Harold and Elizabeth sit down to discuss the impact COVID-19 has had on cognitive development and daily routines for many children and adolescents. Harold also shares tips for what parents and physicians can do to address and strengthen a child’s mental health.

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Episode transcript

Elizabeth Vargas:

Harold Koplewicz, welcome to Heart of the Matter. It’s great to have you.

Harold Koplewicz:

It’s a pleasure to be with you, Elizabeth.

Elizabeth Vargas:

You know what? It’s incredibly, incredibly important. We have you right now. I just want to read you some headlines from some recent … Just in the last, I would say month, six weeks. Some recent headlines from newspapers. Teens in distress are swamping pediatricians. Hundreds of suicidal teens sleep in ERs every night. It’s life or death, the mental health crisis among US teens. Eight-year-olds in despair, why the mental health crisis is getting younger and where the despairing log on to learn ways to die. My God. These headlines, and these are just a handful. We are in trouble when it comes to our kids, and our teens, and our young adults, and mental health.

Harold Koplewicz:

I agree with you. Our kids are not okay, and COVID has just made it worse. I think we should step back for a moment and just get some basic facts. The most common illnesses of childhood and adolescents are mental health disorders. One out of five kids have one of these disorders. And in fact, compared to seven million kids who have asthma, and seven million kids who have peanut allergy, and 200,000 that have diabetes, and 15,000 that have cancer, 17.1 million children in the United States have a mental health disorder. So if you took all those others, asthma, peanut allergy, diabetes, and cancer, that’s 14,215,000 and here we have 17 million. So that means that everyone listening knows and loves one of these kids. So if it’s not your child, then it’s your niece or nephew or it’s your best friend from college’s child or it’s your child’s best friend. They are people who are struggling and suffering right underneath our nose. And that’s before COVID.

So before COVID, we had less than 9,000 child and adolescent psychiatrists in this country. We had less than 4,000 child and adolescent psychologists. In other words, people who actually trained in child psychology versus general psychology. And we knew that we didn’t even have enough hospital beds for the kids who get that symptomatic that they need the safety of being in the hospital and we knew all of this before COVID. And there’s many reasons for it. Psychiatry and psychology don’t pay as well as other procedure-driven specialties. A hospital that has a liver transplant unit versus a child psychiatric unit, they going to make a lot more money on those transplants. Cancer makes more money in a hospital. So there’s economic reasons why a lot of those services aren’t available, but the suicide rate and the suicide attempts went up precipitously about five years, the five years that preceded COVID. So from around 2007 to 2018, we saw an increase from 600,000 attempts every year that landed in emergency rooms to 1.2 million. That means one every 30 seconds, Elizabeth.

Elizabeth Vargas:

Wait, wait. One kid every 30 seconds is showing up.

Harold Koplewicz:

In the United States is showing up in an emergency room because of either very bad suicidal ideation or actually a suicide attempt. And we went from a death rate of 5,000 young people dying from suicide to 6,120. Imagine that increase if that was an increase in cancer, or an increase in seizure deaths, or increase in traffic deaths. That would be on the front page of every paper. So none of that really alarmed us before COVID. And then COVID came around and we know that COVID has been awful for everyone’s mental health. It doesn’t cause mental health disorders, but it certainly takes the children who were struggling before who weren’t getting any help and made them more symptomatic. Kids who lost their routine of going to school, waking up at a certain time, of moving from one class to another socially anxious kids who struggled with social interaction, but now were at home. So they weren’t struggling as much. But now they’re back in school so they’re struggling even more. Kids who had depression before. Certainly poor kids, black kids, kids of color all struggled more because of the way school worked for them. They were much less likely to get synchronized in Zoom learning.

So a bad situation has been made horrific. And some of those headlines show it. You go to an emergency room, there’s no bed for a kid who has a psychiatric disorder and they stay lot. Some of them get handcuffed to a stretcher because they don’t want them hurting themselves, but they’re there for two, three, four days while people are looking for a bed and you call around for an appointment and you can see that public clinics have appointments a month, two months, three months. A developmental pediatrician told me at one of the local hospitals that they’re booking 14 months in advance. Now, you tell me that if you have to see a developmental pediatrician about your kid’s ADHD or about their learning disorder, you’re going to wait 14 months? A whole school year is going to go away and the kids’ problems are only going to get worse and be exacerbated. So we have a national epidemic of psychiatric disorders among kids.

