yourself. I'm Dr. Varma Pinnamacha. I'm a forensic psychiatrist from Oregon State Hospital. Great. So I have the forensic lens to this thing. Yes. We need that. Tell me what platform are you referring to for this thing? We deliberately left it blank, but say it's Instagram, Instagram Live. Okay, I mean, that's better. Well, I mean, okay. I post on Instagram. So I'm not gonna say it's better just because I do it. I have a narcissistic need to post stuff. You know, I have to figure that out eventually in therapy. But the reason I asked platform, it was currently in, as you know, as of yesterday, 20 hours ago, ByteDance, the owner of TikTok, sued US government with the freedom of speech argument. I mean, there's a whole thing about platform, right? You know, whether there is some kind of immunity for individuals with platform. That's, I think at some point we'll get to Supreme Court. We'll see what happens to that. I'm worried. The reason I asked platform. Yeah. I'll get to the point. Yes. Is no one, you guys know there's no TikTok in China. Right? Yeah. That's doing, right? Do you know how the algorithm is different? So, okay. I'll tell you. New York Times, look up an article on April 25th. There's always this like talk in people that the algorithms are different in US and all. I wanted to look for evidence. New York Times is reputable. I just walked by their office. I subscribed to them. So, I think they're reputable. They talked about doing and TikTok. What they said was doing in China caters mostly to older people. If you look at the demographic, it's not kids. Interesting. So, different focus group, what you're saying? Right. Yeah. And you know how much they make in China? 55 billion. 80% of the renew. Interesting. In US, they make 20% of the revenue. And I'll get to the point. There's a math to this talk. They make 20% of the revenue. It caters mostly to kids. Who has control of the algorithm that dictates what is the next video that you see? By dance. Mm-hmm. Right? I'm not gonna get too political. I mean, I'll leave the bigger political thing here. But when you post a video, right? Let's say you're a doctor. I mean, I'll see your video in TikTok, wherever you post it, right? But when you don't have the control of the algorithm and people trust you as a doctor from a university, the next video that comes is run by an algorithm that is driven by profit. Mm-hmm. So you're asking what's the ulterior motive for what's coming through, right? Well, I know the ulterior motive of the company, capitalism. They're trying to earn money. Good for them. I mean, they should do it. We gotta keep going here, but. As doctors who are posting, as individuals who are posting, I think we have some responsibility to, you know, why that we are using a platform that is harmful to kids. This is not, that's why I asked which platform. Sure, sure. Thank you for the question. Appreciate that. And, you know, I'd say that we are gonna have actually a TikTok expert here come up next. So I think it's timely. And did you wanna make a comment as well, this gentleman here? And please introduce yourself. My name is Wayne. I'm a psychiatrist in Cambridge. We were concerned that these kids who share their stories might be subjected to bullying. Also concerned that later in their lives it might be a disadvantage to, like, if they seek employment and other situations like that, of all that situations out there. That's great. All that information's out there. Yeah, so the thought is the long and perhaps eternal shelf life of things that were made in a moment when you're not fully, you know, maybe thinking like an adult, right? And sometimes it's the same dilemma for medical students applying to residency about self-disclosure, about their own mental health journeys, right? And they have the same challenge. I'm a former clerkship director, so we have this discussion often. And what I say to them is the same informed consent. Just know it can be taken out of context and might live on beyond this cycle, right? So just think about that for licensure and all those pieces. So really thoughtful to think ahead, right? And sometimes in an unscripted live event, you don't really know what anyone's going to be saying, how explicit, what kind of names to be named, those kind of things. There's also nowhere here that this was signed off on by the school administration, right? So is it a school activity? Is it not? Where is it filmed? All these different nuances, but very thoughtful, you know, thinking about the guidelines. Thank you. I think we're gonna move on, but round of applause. Thank you very much for the robust discussion. And I'm gonna turn it over to my colleague, Dr. Ashwin Suh, to talk about taking action. Well, let's get political. Just kidding. Thank you so much. Wonderful talks this morning. Today, for my portion, we're gonna talk about the lawsuits and the political landscape of meta and TikTok. It changes a lot. So thank you for teaching me that 20 hours ago that the actual, I have a toddler, so I was not on TikTok or anything. So it's good to know that ByteDance is now suing, but we're gonna talk a little bit about that legal landscape. We're gonna talk about social media legislation in general, and we're gonna talk about what we can do as clinicians, because I presume none of us are in