Welcome to the American Psychiatric Association's APA Lookin' Beyond series. My name is Gabriel Escontreras, Jr., and I'm the managing director for the APA's Division of Diversity and Health Equity. Our Lookin' Beyond series and podcast series were developed with the goal of bringing diverse disciplines together to explore ways to address mental health inequities. This year, we have assembled panels of experts around key topics in substance use and addiction and minoritized communities. We continue this series with two nice topics, and you're going to hear from a phenomenal panel. I had the chance to just chat with them a little bit before this, and I think you're in for an amazing evening, and I know you're going to learn a lot. And please feel free to utilize the Q&A function and the chat to engage, as this is meant to be a dialogue in addition. But first, also, it is my pleasure to present our moderator, Dr. Tammy Benton. She is psychiatrist-in-chief and executive director of the Department of Child and Adolescent Psychiatry and Behavioral Sciences at Children's Hospital of Philadelphia. In addition, she's a professor of psychiatry at the University of Pennsylvania's medical school. But I can't end there. Also in 2021, Dr. Benton was nominated by her peers and elected president of the American Academy of Child and Adolescent Psychiatry, and she is now leading the academy through 2025. A little bit more about Dr. Benton, she earned her BA in biology from Oberlin and her medical degree from the Ohio State University College of Medicine. Thereafter, she trained at the Albert Einstein College of Medicine, Montefiore Medical Center, hopefully I said that correct, in pediatrics, adult psychiatry, and child and adolescent psychiatry. Dr. Benton also trained in psychosomatic medicine. Needless to say, when it comes to speaking about this important issue, Dr. Benton is one that is always called upon. In 2017, she was on documentary on suicide prevention and was recognized by the American Foundation for Suicide Prevention, Greater Philadelphia Chapter with the Community Impact Award for her outstanding contributions in suicide prevention and awareness made to the greater Philadelphia region. In addition, just a few more accolades just to mention, in 2020, she was awarded the humanitarian award by the Society of Biological Psychiatry. The award recognizes those who have demonstrated service and advocacy for mental illness. When the U.S. Senate held a hearing on the barriers of children and youth facing access to behavioral and mental health healthcare, Dr. Benton was called to testify. She outlined the youth mental health crisis, described how it was exasperated by the COVID-19 pandemic and offered ways Congress could help. As a leader, advocate, researcher, and physician, Dr. Benton continues to find ways to help eliminate barriers to accessing mental health care so that children and their families can receive the right level of care at the right place and at the right time. So please help me welcome your moderator for this evening, Dr. Benton. Thank you, Gabriel, for that generous introduction. I'm so excited to be here with our outstanding group of panelists, and thank you for inviting me. I'm really excited to be able to introduce our discussion tonight on navigating the virtual crisis, enhancing awareness of technology addiction, and its impact on suicidality and youth of color. And to just provide you with some background, with the rise of digital technology, adolescents are increasingly vulnerable to the detrimental effects of excessive screen time, cyber bullying, social media comparisons, and online harassment, which can significantly contribute to suicidal thoughts and behaviors. Communities of color are particularly vulnerable to suicidal thoughts and behaviors. Communities of color are particularly vulnerable to suicidal risk factors that are rooted in disparities in social determinants of health and systemic and cultural vulnerabilities. Our panelists tonight will discuss technology addiction and suicidality in minoritized youth, exploring risk factors, protective factors, assessment strategies, and evidence-based interventions. And at the end of this presentation, we will all have gained insights into providing comprehensive care to prevent and address suicidality related to technology addiction in youth. So some of the learning objectives for this activity are that you'll acquire knowledge of evidence-based interventions and therapeutic approaches to address these addictions and reduce suicidality in adolescents. We'll explore cultural considerations and specific risk factors, as well as barriers that impede help-seeking behavior associated with suicidality in diverse racial and ethnic communities. And then we'll also gain knowledge of evidence-based interventions and treatment approaches for addressing technology addiction and suicidality in youth of color, including culturally responsive and trauma-informed care. I want to share with you a little bit about our panelists tonight. So one of our panelists, Dr. Wei-Sheng Deng, is an MD-PhD clinical assistant professor in the Department of Psychiatry and Behavioral Sciences at the Stanford University School of Medicine. She is also the co-director of Stanford Mental Health for Asians Research and Treatment, aka the SMART Clinic. In addition to a medical degree, she earned her PhD with a major in rehabilitation science and a major in neurosciences. She specializes in the areas of cultural and interventional psychiatry and addiction. Her goal is to help each patient along the journey to achieve optimal health and quality of life. As the author of more than a dozen scholarly articles, Dr. Deng's work has appeared in psychiatry research, psychiatric annals, restorative neurology and neurosciences, and other publications. Since she joined the faculty at Stanford, Dr. Deng has received research grant support by the Department of Psychiatry and Behavioral Sciences Innovator Grant Program and the Stanford Center for Asian Health Research and Education. Our next panelist is Dr. James Scherer, MD, who is the director of Addiction Medicine Consult Service at Hackensack Meridian at Jersey Shore University. Dr. Scherer is an addiction psychiatrist, educator, author, and patient advocate. He's board certified in psychiatry and addiction psychiatry. He completed medical school and psychiatric residency training at Rutgers New Jersey Medical School