Elizabeth Vargas:

The US Surgeon General said that we have a quote, “devastating mental health crisis when it comes to our teenagers and young adults.” And you say that this was actually already an issue pre-pandemic, and it’s obviously been exacerbated in the pandemic. So let’s break all this down. First of all, when we just talk about the pandemic and all the anxiety and depression that everybody across the spectrum, no matter how old or how young you are, is grappling with, are teens, and kids, and young adults more vulnerable to the consequences of anxiety and depression more likely to be severely anxious or severely depressed than adults? And if so, why?

Harold Koplewicz:

We’ll do a little neuroscience. So there’s a reason why Hertz doesn’t rent you a car until you’re 25 years old. They have figured out that kids between the ages of 18 and 24 have more car accidents than people who are above 25 years of age. It’s a business decision. So next time you go on vacation, you want to rent a car and you want your 19-year-old or 20-year-old son or daughter to drive, they’ll say, “They’re not covered under the standard policy. If you want to pay much more, we’ll give you that permission, but you’re going to have to pay for it because we know.” Now, how do they know that? Well, they know that because the prefrontal cortex, the part of the brain that’s right behind your frontal bone right here behind your forehead, does not communicate to the rest of the brain until you hit 25. Which means the cause and effect.

Elizabeth Vargas:

For both boys and girls?

Harold Koplewicz:

Worse for boys. Boys are more like 27. Girls sometimes can be earlier. Teenagers just see opportunity. “Oh, there’s a very good looking person. Let’s have sex. There’s a terrific convertible. Let’s go for a ride.” Or, “There’s a bicycle or a motorcycle. Let’s hop on it.” Opportunity is always more important than risk. They don’t know how to evaluate risk. And if you remember your teen years, you were boiling, you were freezing, you were madly in love, you hated the other person. You had very intense emotions all the time. Now, once the prefrontal cortex starts communicating to the rest of the brain, you say, “Okay. Let’s have sex, but let’s have a condom.” Or, “Are you taking some kind of precaution?” Or, “Do I know you well enough?” Or, “What is the risk-benefit ratio of getting a venereal disease or getting someone pregnant? I really would like to go in that sports car, but I really know that I have to put a seatbelt on because in case I get into an accident, I don’t want my head bashed into the windshield.” Or, “I’m going to put a helmet on if I’m getting onto a motorcycle.” And it’s kind of amazing once that starts to happen, we see a real maturity.

However, after 24, it’s harder and harder to treat people for disease also, your brain has gotten older. So the reason why children and teenagers who get mental health disorders and most of them have their onset before, 50% before the age of 14, 75% before the age of 24-

Elizabeth Vargas:

Wait a minute. Wait. Back up and repeat that. Most kids and young adults-

Harold Koplewicz:

So most psychiatric illnesses have their onset. 50% of them have their onset before the age of 14. You get ADHD, you get separation anxiety disorder, you get obsessive compulsive disorder before you’re 14. There’s an additional 25% or 75% of all psychiatric illnesses occur before the age of 24. So Elizabeth, you and I are both more than 24. So if we got a psychiatric illness now, I could tell you might get depression, menopausal depression. I might get depression in my 60s. That’s when men get it. We might get dementia when we’re in our 80s, but that’s about it. You’re not developing new OCD, you’re not developing ADHD, you’re not developing social anxiety when you’re over 24.

Elizabeth Vargas:

No. I suffer from anxiety, but I have suffered from anxiety since I was six. So yeah.

Harold Koplewicz:

Right. And I will tell you that if you were my patient when you were six, we had a much better chance of doing something about it, especially if we used evidence-based treatments like cognitive behavioral therapy or even a low dose of an SSRI like Prozac on a six-year-old than on a 26-year-old, or on a 36-year-old, or a 56-year-old because your brain has gotten older, it’s more rigid, and you have patterns of behavior and patterns in your brain that are very, very hard to stop.

Elizabeth Vargas:

So it’s a good news, bad news thing.

Harold Koplewicz:

Correct.

Elizabeth Vargas:

The bad news is adolescents have wildly extreme emotions and moods. As the parent of two teenage boys, I can vouch for that. But the pre, the brain isn’t fully formed.

Harold Koplewicz:

Prefrontal cortex-

Elizabeth Vargas:

Cortex isn’t communicating.