Congress, and if you are, welcome, to minimize the harm and harness the benefits of social media. So, you know, as we learned from our earlier speakers today, social media has been more scrutinized as of late by both clinicians and researchers. We also need to examine the legal landscape as well. And in order to understand this, we need to have a timeline of events, starting with COPPA. Raise your hand. Did you know what COPPA was before you came today? Great, fantastic. This is a great place, because I didn't either before I made this presentation. So this was a great research project for me. So it was created in 1998 by the FTC, also known as the Federal Trade Commission, and COPPA, or the Children's Online Privacy Protection Act, was built to protect children by making websites give notice to parents that their children are using these websites and that parents need to give parental consent before children's data can be collected, shared, or disclosed, and that data includes full names, home addresses, email addresses, et cetera, et cetera, phone numbers. So that's 1998. And if we have that nugget in mind, let's then look at the evolution of social media. You see, everything starts taking off in 2004, when Facebook is created following MySpace, and then followed shortly comes YouTube, which is now the most, right, commonly visited site by teens, as we've seen earlier, in 2005, then Twitter, which is now known as X, comes into creation in 2006. Instagram comes apart in 2010, Snapchat in 2011, and then TikTok here in 2016, 17. So there is this massive evolution, and we've seen the numbers of how many people are using these social media applications. This takes us to our middle picture, which is Frances Hogwan. Does anybody know who Frances is? Frances is a product manager who worked at Meta. And in 2021, she became well-known globally for becoming the whistleblower at Instagram's internal research programs. She noted how adolescent teens were feeling terrible, particularly adolescent females, about their appearance on Instagram. And yet Instagram, who is owned by now Meta, were doing little to act on this data, and they were collecting this data from kids under the age of 13. And there was the main reason of why they might have not been acting was because they were losing the young user market. So young users drove significant revenue to the platform. In response to this intense scrutiny, as well as kind of all of this research that was starting to be found, ultimately we get the Surgeon General's wording regarding social media, particularly in the context of COVID-19. And in the fall of 2023, 41 states, as well as the District of Columbia, filed both individual and joint lawsuits, the largest coming from California and co-sponsored by 33 state attorney generals, claiming that Meta violated the Federal Children's Online Privacy Protection Act, COPPA, that we talked about earlier, and the State Consumer Protection Law by making Meta and its subsidiary company, Instagram, addictive to young populations and lying about how they would harm children's mental health. The lawsuits in general allege that Meta knew it had users under the age of 13 and did not pursue appropriate age verification or parental consent requirements per COPPA for their users and collected data on these populations without their consent. So this is where the majority of the arguments lie. We all must have been seeing on C-SPAN all these social media CEOs and executives speaking in front of Congress and talking about what's going on. So obviously, we can't talk about any of this without this whole kind of journey. I always get this question at conferences, in clinic, when I'm walking down the side of the road, is TikTok gonna get banned, right? What's happening here? And so let me give you a very sky-high view of this, which majority of which is being directed under the fear of foreign adversary influence, right? This is a, and it's important to kind of go back to the origin of this. So right, TikTok 2016, 2017, it's expanding globally, it comes to the US. So from 2016 to 2019, the FBI highlight the dangers of TikTok and foreign influence from China, claiming that TikTok's owner, ByteDance, is heavily influenced by the Chinese Communist Party or the CCP. And the CCP will have access to America's data, which is a national security risk. So in the 2020 to 2022, the Trump administration attempts to force a sale, trying to get TikTok to be bought by Microsoft. This falls through because this is a massive, you know, antitrust violation, right? Ultimately, a deal is made to have Oracle. Oracle is an American cloud infrastructure program that will shuttle all of TikTok's data through it. And this is known as Project Texas, meaning Oracle is basically headquartered in Texas. And so only it will prevent ByteDance to have access to the information. This is a one and a half billion dollar project that goes into effect. However, in 2023 of February, the Biden administration bans TikTok on federal devices. And then we get to March, 2023, where we see this guy a lot, who is not from China, that he says that he's from Singapore over and over again. There's almost a meme about this, because he's like, I'm from Singapore. And we watch him and his name, he's a TikTok CEO, Zhao Xichu. And so we see him starting