and completed an addiction psychiatry fellowship at New York University School of Medicine. He's currently the medical director of addiction psychiatry at Overlook Medical Center. He is working diligently to expand care to substance use disorder treatment and to educate the public on effective treatment for substance use disorders. Dr. Scherer is a member of the American Psychiatric Association's Presidential Task Force on Addiction. He is also the author of multiple published academic papers and the co-editor and co-author of Technological Addictions, a book that I happen to own, the first textbook published by the American Psychiatric Association to comprehensively cover subjects such as social media and video game addictions. As background for this topic, I want to give you some key facts to anchor you in this discussion. So technology addictions, which we also know as digital addiction, is defined as an obsessive use or dependence on digital devices and technology, such as the internet, video games, social media, and other online platforms. It has recently emerged as a global mental health concern, and our current literature suggests that technological addictions can lead to significant distress and impairments in daily functioning and psychiatric conditions, such as attention deficit hyperactivity disorder, depression, and anxiety. And depression appears as the most prevalent symptom of internet gaming disorder across all age groups from adolescence through adulthood. Additionally, frequent internet users often exhibit symptoms like social anxiety, emotional disturbances, and other cognitive deficits. We also know that digital addictions can have both psychological and physical ramifications for children and adolescents, including visual and hearing impairments, as well as obesity, sleep disruption, and disruptions in eating patterns. Studies have also shown that addiction to digital platforms can lead to specific alterations in brain functions, particularly in reward centers, and can be quite reinforcing for the adolescent developing brain. Despite the severity and the variety of impairments that are known to be associated with technology addiction, systematic treatment approaches remain lacking, and there's a scarcity of a review of studies investigating interventions for individuals, particularly children and adolescents, who are struggling with these technology addictions. And so on that note, I will ask our presenters to start with some comments for the topics of our discussion this evening. Sure. Thank you so much for that introduction, Dr. Benton. I think I'll kick things off by just sharing some slides. But before I do so, I want to talk about why I'm sharing these particular slides, these particular statistics, these particular studies, why I think it's important. I think when we're talking about addiction, I am very much oriented in the motivational interviewing vein. And the reason why I think motivational interviewing, along with cognitive behavioral therapy, is so powerful and transformative is because it frees us up to ask our patients, whether they're adults or children, when they're struggling with either a process addiction or a use disorder, it frees us up to ask them, why do you like doing this thing? What is it giving to you? And why do you think it's so difficult to put down in the first place? And with that in mind, and with that being kind of the general way that I approach this topic when I'm seeing children, either in the emergency room or in my private practice where I'm sitting now, I just wanted to share a couple statistics with you. So I'm going to go ahead and share my screen now. All right. I'm just going to trust that everyone can see that. I'm going to also trust that I can actually put it into presenter view, which I think I just did. Okay, good. All right. So just a couple slides here that I wanted to share. And again, the reason why I wanted to share these points is because I think it's crucial to know what young people and young people of color are thinking about the technology that they're using. And if we don't ask them what they think of it, why they like it, we're not going to know how best we can intervene to help moderate that use. And a lot of the best statistics that I come across, whether I'm researching social media's impacts on kids, video games impacts on kids, television and music and other media's impacts on kids comes from a group, the Common Sense Media Group. They put out these periodic reports that is based on survey results. The surveys are pretty well put together and scientifically put together. They aren't presented in a scientific fashion. And I am going to end the talk with some more peer reviewed research for y'all. But I do like the way that the Common Sense Media Group kind of conceptualizes of problems with social media use and video game use. I like the questions that they ask. I think that they're telling. And I think a lot of the statistics that they collect are very meaningful. One of the most recent reports that they put out after surveying about 1400 girls in the U.S. aged 11 to 15, and the report had to do with how do girls really feel about social media? Why are they using it? You know, why are they overusing it? So on and so forth. And it really split girls, young girls, impressions of social media into three categories, things that they feel positive about when it comes to social media, things they feel negative about and things that they feel mixed about. So what are some things that girls feel positive about when they're using social media platforms? And this goes for a myriad of social media platforms, TikTok, you know, Snapchat seems to be very popular, so on and so forth. So what do they feel positive about? Girls feel positive about being able to private message their friends on these platforms. So they feel good about the kind of individual connections that are being forged between friends via these platforms. And they feel good about video content that is being displayed on these platforms. They like to consume it. It seems that they like videos that are short, that get to the point that they can watch for two seconds, and then they can scroll to another video. So when you ask young girls, these are the things that they really love about using these platforms. But what are some things that they don't like about using these platforms? They don't like location sharing, which I know from my work in my