Harold Koplewicz:

The cortex is there. It’s just not connecting to the rest of the brain.

Elizabeth Vargas:

So kids, and teenagers, and young adults aren’t fully appreciating risks, but the good news is if you can catch the mental health disorders, they’re treatable because the brain is more elastic because they’re young.

Harold Koplewicz:

So real common and very treatable. But also let’s talk about the good stuff about adolescents. The great stuff about adolescents is the creativity, the passion that they have. Do you remember that terrible event in Parkland? All those kids who died in that high school and then their classmates decided they were taking in on the NRA. And for a while, it really looked unbelievable. The impossible looked possible, and that’s what adolescent … So we see opportunity. And so it could be for the good, right?

Elizabeth Vargas:

Mm-hmm.

Harold Koplewicz:

If you see fashion is designed for them, not for us. They go to the limits, they take it to the edge. And some of that is really quite wonderful. And if adolescents really ends at 25, not really 18, but 25, you would also understand how college is a great time of adding another four years to let the brain settle, for you to do creative things, for you to learn. It’s also much easier to learn stuff when you’re under 24 than when you’re over 24. You take your two teenage boys and we drop them in the middle of China. No one speaks English. And we’ll come back three or four months later, your boys will be speaking Chinese. You drop me in the middle of China, I’ll be still doing sign language and pointing to food that I want to eat. So it’s like a lost cause of trying to teach me a foreign language in my 60s.

Elizabeth Vargas:

Let’s get back to what the Surgeon General is warning about with our teens and what I’m sure you are seeing at the Child Mind Institute. For example, I have read that teens report feeling especially lonely in the pandemic and that is triggering lots of the anxiety and depression. You told me recently that kids who witnessed 9/11, it took them four years, I believe, to get over that trauma. Do I have that correct?

Harold Koplewicz:

Absolutely right. After 9/11, there were many mental health services to start to be offered at the schools right around the World Trade Center. And we thought it made a lot of sense to provide those mental health services in the school. And the schools were very open to it. We were pretty convinced that the next semester or the next school year, the funding would disappear and the schools would basically say, “Thanks. But no, thanks.” Four years later, they were finding the funding and didn’t want us to leave. So I would tell you that we lost 3,000 people as a nation during 9/11. We’ve lost over a million Americans during COVID and 176,000 kids lost a caregiver. So if you think about the grief and trauma from the loss of someone who cared for you or the someone that was next to that or three degrees of separation or four degrees of separation, you can understand how millions of kids are going to be affected by that loss.

The other thing they lose is they’ve lost an academic year. I think we’re fooling ourselves to believe that they’re just going to catch up miraculously. For a lot of those kids, even little kids, we now see from kindergarten to second grade, when we check their reading levels, their reading levels are one standard deviation below what they were five years ago. Reading is something you have to teach. If you weren’t in school as a kindergartner, if you didn’t get it in first grade because you were Zooming, we have a lot of makeup to do. As a nation, I think we should do summer school, or academic boot camps, or after school study halls because we are going to have a nation who have a bunch of children who will have holes academically. Much easier to see, Elizabeth, than the holes we’re going to see emotionally. Kids who are going to feel less assertive, less ready to raise their hand, less ready to sleep away from home, and kids who are more moody.

Elizabeth Vargas:

In a recent article just a couple days ago actually in The Atlantic Magazine said that from 2009 to 2021, the share of American teenagers feeling “persistent sadness or hopelessness rose from 26% to 44%.” It’s the highest level of teenage sadness ever recorded.

Harold Koplewicz:

Think about it for a second. Adolescence is a tough time. There are five things that you’re supposed to do during adolescence. Adolescence starts the minute puberty starts. So puberty could be pigmented pubic hair for boys, it could be breast buds for girls. So it’s very subtle. And now you have about 12 years, from 11 to 24 or 12 to 24, to accomplish, A. Adjusting to the physical science of puberty. Hair on your body, body odor, menses. These are things you have to adjust to. Number two is you have to separate from mom and dad. You don’t walk out of the house, but you do start flirting with ideas that maybe they don’t like. You want to have an earring, or you want to have long hair, or you want to be a Democrat, or you want to be a Republican, or you like music that they can’t stand. You separate. And as you get to 24, you’re comfortable with that separation. You don’t have to live next to each other, you don’t have to speak five times a day, but when they come to town, you don’t have to leave town also. So you have a good separation.