to come up and we see him again in 2024, again with Mark Zuckerberg and the owners of Instagram and Snapchat and everything like that. And then in May of 2023, Montana becomes the first state to attempt a full ban on TikTok, but the legislation is shot down in end of 2023, and other states tried to lead banning as well. And then we get to this year, March of 2024, the House of Representatives pass a bipartisan bill that demands a ByteDance, the owner, to divest its TikTok ownership within six months of the bill being passed. This is where we start to hear everyone on social media talk about the banning of TikTok. It's actually gonna pass. What's gonna happen? What's gonna happen? And then now, just recently, I didn't even edit this slide, but I can tell you the Senate just passed this bill about two, three weeks ago on a Saturday where in a massive kind of bill of sending arms to Ukraine, sending military support to Israel, they added the TikTok ban in there too as well. And so that extended ByteDance time to sell to nine months instead of six. So now it's passed, right? And now we're in the process of who's gonna own TikTok, right? They have to sell it to somebody. It will be private equity. It's valued over billions of dollars. Who can actually buy that? The other aspect is besides ownership, right? Is it gonna be fought in the courts? That was the biggest concern. And as you just heard from one of our audience members, 20 hours ago, ByteDance just sued the US government for free speech, right? So people ask all the time, is it gonna be banned? I don't know. But I think it's gotten to the point where we're gonna get into this legislative long process. I don't think it's going to be banned this year, but I could be wrong, but I think it's gonna be very drawn out. It is a huge revenue driver too. And I say all of this because TikTok and Snapchat, as I was talking about in the slide before, had been hit with several lawsuits as well, much like Meta from states like here in New York and Iowa, as well as Canada, where prosecutors highlight children's mental health as a main concern and privacy data and collection. So we talked about kind of like COPPA, but in response to all of this, there's now CASA, our Kids Online Safety Act of 2022 to 2023. Basically, it indicated that social media sites have responsibility to protect minors with appropriate safeguards. And social media sites must provide tools for parents and guardians to supervise minor accounts. The criticism to CASA is that this legislature is enforced by state attorney generals for each state, which would then be politically driven, leading to the content that could be censored by marginalized populations, saying, hey, this social media site is allowing maybe BIPOC populations more ability to connection, but if it's led by more conservative legislatures, they might start banning some of these actual important topics like trans health. I was on a panel with Jack Turbin, who's very prominent in advocating for trans health. And this is actually an area where CASA would target and potentially limit. So you can see this is all, there's so many players in this game of what's being banned and what's not being banned and foreign influence, profit. It's very hard to tell. There's always multiple players here. And then COPPA 2.0 is also in discussion right now and increases the age of consent regarding collecting personal information from 13 to 16. So that's important. And as well as ban targeting and advertising to children and teens. So what does that mean? So does anybody have access or ever access YouTube Kids, for example? No, over there. Yeah, YouTube Kids does not have specific ads on it that can be shown on the platform. It's just banned all totally. So very similar to that, that would be the targeted kind of like advertising, which again, advertising drives a lot of profit to social media companies. So something to be important. And then creates an eraser buttons for parents and kids by requiring companies to permit users to eliminate their personal information, meaning I'm done with you, TikTok deleted. You cannot have any more of my information. Both CASA and COPPA have been passed on Senate panels, but not have gotten to the floor for Senate for vote yet. CASA's language has also been changed, focusing more on product features and how users interact with a platform rather than actual content. So this is again kind of highlighting like language is constantly changing. Some of these bills are in process, but they're not there yet. Great. So we can feel incredibly overwhelmed by tech giants, congressional data and teenagers who do not want to give up on social media. And I don't blame you, whether it's this cat who's exhausted or the dog who just in pure denial, like I'm not on social media, it's not my problem. Clinicians are given the difficult task is somehow solve youth mental health. And maybe a 30 minute once a month follow-up, right? However, I can show you there are tools in which we can help our patients, their parents and their communities in this dilemma. And as Winnie the Pooh says, you are braver than you believe, stronger than you seem and smarter than you think. So I assure you, we can do something about this. So I practice a lot of social media interviewing and how do I connect with teens