private practice is something that some parents insist on as a, you know, something that the parents want the kids to do in order to receive a phone in the first place, we're going to turn location tracking on, we're going to know where you are at all times. And that can extend into, in particular, Snapchat, which has a function where you can see exactly where your friends are at any given time. And girls in particular, do not like that function. Now, Common Sense Media did not put out a comparable report about young boys, but I can tell you in my small experience in my private practice, I think that boys actually seem to like this. They like to know where their friends are. They like to know where the girls are. So I'm not sure if you were to ask boys aged 11 to 15 if they would have the same response. Another thing that girls don't like is they don't like accounts that are public. They don't like when someone is putting on a persona. They don't like when someone, one of their friends is trying to portray themselves as something that they're not. They don't like that there's a sense of artifice to that, which is interesting. And they also don't like the unwanted contact that can come when you're engaging in that type of relationship on social media. And what do girls feel mixed about? They feel mixed about filters. And by filters, I mean photo filters. And for those of you who don't know, those are simply, you know, things that you can apply to a photograph to make you look a certain way or to make the photograph look a certain way. So again, girls don't like that kind of, that artificial kind of nature that comes from applying filters to a photograph. And they don't actually like endless scrolling. They don't like doom scrolling, so to say. And I want to, I want to contrast this Common Sense Media report with another one that was put out a year before that. That really highlights kind of the conflicting nature of, you know, technology access these days. Yes, you know, we want to make sure that our kids are moderated in terms of their social media use. But the fact of the matter is, a lot of school is online these days. And to excel at school, to excel in the reports that, you know, young kids need to make, you know, they do need online access. They need constant access to the internet. And so I just thought it was interesting that Common Sense Media also put out another report just talking about the importance of extending broadband access, especially to at-risk communities and communities of color. The report mentioned a couple of interesting things I just wanted to highlight. One of them is that 40% of teachers don't prescribe homework that would require internet access because they think it would make inequalities worse. I think that's very interesting to take into consideration. Another thing to consider is that when it comes to graduating from high school and applying for jobs and applying for schools, you really need a deep familiarization of how the internet works and how, you know, creating a profile on a website works for you to be able to do that in an effective manner. And then the other thing that I want to point out is, you know, accessing appropriate and effective mental health care is much more difficult if you do not have access to broadband internet. And I can say that, you know, as a psychiatrist that's boarded in multiple states, you know, I'm able to reach patients who I wouldn't be able to reach otherwise because of, you know, online and telehealth. But let's get to kind of the heart of it. This is, I think, the Common Sense. This is the most thing. This is the thing that's most germane to what we're talking about today. This is kind of the big report that Common Sense Media puts out every couple of years. It's the Common Sense Media Census, where they collect a whole bunch of information and put out this very telling, extensive report. The thing that I think is really interesting is that they do breakdowns based on not only gender, but by race, ethnicity, and they also take into account a lot of times socioeconomic status. And, you know, you can, you get a sense just looking at this chart, but it's, you don't need to look at it too long to realize that screen time among children of color is much higher as compared to, you know, white children. And I think there are a number of reasons for that. There are a number of reasons that parents and patients have told me. There are a number of reasons that are borne out in the Common Sense Media Consensus. Some of the reasons that are mentioned in the report and elsewhere is that, you know, parents of color, parents with lesser means, find that they need to use the phone as a means to kind of distract or entertain the child more frequently than perhaps a parent who has more means and is able to hire a babysitter and is able to send their kids to various sports and tutoring and things like that. Right? So that makes sense. And that is something that I also see in my own practice. There are a couple, you know, peer-reviewed research studies that have looked at social media's impact in minority and at-risk populations, including this paper here. This was a small, but I think well put together study that looked at social media use in a very particular Louisiana community that had a lot of people of color in it and a lot of low socioeconomic status patients in that community as well. This study found that with regards to social media use, females were more likely to use it heavily and they were also more likely to report body image issues as compared to males. Meanwhile, both sexes report body image issues the more time they spend with any social media platform. And a diversity of platforms were associated with increasing body image issues among social media users compared to non-users. So, and they looked specifically at Pinterest, Reddit, Snapchat, TikTok, Twitter, and YouTube, say that five times fast. There was another study that I thought was telling about social media and just bullying generally in minority populations. And while this study focused mainly on bullying, not being tied to any particular platform, I do find that in my own practice, especially LGBTQ young people tell me that, you know, they experienced verbal harassment, gender policing, physical violence at a much higher rate than their, you know, hetero counterparts. And I've had plenty of young LGBTQ patients who have described social media as a 24-7 firing