The next thing you have to be able to do, the third is that you have to be able to start getting educational or vocational goals. So by the time I’m 24, I should say, “I want to be a doctor. I want to be a journalist. I want to be an actor. I want to be a lawyer.” People who at 40 still don’t know what they want to do professionally are very adolescent. And the next task is to develop a social network. And you start seeing this even in seventh grade. You sit at a lunch table with other people who love baseball or you sit at a lunch table where everyone is very studious, or the geeky kids, or the hot kids. It doesn’t really make a difference. You find your group.

If you saw the movie, Dear Evan Hansen, that feeling where Evan is coming back to school after summer vacation and feels totally isolated from everyone else, that feeling is actually a universal feeling, but most of us are able to get over that feeling and find that group. And that social network becomes very important because you are able to really be intimate with them. Not necessarily physically, but emotionally. I’ll tell you a secret, you’ll tell me a secret. I won’t judge you on it. And some of those people can become lifelong friends.

The last thing is, you have to figure out what turns you on physically, sexually. You don’t have to have sex to know that because the largest sex organ in your body is between your ears, it’s your brain. So what is turning you on when you think about it? And you have to become comfortable with whatever that is, whether it’s straight, gay, bi, trans, that’s a lot of stuff, especially when hormones are throwing themselves all around your body, your body seems to be changing every day and your brain is changing also.

So on a good day, adolescence is trying. On a bad day like COVID, which went on for what? Two years now. And you don’t have the routine, you don’t have the drama club, you don’t have the tennis team. You don’t have the football team, you don’t have those structures that make it easy, you don’t even have two shy kids sitting next to each other in class who whisper to each other, “I don’t understand what’s going on.” Or, “Isn’t that teacher just the biggest jerk ever?” You lose all of that and you could understand how loneliness is going to increase.

Elizabeth Vargas:

So what’s the solution to that? And why is the loneliness persisting even though schools are opening back up and kids are going back? In other words, we’re no longer locked down, we’re no longer Zoom schooling. Kids are going back. Why are we still seeing these astronomically high levels of loneliness, and anxiety, and depression?

Harold Koplewicz:

So I would tell you that it’s not that quick. It’s not turn it on, turn it off. Certainly the kids who had that social anxiety, the kids who were pathologically self-conscious don’t know … “Am I using my hands too much? Are people judging me because of that? Am I not sitting up straight?” All the things that are in these kids’ head, which basically freezes them. For those kids to go back to school is very anxiety provoking. They can’t wait for school to end again because it took them a while to get the best treatment for this. It’s called exposure response prevention. And the exposure is attending school.

So I would tell you that if I was a parent and I had a child that’s struggling, I would set it up to make it easier. I would make sure we’re having a barbecue in our backyard with lots of cousins and maybe some neighbors. Not too many, but many barbecues, but a small group of people to make it easier for my child to practice social skills. If that doesn’t work, I would go to church or synagogue and there’s all these youth groups. Again, something protected something small to get my son and daughter to practice and to also say, “There’s no permanent record card here. We’re just practicing.”

I would also practice at the table. I would ask my child to ask me three ‘you’ questions and I will ask you three ‘you’ questions. Everyone likes to talk about themselves. And just do things that you would think a child knows naturally and not every kid gets. My oldest son is still a man of very few words, but as a child, we used to practice how to shake hands that it was a puzzle and both hands went in. “Look me in the eye long enough to tell me what color my irises are. Remember to ask me ‘you’ questions because everyone likes to talk about themselves and then that a person will ask you questions. If they don’t, you’re done. You don’t have to worry about it.” I have a third son who could teach those social skills. He could run for mayor. He doesn’t have some of the assets that my first son has. My first son was one of these straight A kind of kids who didn’t have to work very hard, but I think you give each child what they need. And right now you have to look and see, is my kid behaving and acting the way they would typically behave pre-COVID? Are they passionate about baseball? Are they really interested in the TV programs they used to be in? And I would force conversations in the way that you would lean into a client.