about social media? Much like Dr. Liu was talking about earlier, there are pros, there are cons, there are ways we can navigate it together. My biggest thing is, you know, I think, I like to think with the interview as a time in which the child and teen can learn to trust us as adults in the room. Their parents are bringing them in, and they're probably looking at us and being like, oh great, another adult who's going to judge me for using social media. And technology advances every day, and most of us, including myself, have a difficult time keeping up. So when a child or adolescent is glued to their phones, I start with basic body language and mannerisms. Hey, I'm curious. Tell me more. I'm dumb. I don't know any of this stuff. Teach me. We should not roll our eyes. We should have a lot of empathy, right, during the COVID-19 pandemic. This was how teenagers and children developed a sense of identity with each other. This was their only way they could connect, right? We think of Eric Erickson's developmental stages, right? Identity versus role confusion. What group am I a part of? Well, now that I'm isolated in my house because I can't go out because of a pandemic, the only way I can find a group is through social media. So we have to always remember that when they're using their phones a lot. Open-ended questions. Tell me more about it. Teach me about it. Normalize the language, right? Talk about like, you know, I always normalize language like, listen, I know nudes are sent on Snapchat. Can you tell me more about that? Like does your friend send nudes? Like have you ever been pressured to send nudes? You're not in trouble if you do, right? Like I just want to learn more about it. And remember vulnerable populations such as teens who suffer from severe depression and anxiety often use more social media than their peers. So all of our populations are vulnerable because if they weren't, they probably won't be seeing us. So they're most likely using it more than their peers. And they rely heavily on external experiences through social media for positive validation. They feel good as well as negative critique. So they are influenced. So here are some just little tips and techniques I like to use that kind of help you understand. So I didn't talk much about Snapchat. Who here has a Snapchat? Okay, we got one person. Fantastic. I have a Snapchat too. Most of our teens use Snapchat for direct messaging. They also use it for sexting. So when I, you know, ask about Snapchat and sexting, I say, you know, they often go together. Do you sext on Snapchat? If they say yes, are there snaps you didn't want to send such as nudes but you were pressured to do so? And if they say yes to that, did anything bad happen to you after you sent that snap? And if you're open to it, I can highlight how we can protect your privacy in the future. I never go into the content of it, right? That can be traumatic. And I also want to just highlight, again, no judgment here. Sexting in one in five teens I think above the age of 15 send a nude. So it's very, very common. And one in seven, I think, below the age of 12 have sent a nude. Yeah. Pretty incriminating evidence. Project Rose, if you've ever heard of it, is a good resource to check out. Are there snaps that you didn't want to send such as nudes but were pressured to do so? If they say no, what would you do if someone pressured you? Role play. Somebody asked you about it. How do you navigate that, right? Kids don't have these conversations. And if they if you want to go into a different direction, you can often ask, you know, did anyone ever send you something you didn't want to see, right? If so, what were the feelings that came up for you? Feel good about it? Feel bad about it? They might say, ew, it was gross. Wow. Anything else besides gross? It definitely sounds gross. What else? Right? And when you feel ready, we can talk about how to keep you safe. What are some ways we can do that? With TikTok, we talk about this a lot with the external consultation that I do, you know, how do we talk about reducing contagion, self-harm, things like that. On your For You page, so TikTok has a For You page, right? It's like your algorithm page. Whatever you scroll through, that's the first video you see. Do you have any videos that show you any self-harm? If so, how often do they come up? Are they coming up like every video, every other video? And what do you think about these videos? When I work with TikTok, they talk about this contagion and self-harm, and they say they're doing everything they can, they're trying to moderate. But as we know, this is, this Instagram, Snapchat, billions of people use these applications. Millions to billions. And so human error is there. That's just how it is. And so I look for like about three minutes, I can find a video of a young girl who had scars all up her arm and saying, I'm not ashamed to show these to an audience, right? Then that was like a month ago. So it's very easy to find these videos. When we talk about self-esteem, this is really important. Personally, as a content creator, I was telling my other colleagues up here, like TikTok has destroyed my mental health as a content creator. Because it's a lot of external validation, right? You're looking at views, you're looking at how many people like your