squad when it comes to bullying and, you know, just feeling like, you know, it doesn't end at school, right? The bullies who are torturing you at school, when the bell rings, it's not over. It keeps going. It spills into social media and it really becomes this vicious cycle. So that's really it. Here are my sources. I just wanted to share those with you. I hope you found it somewhat enlightening and then we can jump back into the discussion. Thank you so much, Dr. Scherer. And so I have some questions that I'd really like to ask our panelists today. And I'd like to start with asking you a question about the high prevalences of these addictions. So in a meta-analysis of about 31 countries revealed a 6% prevalence of internet use disorder among 12 to 41 year olds. And, you know, I'd be interested in hearing your thoughts about why do you think that these addictions have such a high prevalence and such a stronghold on youth and children? And how do you see it differing from other addictions like substance abuse in this particular demographic? Yeah, I can comment on that. I want to say I conquer what Dr. Scherer just shared in one of the slides mentioning, because nowadays we have access to technology so often, including young people. They have to, for example, apply for a job or a summer program. They have to fill out all the online forms and some of the homeworks or projects are done online. So it's very easily accessible even from very, very young age, right? So even like a toddler, sometimes they have a grandma on the East Coast or West Coast, right? So parents would do like a screen time with the extended family members or something like that. So people got exposed to modern technology very, very easily. So that's, I think from access perspective, it's just so prevalent, it's everywhere. And if parents don't supervise well or do not control that time limit to the screen time, so kids, they just tend to use it because there are so many fun things online, on the website they can explore, but also expose them to risks, right? So compared to substance, I think one thing about substance is that we usually, like, for example, I see patients in the hospital, on the different hospital consults all the time, we advise them, for example, start with detox, start with abstinence. But technology is just so difficult because people, they can say, oh, I need it for my work. I need to access my email and I need to use my smartphone, I need to use computer and abstinence, just becomes like to some people, like impossible. I mean, we still have ways to deal with that. I'm happy to extend on that later, but that's one thing compared to the traditional, like a substance addiction, technology access is just so much harder for people to control, that's one thing. So that's, I think is really like a front access perspective and also is more acceptable, right? So from that perspective, so a lot of like homework on projects or a program application, all those is more acceptable in a way. So sometimes, for example, if parents do not monitor what's accessed in terms of the contents, right? So you don't know what's going on. So those are the, I think the big majority of the difference I wanna point out. Thank you, Dr. Deng. And what about you, Dr. Sher, do you have any additional comments? Yeah, I completely agree with what Dr. Deng said, but specifically, and great observations there, and specifically with regards to the prevalence rates, I think part of the issue in terms of getting an accurate prevalence number for any of these things is that we're still in the process as a field of defining these things, right? There's only one behavioral addiction that's in the DSM, that's gambling disorder. Even my baby, internet gaming disorder, it's in the DSM, it's in the back, it's in the section requiring further research, right? And there's nothing in the DSM currently about internet addiction broadly. There's nothing in the DSM specifically about social media addiction, right? And even when we're talking about something like internet gaming disorder, the criteria that are outlined in the DSM-5 are completely different from the criteria outlined in the ICD-10 and 11 talking about gaming disorder, which is like a completely different thing. So the prevalence rates will vary based on how we're looking at it, right? A lot of times when we're talking about social media in particular, it seems that the Bergen social media scale is one of the most researched and kind of commonly used ways to screen for and perhaps come approach a prevalence number for how many people are actually addicted to that particular technology. And that even gets into another question, like is social media addiction different from online shopping addiction? Is it different from video game addiction? What about video games that include social media elements? What about video games that include gambling elements? Are these really distinct entities or are these all kind of a confluence of like one broader behavioral addiction? I think these are all questions that we need to answer. And until we do, I think the prevalence rates are gonna be all over the place based on the population and what we're looking at. Just one last thing, before the pandemic in China, video games were considered like public enemy number one, like the number one public health crisis. And if you took even the same criteria and you applied it to a population of Chinese youth, you might get a very different rate for internet gaming disorder, for example, if you did another study in the United States. So I think we're still, it's very early days for all of this. Yeah, I totally agree with that. I think definition is one thing because right now we don't have like a consensus. So that can lead to like a big variance of the data we have. For example, I know there's a paper published in 2014 also by Koss et al. They did actually a systematic review of the prevalence of internet addiction. So it actually has very, very broad regional variation. For example, they reported a 0.8 in Italian as compared to 26.7 in Hong Kong, right? So that's a big variation. And per DSM-5-TR published in 2022. So using the DSM-5-TR diagnosis criteria, as Dr. Shirell pointed out earlier, it's actually not a formal part. It's a section needs further research, right? So, but by the proposed DSM-5 criteria, actually Asian and Western countries, they have very similar prevalence. So you see, right? So as I just quoted