So find out what they’re interested in and then find out if you can talk about that. Make sure you are watching a TV program they’re watching, make sure you’re following the team that they’re following so that you can ask the right questions. And don’t ask questions that are, “How was school today?” You’re going to get good or bad. “What was your favorite part of school today? What was the worst part of the school day?” I remember these days asking my kids, “What did you learn today?” And most of the time they would say, “Nothing.” And since they went to private school, I said, “I’m going to have to call tomorrow. I want to refund. I am paying a lot of money and you learn nothing.” “Okay, dad. Okay. Cut it out. We had a discussion about something.” And it was not only that I was interested, but I wanted that give and take. And sometimes that means that I have to tell them what was the worst part of my day.

Elizabeth Vargas:

These are great skills for teenagers who may be struggling with these issues, but the issue isn’t quite yet serious.

Harold Koplewicz:

Correct.

Elizabeth Vargas:

And for those kids, we know that more than one in four girls have reported seriously contemplating suicide during the pandemic. Nearly half of LGBTQ teenagers have contemplated suicide during the pandemic. It’s not just a matter of we’re finding it more because we’re asking about it more. The objective measures of teen anxiety and depression are also up. Eating disorders, self-harm, teen suicides. There are plenty of blinking red lights warning that we have an issue here.

Harold Koplewicz:

Right. So I think that parents, again, have to be aware of who their kid is. Is their child sleeping properly or are they having difficulty? Is their appetite increased or decreased? And to be able to say, “I read this article that so many teenagers are thinking about hurting themselves. Have you ever thought about that?” Can you imagine? It’s a very hard conversation and if they say, “Yes.” And you say, “That’s worrisome. How often does that happen? Have you talked to anyone about it at school? Why don’t we go and talk to your pediatrician about it?” Or, “Why don’t we go get a mental health professional to talk about it? Because that bothers me. That you’re in that much pain. And as your parent, I’m here to make sure that you don’t have to suffer.” I think that parents have to be better informed today than ever before.

Elizabeth Vargas:

Well, they also have to be better informed because they’re on their own to a large extent. The other statistic that you mentioned at the beginning here that really is staggering, is that 70%, seven, zero percent of US counties have no adolescent psychiatrists.

Harold Koplewicz:

Child or adolescent psychiatrists. And not one. 70% of all the counties. Not one.

Elizabeth Vargas:

So what are you supposed to do?

Harold Koplewicz:

So when we started the Child Mind Institute almost 13 years ago, the idea of a website was clever, but how important would that be? Our science was going to really break through. We were going to find biomarkers. Our care that we were giving is evidence-based. So we weren’t going to make kids come 40 times if they didn’t have to. They might only come 16 times in a year. That’s where we were focused. And it turns out that the biggest impact we’ve had is with our website, childmind.org. That parents are desperate for evidence-based treatments, scientifically sound that isn’t paid for by a pharmaceutical company, or by a liquor company, or a gun company. It’s just scientifically sound information. And so during COVID, we went from half a million unique visitors a month to 2.1 million.

Elizabeth Vargas:

You quadrupled?

Harold Koplewicz:

Yes. And one day last week, we had 110,000 people after the shootings. 110,000 unique visitors in that one day. That would be the equivalent of three million, but parents are hungry for information and they want a place that they can trust. And the internet is unreliable sometimes. But I think that if they come to Child Mind, they see that we’re not taking money from anybody else, that we’re not even saying, “Please come here to get treated.” That’s not the goal. The goal is that a better informed parent is going to be a better parent.

Elizabeth Vargas:

Do you give them warning signs? Do you give them tips on how to-

Harold Koplewicz:

We even have a symptom checker, Elizabeth. So you could go on, put in what do you think the symptoms are, and then they’ll give you a differential diagnosis. “These are the five most likely things, including normal development.” Or, “These are three things that you should be worried about.” Which makes you more informed. So you pick up the phone, you call the pediatrician, you said, “I filled this out from Child Mind. I think we have to be concerned. It seems that two or three of them are major depression or anxiety disorder. Where is the best place that I can go to get my child treated nearby?”

Elizabeth Vargas:

So we know that kids, and adolescents, and teens crave order and stability, and that was upended in the pandemic. We also know that kids and adolescents need to feel safe. That is our number one job as parents. Is to make sure our kids are safe and that they feel safe. You just mentioned you had a 110,000 parents come onto your website asking for help the day after the shooting at … in Uvalde, Texas. What do you do? My God. The mass shootings are … We can’t even count them anymore. They’re happening almost every single day in this country. We have the pandemic, we have a level of vitriol when it comes to our political discussions, whether it’s on television, or online, or even on the street between people who don’t agree. And they can’t even disagree in a way that is respectful or it makes any attempt to actually hearing what the other person has to say. All of that I’ve got to think has got to impact. And even if the kids aren’t watching political news and reading newspapers, it’s on in the background, they hear what’s going on. They know it. They can feel what’s in the air and what’s in the air right now, Harold, is pretty stressful for me. I can’t imagine how it is for kids.