stuff, how many people leave comments on your videos. Does anyone comment on your videos? If so, are the comments positive or negative? Both. If negative, how does that affect you? So these are all really important ways to kind of ask teens and young adults how their social media, and it comes almost from a motivational interviewing standpoint, like an addiction standpoint as well. Interventions, right? So with sexting, for example, approach gently with empathy, acknowledge the exploration of sexuality. Elizabeth Englander is a fantastic person. She's a PhD, I think she's at Mass Gen, I'm not sure. She's definitely in the Northeast somewhere. She's fantastic. She talks about sexual identity in this age right now. Sexual exploration is absolutely normal in adolescent development. It has now shifted to the digital world, right? So we cannot look at it and be like, I can't believe you're sending nudes, or I can't believe you're sexting. I mean, literally, this is how kids are exploring sexual identity now. So it's not to normalize it, but it's just to be like, be aware of it. It's very common. And assess the consensual nature of the interaction. Is it consensual, right? And avoid blaming the victim, right? It's so easy as a parent to have your heart sink and see these kids and be like, why are you sending this, right? Like, you should be ashamed. It's very easy for us as adults to do that, because we did not grow up in this world. So we want them to trust us, we want them to talk to us. Advise on safe sexting practices. Avoid sending photos with faces or any identifying information, right? You don't want this photo to be shared, and you also don't want these kids to be blackmailed or extorted, right, for this stuff. Don't attach a location to these photos, right? That, again, gets into trafficking, and you want to prevent any of that from happening. Apps connected to the camera, right? A lot of these apps are connected to your camera, and you don't know if the camera's recording at that time. So you can ask for removing that accessibility. Now, that's hard, right? Snapchat needs access to your camera, so you can send snaps, right? That is the main vehicle. So you're going to have some more difficult challenges with that. And collect evidence of being blackmailed or pressured, presented to the police. I get this question a lot. A lot of psychiatrists are like, I absolutely say no to sexting. And then I have people who are in the Northeast, so I work all over the country, but like Midwest versus Northeast, you get a lot of different kind of expectations from different psychiatrists. But a lot of people are like, well, I thought sexting is a totally typical thing that most teens do, right? So it also, when you go into the legal landscape of this, it's very, very hard, because each state is different. Sorry. Sure, sure. Oh, no, no worries. So I work in multiple different states, and when I work in the, thank you so much. When I work in the Midwest versus the Northeast, psychiatrists, child and adolescent psychiatrists, who I'm great colleagues with, have very different perspectives on this, where they will say absolutely no sexting. It's against the law in my state, versus others who say that happens all the time, and I come with it from a harm reduction method, because I want to keep them safe. And in the legal landscape, it's very different, because state laws are different than federal laws, meaning laws in California are different than Nebraska, for example. And so it varies state by state of what consent means. So it is a tricky place right now. Cyberbullying, also very important, validate, validate, validate. People get kicked out of group messaging chats all the time. Happens to a lot of your teenage patients, if you see them, and young adults. That is like getting kicked out of a group at school, and it can be incredibly humiliating and demoralizing for a teenager. Weigh the pros and cons of leaving the application. Does this application make you feel better? Does it make you feel worse? And assess pro-social accounts. Pro-social accounts are those accounts that make you feel good about yourself. They are not the highlight reel of traveling, right? If that makes you feel worse, that's not a pro-social account for you. So it's super important to help kids understand, do you feel better after viewing these videos? For cyberbullying, make accounts private, log out from public devices, try not to respond to cyberbullying, and report the platform to school law enforcement. It is considered bullying, and there are bullying, like, you know, zero-tolerance policies in schools. And then when we talk to self-harm in the interview process, I always talk about the triggers on social media, the post, you know, did a post trigger you? Did a comment trigger you? Did a video trigger you? What's the evolution and frequency of the self-harm? Is it getting more rapid, more constant? When you look at social media, I've had teens basically say, I had to delete TikTok, because I can't see any more videos of people, like, slamming a rubber band against their hand, or, you know, talking to me about their self-harm stories and how they've gotten better, because all it makes me want to do is, you know, cut myself. So it's super important. Teens are aware of this, and they talk about