the rate in European countries and Hong Kong, Asian areas, they're quite different, but for DSM-5-TR, they're actually quite similar. Another thing is that there are some data, for example, for the different ethnic group here in the States, right? So there are some data out there too. Asian American youth may be more likely to engage in online gaming compared to their peers from other racial or ethnicity groups. So I think there are factors such as like cultural norms, family expectations and access to technology may contribute to the differences. And the one thing I'm at Stanford, in the Bay Area, there are a lot of like technology companies such as Google, such as Apple. And there are a lot of, for example, high school students, they really wanted to, for example, work about those big companies later, right? So I'm very, very encouraged by parents to have access to online programming, to sharpen those skills, and starting from a very early age, right? So in a way, it's actually encouraged to use the computer in a way. So there are a lot of geographic differences, cultural differences I also want to point out. So to shift gears a little bit, I'd like to ask you what your thoughts are about the relationship between technology and suicidality and self-harm among adolescents. So I think, you know, one of the things that I see in my private practice is this idea of contagion. And when I say contagion, I mean the psychological, you know, phenomenon that's written about more often in the psychological literature as opposed to the psychiatric literature of a negative emotion that kind of spreads, right? And so I think when there was that Netflix show that came out, 13 Reasons Why, I think there was initially kind of a spike in suicidality in young people possibly due to this effect. I think that's very difficult to study, but it is something that I think all of us see. And, you know, I think that when it comes to how I treat it and how I address it and how I approach it, the tools are the same, right? It's a question of doing a Columbia suicide risk assessment. It's a question of assessing strengths and weaknesses. It's a question of assessing, you know, supports. It's, you know, a question of asking whether or not the patient is already stabilized on medications or if they already have providers. But I do think it is yet another kind of risk factor being exposed to this type of thing online. And I would imagine, and again, I'm just speaking subjectively. I have to imagine that it has normalized it to a certain extent, right? It's no longer kind of this boogeyman thing. It's, you know, young people know that people harm themselves. Evidence for that is kind of omnipresent. And I do think that it leads a certain type of young person to kind of leap to that, not only, you know, when they're genuinely feeling that way, but also because maybe they think, you know, this is the way that I get the help that I need if I convey my needs in this way. Any comments, Dr. Deng? No, I think I agree with Dr. Shera's opinion. So could you guys speak to the idea that minoritized children and youth appear to be at risk for mental health harms related to digital addictions, more so than the larger population? And could you, do you have any thoughts about why that phenomenon occurs? Yeah, so I think from a racial ethnicity perspective, so those folks are more prone to exposure to discrimination, racism, and other forms of social stressors. For example, I think family dynamics is really, really important for young kids' youth mental health. A lot of intergenerational communication issues. Myself, being a first-generation immigrant, and I'm an adult psychiatrist, I do community outreach work all the time, talking to parents all the time in the local communities. One thing I come across very frequently, parents really don't know how to communicate with their kids in terms of intergenerational cultural difference. So the parents typically being the first-generation immigrant, and the kids are commonly born in the United States, they are exposed to a different cultural background. So the intergenerational communications can be quite challenging. So all those could, I think, could heighten the vulnerability of those young folks to mental health issues, making them more susceptible to the negative effects of the technology, the internet exposure to them. Yeah. Yeah, did you have a comment, Dr. Sher? Yeah, just real quick. Just building off of Dr. Deng's amazing comments, one other thought I'm having, and one thing that I've heard a lot, comes from just speaking to young people who are very deeply engaged in technology, more so in the gaming space, but also in the social media space. I just came back from PAX East, which is the largest video game convention in the United States. And I've been lucky enough to go there and talk to gamers about technology addiction, gaming addiction for many years. And when I meet young people there, and when I meet young people of color, when I meet young people there in the LGBTQ plus community, a lot of times they tell me that subcultures within gaming, and even subcultures in certain social media platforms, are one of the few safe spaces that they have. It's really, they don't feel necessarily welcomed or safe elsewhere in their life. This is like a refuge for them. On the one hand, that's protective. On the other hand, that could potentially lead you to really overindulging, and building your life around engagement in a specific game or engagement with a specific social media platform. I think it just comes down to each individual case. I do think that for a lot of people it is protective, but I certainly think for some, it's probably leading them or predisposing them to develop a problem. But I'm very curious to see what you have to say, Dr. Benton. I was just gonna comment that, some of the data looking at suicidality in black youth related to online activity, sort of demonstrates that there's, appears to be a strong association between PTSD and trauma for young people in their online activities and the suicidality. And then we've also found that racial socialization and having a strong sense of ethnic identity is actually protective for individuals of color who are on online. And so it sounds like there's some opportunities for intervention development, which leads me to my next question. What evidence-based interventions exist to address technological addictions in youth? I can kick