Harold Koplewicz:

We should start thinking about what we … how we treat mental health versus physical health. And there was an article not too long ago that came out from the CDC suggesting that all children, eight and above, should be screened for anxiety disorders. And I would tell you that’s too late. Kids have anxiety at five. So if we’re going to do vision and hearing at school every year, and I would tell you the pickup of anything positive is very small, I would rather that every pediatrician screen for anxiety in their waiting room for the annual visit.

Elizabeth Vargas:

How do you do that? How do you screen for anxiety?

Harold Koplewicz:

If you give parents a pad and you say, “Is your child frightened of the following? When your child sees one of these things, does it impair their functioning? Does your child have trouble going to sleep? Does your child not speak in front of strangers? Does your child wash their hand or do repetitive behaviors?” You just go through this. Now, at the end, the doctor will say, “You know what? You just fill this out. And there’s some stuff that’s here that’s significant. I would recommend that you do something about this because the treatment response is much greater for younger kids. A parent always has the right to say, “I don’t want to do anything about it.” But to pretend that it doesn’t exist is insanity. We check kids vision and we check their hearing, but we are not going to go after the more common disorder.

The other piece that really is disconcerting is that we have lots of pediatricians in the United States and none of them get formal training in mental health when they do their residency. They learn about diabetes, they learn about cancer, and cardiology problems, and endocrinological problems, which are all important, but not as common as being able to diagnose ADHD and treat it, depression, anxiety, and autism. If they could do those four, they could be the first line of defense in an army that we need to tackle this mental … This is a public health problem. And what bothers me is everyone says, “Oh, it’s impossible.” It’s not impossible. This is the nation that took on polio. I’m old enough to remember when I went to Sunday school. They threw you in the back of a station wagon and you bumped around with six other kids. Today, I can’t get into a taxi without putting a seatbelt on. We tackled AIDS.

There was a scary time in the seventies where people were afraid to shake hands with people, let alone kiss them, because AIDS was in the air. We have medicines now that let people who have AIDS have phenomenally full lives. So it’s either a matter of priority and that we’re going to tackle this with the same kind of rigor and robustness that we tackle cancer. So we need to add more money to the national institutes of health. We need to figure out how to train pediatricians better and give them more money if they are willing to take on this extra training. And I am sure this can be fixed. This is America for God’s sake. We literally take on almost anything.

Elizabeth Vargas:

Just to point out. They don’t study anxiety, and depression, and mental health issues. They don’t screen for them and yet mental health issues are more likely to affect their patients, these kids, than anything else.

Harold Koplewicz:

Right.

Elizabeth Vargas:

Anything else?

Harold Koplewicz:

By the way, how about the fact, Elizabeth, that now the new thing that we’re doing is we need to have passenger vehicles that are going to take us into outer space. This has become so important. It drives me crazy. I can’t identify with billionaires, but people have so much money that they’re going up for these, what? 10 minute rides up in the sky and then they come down. Well, give me a few of those people, put them in a room. They’re super smart, they certainly knew how to make up a lot of money. Let’s tackle this. Now, I have to tell you, you have a phenomenal governor in the United States, Gavin Newsom, who personally suffers from dyslexia, who last year put $4.4 billion into the California budget. Not this year, but last year. And they are spending it over the next four or five years. They’re building more psychiatric beds for kids and teenagers. They’re going to incentivize hospitals to add those units. They’re going to train more and more social workers, and psychologists, and marital and family therapists in evidence-based treatments. They’re developing a portal for parents. So when you’re worried, you know where to go.

It’s historic. No one has ever put $4.4 billion into children’s mental health, but most states right now have surpluses. This makes a lot of sense. This is what you should be spending some money on because kids who are anxious and depressed are more likely to feel hopeless. And hopeless people are more likely to try to hurt themselves.

Elizabeth Vargas:

But get back to my original question, which was how all of this is impacting our kids’ mental health.