this. And obviously assess for suicidal ideation. What's your spectrum here? Tangible skills unfollow certain trends. New profile, new algorithm. A lot of these social media sites are trying to change this. So when I talk with TikTok, they actually have a reset the algorithm button that you can do, and they're trying to say, how do we create this video and make it more prominent on social media with content creators? So you can reset the algorithm, which then changes what you see. Focus mental health professionals that focus on DBT skills. There's a lot of content creators who are DBT therapists on TikTok who are good, good content creators, and you escalate care if necessary. And so these are some of the resources that I can leave this slide up after discussion that we like to use. My colleague, I'm forgetting her name now, but she's at the Department of Psychiatry. She helped create this web page for people that talks about safe social media practices. Healthychildren.org, which is a partner of the American Academy of Pediatrics, has a good family media plan. Common Sense Media is great for data if you want to look and share with other people. We also have a, I'll do a shameful plug at the end, but there's also another website called psychchild.com, which I didn't put up here, which is a great place to look at what's a healthy video game or a healthy social media app. Mind Their Screens, great, great book written by two psychologists, I believe from Harvard, who talk about teen use of social media that just came out in 2022, I think, which is a fantastic book that is very up to date on kind of how to, what teens are using. And then obviously the American Academy of Child and Adolescent Psychiatry has a media plan. So I'll stop there and we'll go to discussion. Oh, okay, thank you so much. I will update that then and put that on here. Thank you. Yeah. Yes. Absolutely. Absolutely. Okay. Yes. Thank you. Hi. We are from Argentina. We have been working. Oh, Argentina. Argentina. Okay. We have been working in nonprofit organization about suicide prevention in teens. So the question is, is there any resource to use for international, this is, I believe, for Americans. For, yeah. One, there's any source or resource to be used by another countries? Great question. The WHO has a branch called FIDES, which another psychiatrist here, Willow Jenkins is a part of and does content creation for, sorry. The WHO has a group called FIDES, F-I-D-E-S, which is a bunch of content creators that talk about mental health content and how to do, how to navigate it safely. It's an international organization. I'm not sure if they have Argentinian content creators. I know they definitely have Latin America content creators, but I don't know specifically for Argentina, but you were absolutely right. Majority of these are, all of these are based off the U.S. And so I have to get back to you on that. That's a great question on the international aspect. Yeah. Sure. Go for it. Hey, thanks for the talk. Yeah. I mean, great info. I didn't think about motivational interviewing, kind of the harm reduction thing. You know, he spoke and you spoke. I'm bad with names. So you both talked about the harm reduction thing, which was, you know, if you can't be them, just join and try to see what less of a harm you can get, right? Yep. I don't have kids, but if I were to tell someone, I think from this talk, that's what I would tell. So thank you for that. Of course. Sorry. I may have come across as an ass. No, no, not at all. So, but, okay. I do that when I'm passionate about something. But my question here, you know, you're all child adults and psychiatrists, right? You know, Jerry? Oh, I think so. No, I mean, I mean, you're a psychiatrist, so yeah, I'll ask. I'll finish the question. Maybe, I mean, there are other people who can answer it. Feel free to answer it. So I have, like, you know, there's this thing, you know, WhatsApp? Yeah. You know, you're part of a family. My family has a group. They're a bunch of. an image of a rose that doesn't carry any meaning to me. And I mute most of the chats which send stuff like that. Sure, sure, sure. Yeah. So getting to the conspiracy theory, if it's a friend that sends me, I have a good relationship, I'll just confirm them. Why did you share this? Did you actually look at the source? Who else did you? I think I hold my friends to a higher kind of tip. Dude, don't share this stuff. If you haven't could validate the truth to it. How do I do it with my father-in-law? Yeah, so this is a fantastic question, because I think a lot of us can relate to that. My dad is on WhatsApp all the time. And he massively, I've had to tell him, please don't send pictures of your grandson on WhatsApp to everyone in your 65 plus member community of your medical school from 1967. Because I appreciate that, but one, they're all over the world. Two, I don't know where that photo's going, right? With AI generated information and identity fraud and theft as we had learned earlier, incredibly difficult. I think the main conflict you have here, and this is another U.S. Surgeon General warning that came out after the social media was loneliness. Loneliness amongst older adults. My wife is a geriatrician, and that's all she talks about is, are there any community groups that we can connect