this one off. So social media addiction, the answer is still very much cognitive behavioral therapy. But when it comes to internet gaming disorder and certainly, you know, internet gambling, which is a problem that increasingly youth are facing, you know, these apps are widely available, they make burner accounts, they lie about their age, they get access to a credit card. You know, these are still things that smart young people can access. When it comes to that, I think a lot of the research and evidence that has been done with regards to gambling disorder, but also internet gaming disorder holds true. And specifically when it comes to young people, we know that antidepressants, in addition to therapy, of course, antidepressants can be effective. You know, Lexapro has been looked at, bupropion has been looked at in particular. We know that stimulants can be effective, especially if there's comorbid ADHD. And there are some really wonderful neuroimaging studies out of China from Han et al around 2019, but he did a couple of studies in this regard that show that if you have a patient with comorbid ADHD and internet gaming disorder, if you treat one, you're treating the other. If you give them a stimulant, the ADHD is gonna get better and the IGD is gonna get better and you're gonna see evidence of that on neuroimaging. So I think that research is really powerful. While the evidence is, it's still early days with regards to social media and other addictive platforms, I would not be surprised if we end up drawing some of the same conclusions there. I would also not be surprised if some of the kind of lower tier medications that we use when we're treating gambling disorder, of course, in gambling disorder, I think the most robust evidence would say that, and there's a wide variety of it, but I would say the most robust evidence is for naltrexone. But then below that, there are a variety of other things you can use. You can use antidepressants, you can use older antidepressants like clomipramine with dual mechanisms. You can even use mood stabilizers, valproate, so on and so forth. And you can use n-acetylcysteine. I think that a lot, I wouldn't be surprised if a lot of these interventions become very effective for youth and technology, especially when we talk about the lower side effect profile medications. N-acetylcysteine is often touted as this medication with very low, still side effects, of course, but a low side effect burden. So I think that we might start to find that as time goes on. Thank you, Dr. Shearer. Dr. Deng, any comments? Yeah, I also want to emphasize the family role in this intervention because we're facing the client being the youth, being the children, being the kids, right? And it's very important because they are in this age, under family, under a family roof, in a way, protected, but also, as I mentioned earlier, the intergenerational communication can be challenging to a lot of the families, so family-based interventions involve educating patients about effective parenting strategies, improving communication within the family, and fostering a supportive environment for healthy technology use. Sometimes we have to, like, start with, hey, what about your use, right? So, parents, asking parents, how much do you expose yourself to computers, to online, and do you actually monitor what your kids are doing online on the computer, right? So, sometimes they tell you, oh, there's homework, there's a project, but maybe there's something else ongoing, right? So, the family, I think, is actually key for all this I just mentioned. Well, thank you, because you actually just answered the next question I was going to ask you, and the only thing that I would add to your comments is that for people who are looking for guidance for families about the utilization of, you know, internet access, social media, video, the American Academy of Pediatrics actually has media guidelines and, you know, technology platforms that families can actually go online and use to develop guidelines for how media is used within their families. They actually call them the Media Plan for Youth, and it's free, it's freely accessible, and it's available for kids at all ages. So, I think that's a really great resource, you know, for working with families. Are there specific cultural considerations that should be considered when you're developing interventions for technology addiction when you're working with youth of color? Yeah. So, I think it's important to actually consider those factors we just mentioned, Dr. Benton. So, for example, specific cultural considerations to ensure relevance, effectiveness, and cultural sensitivity. So, those could involve tailoring interventions to So, those could involve tailoring interventions to reflect cultural values, beliefs, and norms related to technology use and family dynamics. So, and another thing I want to emphasize within the Asian-American community, help-seeking behavior is a big challenge, right? So, it can be heavily stigmatized, and it could be like a taboo topic within the family to seek mental health help to talk about addiction. So, I think those are things especially important from cultural considerations perspective, and sometimes I see patients, I see many adults, patients, like parents, right? So, I start with telling them, oh, if you're concerned about your kids or you want to encourage your children to go to seek professional help, and it sometimes can start with, for example, a primary care physician with a sub-specialty in addiction. So, maybe that's better accepted in terms of, like, compared to, I guess, psychiatrists or counselors, they feel like this is a very stigmatized word in certain subcultures, I want to say, but get them to step out, like, first step, right? So, get them going. That's very, very important, being culturally sensitive when you approach those topics. Dr. Sher, did you have any comments about that topic? Yeah, I just wanted to add, I just wanted to share briefly just the story of a patient that I treated actually in residency at University Hospital in Newark, New Jersey, who was in the foster care system, and he was using Snapchat as the only means to communicate with his biological father, and at first, I was a little concerned about this. It didn't seem from the collateral that I had obtained that it would be beneficial for him to have any contact with his biological father, and yet this, it was, it was a young African-American