Harold Koplewicz:

The kids who are going to be most at risk from the post COVID era are the kids who had these disorders and weren’t getting treated. So the most common disorder among all the psychiatric disorders are anxiety. And 80% of kids who have anxiety do not get identified or treated because they internalize. Their thoughts are inside their head. Sometimes they’re really good children or sometimes they’re really quiet kids. The kids who get most treatment are the disruptive kids. The kids who have contact problems or ADHD, they’re very noisy and so therefore they get attention. So the kids who were quiet or moody, those are the kids who are most sensitive to this toxicity. This is toxic for them. And for the overwhelming majority of kids, they are really quite resilient. They just go through it, they power through it and it doesn’t affect them. But that doesn’t mean that as a parent, we shouldn’t be screening, we shouldn’t be asking questions. We should be watching our kids sleep, their appetites, their joyful activities, and how they’re performing in life. Those are things that are telltale signs that maybe my kid has one of these disorders.

Elizabeth Vargas:

With a lot of people, there was a lot of discussion during the pandemic. Thank God for the internet because we could all work through Zoom and connect through Zoom meetings of different kinds where kids could go to school on Zoom. But there’s the good side and the bad side. For our kids, the only way they could connect was on social media. And we have seen as a result of that and of literally all the other socialization fell off entirely during the lockdown and during the first year of the pandemic. It may be coming back now and in fits and starts for everybody. But we do know statistically, we’ve seen hearings about this on Capitol Hill about the impact of social media on our kids’ brains, on girls in particular, which is … it’s pretty amazing. One third of teenage girls said Instagram made them feel worse. Talk about the fact that thing that got us through the pandemic and connected us in ways that we couldn’t connect in person has a real downside and a dangerous side for some kids.

Harold Koplewicz:

We can’t prove cause and effect, but there’s definitely a correlation in the fact that the use of the internet jumped in the 10 years before COVID hit. And that’s exactly when we saw more suicide, we saw more suicide attempts, more suicide completions. So we didn’t change the water supply, we didn’t change the telephone poles or the telephone wires. So the one thing that did change in America was a lot of social media. I think social, it’s not all bad. For kids who are very isolated, lonely, and particularly feel vulnerable and they can find a group of people who feel similar to them, some kind of group, that could be very helpful. But it is a rabbit hole that you can go down and you can spend endless hours. And we have done a study recently during COVID that there are a group of kids who have something we call problematic internet usage and they use the internet and social media about eight hours or more a day. And that if they had a preexisting depression or a preexisting ADHD, their symptoms got worse.

Now, what would really surprise me is it didn’t make anxiety worse. It would seem to me that it would, but the science didn’t prove that. So that means that if you have a child, you have to be aware of how much time they’re spending on the internet. There has to be times, first of all, at bedtime that you’re going to have to take your kids’ laptop, and phone, and maybe take the computer out of the room. That there’s got to be eight hours of no internet.

Elizabeth Vargas:

And what age do you start … I did that with my kids. But once they got to be like in high school, my confiscating the electronic devices at bedtime, I couldn’t do it-

Harold Koplewicz:

Right. But then you have to have a discuss-

Elizabeth Vargas:

… because he’s doing homework on his laptop.

Harold Koplewicz:

Right. But then you have to discuss what time are you turning that computer off or what time is your house turning the WiFi off? Because it’s very addictive. It reminds me of Netflix. I tell everyone that self-care is childcare. And that the first thing they have to do is they have to sleep at least seven hours as an adult, they have to eat something green, they have to go take a walk every day or do something physical, and they also have to do some mindfulness or spirituality. And during COVID, that became very difficult. And post-COVID people are just more lethargic. So it’s very easy to sit in front of the TV at 11:00 and watch one more episode or one more … just one more episode or whatever you’re watching…

Elizabeth Vargas:

Yeah. Guilty as charged.

Harold Koplewicz:

…. and now it’s 1:00. It’s not 11:00 when you go to sleep. So I would tell you that kids don’t have that self-control. And you have to have a discussion with them to say, “This is what we’re going to do.” You also have to model. I think most of us have to go on a social media diet. I think we’ve been on it so much during COVID that it might make sense that on a Sunday to say, “Well, half of Sunday we’re not going to use our devices. From the time we wake up till 1:00, we’re not going to use our devices.” And certainly during meal time. Can we please put it in a basket? And meals are only going the last 30 minutes. I’ll model for you. I’m not a cardiac surgeon and I’m not on call. So if someone needs me they could wait 30 minutes. I think it’s very hard to stop, but I think we have to model that kind of … The same way you should model some mindfulness, and some exercise, and eating well, and sleeping well, we have to get those devices back under control for our kids.