people to? And that is where I think WhatsApp has come into play. It's more text-based, right? And it's more text-based and user-savvy in that sense. And that's where I think digital literacy has to go next. We talk a lot about youth. We talk a lot about teens. We do not talk about older populations. I don't want to hold up the line. Are you saying WhatsApp is helping with social isolation? I mean, I think it is. I don't know, this is a great question. Does social media help with isolation? It can connect people. It can connect people. But those people also need training in digital literacy, just like our teens, just like young adults. Okay, I mean, we should talk over some tea. Yeah, absolutely, absolutely, after. But thanks for the talk. I appreciate all of you. Of course, thank you. Great question. I'll try to bring it back to the younger generation. So for your benefits, I came in a little late, so I apologize if this is covered already. But part of that social piece to social media is potentially creating social groups that can actually be damaging or potentially harmful. And I'm wondering in particular about your opinions around self-diagnosis and social media groups that create self-diagnosis. It's starting to trend, the dissociative identity disorder crew is starting to trend down a little more in maybe the last couple of months compared to before. But it's only a matter of time before the next wave of whatever diagnosis is popular becomes the hot topic. And it seems like, at least what I see often in emergency room settings, teens, young adults coming in self-diagnosed because they want to be part of a larger group because it feels social for them. And effectively reporting symptoms in an emergency room environment for the benefit of gaining a diagnosis so that they can post it on social media so that they can have followers and be part of a group. And then creates the diagnostic quandary of well, what's really going on here? Is this about social media use and wanting to be attached to something or is this actually something that needs treatment? So I was wondering if you can talk about your experiences around that and maybe even how to sort through all of this. I can jump in. Uh, I cannot solve. may be, or is it they're suffering and just. I'm gonna add on there. There's autism tick-tock ADHD tick-tock odd tick-tock, which is autism plus ADHD tick-tock I've started to realize and I would get so frustrated because people would come with self-diagnosis I had my last patient before coming to conference at the end who was self-sabotaging every relationship didn't have a No issues with social emotional reciprocity, but more like, you know managing due to attachment issues and at the end very end She was like, I think I've autism and I was like and it's really hard because you sit there and you're like That's not right, but then you understand identity as well I'm gonna add a tangent to all of this. There has been a You know, I had a separate talk about billions of people socially isolated on devices ADHD like traits because you're seeing things really fast Tell them how telehealth marketing companies like cerebral done and direct-to-consumer Telepsychiatry companies pushing stimulant medications, right? So all of this creates a market very quickly and then everybody wants an ADHD medication I'm starting to realize that how we treat depression is we always assess a substance History and if they have substance induced mood disorder We then prescribe sobriety and get you off whatever you're using and then we reassess if you have depression Same thing with social media if you have quote-unquote ADHD symptoms that have really developed during the pandemic and your screen time is correlated with those symptoms Let's get you off your phone and let's try for a couple months and then let's reassess the ADHD diagnosis That's my that's my epiphany. I've had at conference Howard Margulies from Montreal. Thank you for the talk you know, you've talked a lot about the the harms of social media and I Certainly understand that and I agree with it and our kids are on our kids are on these platforms way too much and It's hard to get them off it. I have four kids myself. I know the situation so But you know because they're already on it. My question is how is there a way in which we can use these platforms to actually Help people and to have an a positive intervention or a positive experience. So, how can we use it? Since they're already on it, how can we turn it around and use it from in a positive perspective any thoughts about that? And well, I'll take that one on and and just say that I do think that there are some positive pieces as well And we also happen to have four kids. So, you know, I Think that what they do have It's such a finely tuned sense of what is on social media and so if you are a content expert and Psychiatrist and you're looking to do some sort of public health advocacy or something like that Provided that there's informed consent. Maybe there's some way to team up, you know, and and might be when they're older and you know, I think also just just in terms of sharing some of the Pieces that you know you as you're working with your patients and As a child psychiatrist, you know, I gain a lot of insights from my kids about what's going on out there What's