child, and the family was tremendously fractured, and the foster situation was not great, and after discussing things with him, and even asking him to show me some examples of some of the conversations that he had with his father, I really walked away from it thinking, like, this is exactly the amount of interaction that this child should be having with their biological parent at this time, and I really came away from it thinking that it was actually quite a protective thing, and I was really thankful that he, you know, had this means of contacting him. Now, you know, you might say, well, he could just text him, and to that I'll say, you know, a lot of patients that I met in Newark do not have the money to, month after month, pay for a cellular plan, and to keep the same phone number, and to constantly have access to any digital device, but what they do have the ability to do is buy SIM cards and buy temporary phones, but they can access their social media accounts no matter what device they're coming on to, so I think we have to be, you know, mindful of that when we're thinking about these things. For some populations, this may be the most effective way for them to stay in touch and communicate. So, thank you so much for those excellent responses. I want to ask you one last question before we open this up to questions from our audience. You know, there was a study conducted by Hermawati et al. in 2018 that revealed that children under two years of age exposed to more than three hours of screen time per day exhibited attention problems and hyperactivity. The age at which children are exposed and use these devices continues to go down. How can we as mental health professionals advise families about the risk and the impacts of this technological exposure, given all the things that the two of you discussed that require young people to be online? I'll kick things off. I'm very curious to hear what Dr. Deng says, but, you know, it's such an interesting question. I wish I was running into these parents, you know. Actually, I'm thankful that I'm not. Most of the time, parents come to me and they're already terrified. You know, I feel like perhaps it's the area that I'm practicing in, but I think that most I'm kind of doing the opposite a lot of times. I'm kind of being like, well, you know, there are good things about social media if it's used in moderation. I think most of the time it's doom and gloom from parents, but I think that if I were to run into a parent like that, I think the single most impactful thing I could possibly do is probably point them in the direction of commonsensemedia.org, to be honest. Have them read through one of the census reports and show them, you know, how negatively these things can impact young people. There was another Common Sense Media report that had a different statistic that I always find very telling and I like to share with parents, which is that 70 percent of young people and teenagers specifically who use social media know that they're being actively manipulated by social media and they still can't reduce their use. I find simple statistics like that, you know, that kids keep using it even though they know that they're being, you know, their arms are being twisted in certain ways. They're being shunted towards certain, you know, topics and certain news stories that they might otherwise not be. They're being shunted towards certain products that they might not otherwise be. I think that in and of itself is very terrifying and scary. Dr. Dang, any comments? Thank you, Dr. Sher. Yeah, yeah, so I think I agree with Dr. Sher mentioned about the comments. I think it's about the contents is really the key because nowadays it's just so accessible, it's so prevalent and there are a lot of good use of internet, of computers, of smartphones. So it's very, very difficult just to say get it out of our life, right? It's just not possible. So the nutrition of the contents, right? So I know Dr. Kimberley who's one of the pioneer psychologists in this field actually brought up a concept of digital diet, right? So similar to the food we are taking in, so the exposure to the contents, I think that's the key. So I always talk with parents about this, like not only you need to know the time limit, right? So for example, for kids, they are important to keep up the school. It's a lot of school time, they have hours already and to keep up on sleep, right? So you cannot have like five hours of gaming, then you definitely are going to lose some quality sleep hours, right? But not only the screen time is about the contents, right? So make sure parents go through so you know what your kids are exposed to. Sometimes, for example, gaming, right? It's so popular and it's so difficult to control. Maybe play a game with your kids together so you know what they are exposed to or pre-play, like just do it on your own before your kids get exposed. I think the contents are the key. Well, thank you guys so much. I mean, that is such excellent advice about what we as psychiatrists can do to help families address this specific issue. And the only thing that I would add is we can also support the Bipartisan Protecting Kids on Social Media Act, which was introduced in 2022, which protects children who are under 18 years of age from AI algorithms and prohibits kids who are younger than 13 from social media platform access at all. And so those bills are working their way through Congress and those are things that we actually could support to help us address some of these issues. So thank you so much for all of that important and excellent information. Are there questions from our participants? We have a few minutes to answer questions now. So there's a lot of stuff in the chat. Okay. I don't, you know what, I don't know how to unmute someone with a raised hand. So there's a raised hand in the Q&A. Gabrielle or Fatima? We will take a look and make something happen. Okay, thank you. Yeah, there we go. There we go. Okay. They have access now. Hello. Can you hear me? Yes. Perfect. So hi guys. I'm Chaitanya and I'm 16 years old. I go to Dublin High School and I came to this webinar to learn more about this because it's a very real and prevalent subject that we as youth go through, even in elders, elderly people, very young kids too. And a question I had was, although I understand that definitely putting placement on internet usage, the different apps people access, I think a big part is having