We’re trying to do a project now on how can we make social media positive for mental health? The whole idea of the Metaverse. McDonald’s is now in the Metaverse, Nike is in the Metaverse. If that’s the case, maybe the Child Mind Institute should be in the Metaverse, but what would we provide for those kids? And how do you turn a negative into a positive, especially when frankly, the companies that are producing this, Facebook, and Instagram, and Snapchat, want you to spend a lot of time? Their goal is to keep your eyeballs on them as long as possible. Those eyeballs really have to be doing social things with real live people and they have to be reading real live books and doing real live academic work. And so it’s going to be a tough one to figure out how we can collaborate with them.

Elizabeth Vargas:

Bottom line, final question, Harold. The trend lines are all going in the wrong direction. The leading CDC, Surgeon General, everybody is saying this is a devastating crisis, an extreme crisis. These are their words, not mine.

Harold Koplewicz:

Right.

Elizabeth Vargas:

What is it going to take to reverse the trend? God, help us. It’s not going to continue in this direction. Is it?

Harold Koplewicz:

First of all, you have to remember that I am dangerously optimistic. So I just have to tell you, I started an independent nonprofit in 2009 in the middle of an economic tsunami and it’s worked out, but I think there are two silver linings to COVID. One is telehealth, certainly for mental health. I don’t think that’s going to go away. I think there’s a whole bunch of new products out there where people are able to get quality care in their home without driving 100 miles or much more efficient for kids who have homework and have very busy schedules. So that’s one. And I think the second good news is that everyone is talking about child mental health. Maybe they’re talking about it for the wrong reasons because they don’t want to talk about gun safety, but I think in general, post-COVID everyone is concerned about their child’s mental health. Not that they may have a mental health disorder, but their mental health might have been negatively affected by COVID. And I think that’s the first time that’s ever happened.

We got more people to participate in this year’s campaign Dare to Share in May for Mental Health Awareness Month than ever before. Celebrities seem to be less embarrassed. The stigma must be decreasing a little bit. It’s not completely gone. And that means that as we move in that direction, I think two things will happen. Once people are worried about their kids’ mental health, the next step is to say, “Well, we need more resources. The government has to allocate more resources for research and has to allocate more money for clinical programs.” It’s very simple. If you pay a hospital money to prioritize child mental health over cancer or over heart disease, they’re going to do that. And I think that only happens when citizens protest. When someone says, “This is unacceptable. The suicide rate cannot go above 6,120. We can’t lose a whole bunch more young people next year from a disease that’s taking away more lives than all the other physical illnesses we have out there.

Elizabeth Vargas:

Right.

Harold Koplewicz:

So I think there’s hope as long as we’re not complacent. As long as we say, “This is bad. What are we going to do about it?”

Elizabeth Vargas:

It’s bad.

Harold Koplewicz:

But Elizabeth, we did take care of polio, we did tackle AIDS. Traffic deaths with seat belts have decreased. Drunk driving went down when we raised the drinking age to 21. So there are things that we can do. We have lots of smart people. The only thing that’s different right now is the divisiveness we have in our nation right now, but I don’t think there’s much to divide us when it comes to thinking about the importance of mental health for our kids. If their kids are not mentally healthy, they can’t attend school. And if they attend school, they can’t focus and be present. They don’t have the energy for sports. They don’t have the energy to do extracurricular activities. That as a nation should really concern us because academic productivity is what makes kids successful professionally later on in life and mental health disorders are barriers to learning.

Elizabeth Vargas:

I would encourage our listeners to go onto the childmind.org website and take that questionnaire if you’re concerned about your child. The warning signs are there, resources are there. Increasingly, you can find help. So let’s hope it continues to grow. Harold Koplewicz, thank you so much for being with us today in Heart of the Matter and thanks so much for all of your work at the Child Mind Institute, to help kids and adolescents live better, happier lives.

Harold Koplewicz:

Thank you for your support and your friendship and for doing this podcast.

Elizabeth Vargas:

Thanks, Harold.