trending those kind of things because I think the algorithms are pushing different things to my demographic than what they're getting as well So I do think there are some opportunities back to what? Dr. Benson said before I think we do have to be a little bit worried about the kid fluencer piece and then in Sharenting too much as well. So I think there is a balance but I do think there's some possible pieces. Did you want to anything? Another thing that I've noticed that can be helpful is when I've had patients and it's it's very clear that they are spending a lot of their time on social media or on their smartphone I'll talk with them about Some practical tips on how to reduce their use of it So for instance with social media, so like say Facebook or Instagram saying, you know It's it's a good idea to maybe turn off your notifications. Don't let them pop up You have to touch on the app to check it. Don't let it ping you Don't let you so ways to minimize that or like move your app into like the back So you have to scroll a few pages to get to it, maybe put it in a folder, you know try to Make access to it a little more difficult to kind of minimize that use and then Other things if it's kind of a more of a severe If you all say, you know, you can make a rule that you only access it through your computer Don't look at it on your smartphone And that also put some space in between them and using that Another thing I'll suggest especially if I have patients who are really depressed and they find that they're kind of doom scrolling a lot I'll say, you know, if you're noticing these harmful videos Just scroll past them Don't watch them because if you watch what you watch is gonna appear more frequently Because it looks at what you like and what you pay attention to you. It's predicting What you're going to be interested in and maybe share so I'll say, you know If you want to just start seeing golden doodles all the time Watch those videos and then everything else just quickly pass through and so you can kind of try to curate a more healthy positive Page for yourself, so I'm just wondering are you guys aware? I think there's various technologies being developed for that piece, and I think there's also some push for identification when things have been generated by AI. And this kind of dovetails with the prior gentleman's question, too, about what kids and teens can do. You know, my daughter started an AI club in her high school, and, you know, we talk about it, you know, things like that at dinner. And, you know, and, yeah, because some people, there have been some high-profile, I think, New York Times and other stories about people generating these deepfake nude and other pornographic videos just from, like, a headshot, right, from, like, a yearbook kind of thing, and it's out there. And I think a lot of schools' policies lag, right, in terms of, you know, this is against the rules, and then a lot of states lag behind enforcement as well. So I do think one thing that's possible is trying to empower that student voice. And I think for their club, they have a teacher sponsor or something, so there's some connection with administration as well. But I do think that some of the solutions will come from that piece as well, if there's enough kind of peer pressure as well. But at times, people make these kind of harebrained decisions, right, and not always thinking it through, and, you know, you're a child psychiatrist. So I think that is something that's gonna become, unfortunately, more and more prevalent, and we're just gonna have to be aware of it. I think schools, boards, are gonna need to adapt to be ahead of times and just think about what some of these risks are. Well, understanding there are some benefits still of AI as well, so you guys want to comment? Yeah, I mean, not to be a pessimist here, but being on the startup, and I used to work in startup kind of world a little bit, and it's kind of move fast and break things is the philosophy, and there are other startup companies that are actually doing the opposite in trying to protect children's mental health. But one of my colleagues is a social media marketing person, and he was like, you know, my field is dying because people are generating AI, and they're doing the work, you know, that we don't do. One of those fields is AI girlfriends. Guess how much that industry is valued at now? Anybody gonna give a number? Getting there. It's like one and a half to two billion dollars right now in investment, right? AI-generated partners, right? I say girlfriends, but it's actually partners. And so that is a, how do you take a deepfake, right, of a person and put them on an AI and then generate connection? So we are moving very fast. I was talking to you earlier, an IT crowd, right? Whether we can or whether we should, and as often, can we do it? So I'm hoping there's a lot more legislation and restriction around this, but we are moving exponentially fast in that area. Thanks. Of course. We are actually out of time too, so I just wanna give the, it's okay to leave, but we'll stick around for questions. Thank you guys so much.

social media

mental health

children

adolescents

digital wellness

misinformation

smartphones

body image

digital literacy

motivational interviewing

content regulation

parental involvement