choice and having healthy communication within familial relationships, friendships, etc. And I feel like there's a conversational divide within it. And one thing I'm trying to do amongst my peers in school is create different forums where families and students can come together just to learn how to communicate in a healthy manner. Because like Dr. Deng brought up, there is a cultural divide. There are internalized beliefs and values that can make it very, very hard to modernize and evolve, especially as social culture changes. And I feel like in the youth and parents, it makes it very hard. So I was wondering, would you guys feel comfortable sharing your contact information or different resources that we can share to people so we can further normalize this and help continue to create that space? Yeah, I'm happy to share my email address. Yeah, so I don't know if Fatima is the best way to do that. Like on the website, I'm happy to share my Stanford email address. I can type it in the chat if that works. Yeah, yeah. And another thing I noticed is that there, Natalie Wu shared resources from the ACAP Media Resource Center. And then there are always also resources that can be assessed online through the American Academy of Pediatrics. It's interesting. I work with a school local to the area called Kent Place, and they have a club that sounds very much like what Chaitanya was talking about. And first off, 16-year-old attending an APA webinar. I don't want to tell you what I was doing at 16, but I think Chaitanya is going to grow up to be the best psychiatrist in the world. But they have basically a safe space where young people can talk about what's been going on in social media, and they encourage them to make it a narrative. It's like a storytelling exercise. And I think there are so many, they call it reboot, and they're trying to manualize it and spread it out. I think a lot of schools are realizing that there's a problem and trying to address things in this way. I think it's a shame that there isn't some way that all of these disparate schools and interests can effectively communicate and collaborate. But I think it's going to lead to a plurality of different interventions that can be effective for this kind of thing. And I'm sure Chaitanya is going to come up with probably like the most effective one. And I put my email in the chat for you. So we had another hand raised. Correct. I'll let them in. Hello. We can hear you now, Dr. Singh. Okay. So my name is Taha Sinarwala, and I just wanted to ask that we talked so much about social media addiction and how it affects kids. So would it be possible that we can prevent social media addiction by changing the minimum age that is required to create an account on social media? So that is actually one of the proposals that's in Congress right now. I mean, unfortunately, our Congress is not doing a lot of stuff. But yes, this social media bill that's moving forward, that's a bipartisan bill. And interestingly, a lot of the children's mental health bills are bipartisan bills. They're actually trying to prohibit the use of social media platforms for individuals under 13. And the algorithms targeting young people that Dr. Shera mentioned earlier, they're actually trying to prohibit those activities for individuals under 18. And we're thinking that those could prevent some of the harms we're seeing with social media. Probably not all of them, but some of them. And just to clarify, a lot of these social media apps, they have like a minimum age of 18, right? Like Facebook and Instagram, they have a minimum age for 18 to create an account. So is there a way that we can persuade people to actually have a stricter check on like who they let in? Because I've seen a lot of students who are like 13 or 14 create accounts and then have access to social media. I have too. And I mean, I have a couple, I don't know the answer. I don't know if restricting the age will be like a very effective way to do this, but I worry about this for a couple of reasons. I think it needs to happen, but I worry that when it happens, it's going to shunt kids to other social media platforms that don't meet the definition in the same way that TikTok or Snapchat do, but offer much of the same functionality, but in perhaps a different format that is difficult for us adults to fully comprehend like Discord or Twitch. You know, these are social media platforms, but if you ask any adult what Discord is or how it works or why a kid would use it, I think we'd all be at pains to really explain it. But on the other hand, it's one of the biggest platforms out there, specifically with regards to gaming and gaming subcultures. I also worry about, we often talk about that U-shaped curve that happens when we talk about the societal acceptance of a substance or behavior and its harm, right? And when something is very just socially accepted, there's a lot of harm, like alcohol. Alcohol is glamorized, socially accepted, and it leads to a tremendous disease burden. On the other hand, it goes the other way. When something is demonized and kind of, you know, never allowed, I think kids look at that and they go, oh, that's pretty cool. I want to know what that's all about. So I worry about that too. Well, thank you. And I think that would actually be a whole other series for us. So in our remaining minutes, I'd like to introduce Fatima Reynolds so she can take care of some of the housekeeping issues that we need before we close the meeting. Yes. Hello, everyone. I would like to thank our esteemed panelists for joining us tonight and our amazing moderator, Dr. Benton, as well. And thank you all for joining us. We're posting the survey in the chat right now. Please complete our survey. That's the way we can know about topics of interest and how we did on this one as well. And also join us on April 30th for the Moynihan Report Revisited. We're going to be having a discussion on the Moynihan Report in lieu of its anniversary. You can also find our past webinars available on our Learning Center for CME Credit here. I'm posting it in the chat. It's psychiatry.org looking beyond. So you can see all the past ones in this series. And thank you all and good night. Thank you. I had so much fun. Thank you, guys. Good night, everybody.

APA Lookin' Beyond series

mental health inequities

substance use

addiction

minoritized communities

technology addiction

suicidality

cultural considerations

social media addiction