Greg Fritz, MD (Host 1): Welcome back to Mindcast, a podcast from the children's mental health experts at Bradley Hospital. I'm your host, Dr. Greg Fritz. And I'm joined by my co host, Dr. Tanuja Gandhi. With lawmakers seeking to ban social media for teens in some states across the country and some schools wanting to ban cell phones during the entire school day, we wanted to take a deeper dive into screens and social media. We're thrilled to be joined today by Dr. Henry Sachs, President of Bradley Hospital. Welcome, Henry.

Henry Sachs, MD: Thank you. Thank you for having me.

Tanuja Gandhi, MD (Host 2): Welcome, Dr. Sachs, and thanks, Greg. The reality is most kids have access to some kind of device, a social media app nowadays. And I understand the concern around it, that parents and policy makers and lawmakers have, around safety of kids and thus wanting to put some protections and safeguards in place. Because social media is a world that never ends. And you can get, as a child, involved in unlimited screen time, scrolling and finding things that are fun and exciting, and going on videos, which often have an automatic next play.

However, you know, they're like everything, there are pros and cons to social media use, and there are the benefits and challenges. Many kids use social media to make friends, connect with the world, socialize. And while social media can be instrumental in connecting people and sharing information, we do know that it can be dangerous and harmful in many other ways. So today, we want to focus on highlighting all these different aspects as best as possible in the time we have together. So Dr. Sachs, maybe we could start with talking about what you're seeing on the inpatient unit and the clinical service you work on with children using social media. What's your experience nowadays?

Henry Sachs, MD: Well, most of the children I work with are those who have autism or developmental disabilities. Some are on the autism spectrum for many of them. And I think we're seeing sort of the pros and cons of social media on a pretty regular basis. There's clearly, for some who have challenges developing relationships and friendships, a certain anxiety being in a larger group and trying to steer the challenges of complex social interactions. Having one-on-one relationships through social media outlets has actually been helpful for some of those children. They've been able to make relationships sometimes at distance, but that they feel connected to and actually helps them come out a little bit more of their shell and be more engaged and develop some social skills related to that.

On the other hand, we've also seen situations where children who don't maybe have the social awareness of others and sort of the insight who've been taken advantage of in these situations. One example we had very recently was a young man who in school started to spew out Nazi statements and very challenging anti-racial comments. And when they actually brought him out of school, they got the police involved, he ended up in the emergency room, he ended up with us. And what was clear is that he had befriended someone on social media and this person had taken advantage of his sort of social isolation and made a relationship with him and started to feed him a lot of information with a very specific philosophical bend to it that he accepted readily and started to say as his own without understanding the full implications of that and got himself into an awful lot of trouble. And the example I give is he was making some very challenging racial comments, about, you know, populations, about the black population in particular, as an example. And later on, when you would sit there with him and ask him who's his favorite staff on the unit, he would actually name multiple black members of the staff, not realizing what he was saying as a global indictment of a racial group would have any impact on those people who he actually found very friendly and enjoyable.

Host 2: That sounds very challenging. And in the work that we do, often children who come to us are very vulnerable. And I've realized working on the Children's Inpatient Unit that children can have different levels of understanding, be it by age or development, but that is not apparent on the social media sites or apps that they're using. And the content is there for everybody to use and often kids don't know what to make of what they're seeing. And we've seen many instances where children have access to content which is definitely not age-appropriate or appropriate to their level of development, and it creates a lot of problems both at home and school and their interactions with friends and family.

Host 1: This is such a complicated issue. And for every positive, there's a negative and every negative, there's a complication. And so, think about parents who are listening and they're trying to judge whether their kids are having difficulties or there are dangers or something associated with their. social media use. What are the signs that they should evaluate? What signals that there might be a problem going on?

Henry Sachs, MD: I think there's probably a few signals from my perspective. One is that they become more socially isolated in the real world, in real time with people around them. That activities that they used to participate in, whether it's sports or clubs or teams, they start to move away from those things and tend to isolate themselves more just to engage with their telephone or whatever other method they're using to engage for their social media. I also think if you start to hear them talking about topics and things, having a point of view that seems very different than what they had before, without an understanding why they just had this discussion in class and a history class or a social studies class or something like that, you know, where is this coming from and how does it seem to be reflecting their worldview, is probably signs that someone is influencing them and maybe having an adverse impact on them.

Host 1: So, those are qualitative things rather than they're spending X number of hours in front of the screen or something like that. You're talking about actual behaviors that are concerning.

Henry Sachs, MD: Yes. I think it's an interesting question and I'm not sure there's great data on what's the best number of hours that they should be in front of them. But when it starts impacting their entire level of activity and functioning, that's when I would start to be concerned about it. And that might be quite a few hours and it might be relatively short.

Host 2: I think in addition to that, what we've seen on some of the clinical units that we work on is, oftentimes, children get really used to that routine of spending hours in social media or video games or whatever they're doing. And it's really hard for them to have a life without access. And the biggest part of it, if you're seeing like older kids, it's the need to know in real time what's happening with their friends or status updates or pictures and likes and tuning into what people are doing or thinking or reacting to things that they're interested in or even about them.

Henry Sachs, MD: Well, I mean, so much of their self-value is based on pretty unusual metrics, things that we would not have necessarily measured in the past. If I post a picture, how many people like it within a certain amount of time, all of a sudden becomes a metric of how popular I am and how I'm part of the group. That's a lot of work. That's a lot of effort and you're taking your sense of self and giving control of that to someone else. Now, teenagers to some extent do that anyway, but this is now, and it's such a speeded up process that it becomes a real challenge for the individual and puts them at risk of getting pretty negative self-assessments on a regular basis quickly, without a whole lot of evidence that there's anything behind it in reality.

Host 2: And there have been situations when, you know, the child can change their mind, but you can't take it back. And that negative self-assessment or negative feedback they're getting from friends, peer groups, and sometimes strangers, continues. Because what's out there in social media can live a very long life and it's often difficult to see what's happening. I clearly remember at least a few children I worked with in my many years of clinical work who were deeply affected by the comments made by their friends, took it very personally and it really impacted their social, educational, and life at home and just emotional functioning in general.

So, what advice would you give parents on how to help equip their teens with ideas on managing well in social media or keeping themselves safe in social media?

Henry Sachs, MD: I'm not sure that the data out there gives us all the right answers for those questions at this point. Clearly having an open conversation about what they are doing and how they're using social media is a good idea. Some reality checks, whether, you know, someone is looking at body image on these virtual social media devices, social media outlets. And if they're using that as a self-assessment, they are helping the child do a little bit more of a reality check of what's real in the world and what they're perceiving on a day to day basis in these situations.

Education around understanding that this is all unfiltered information that's coming to them. No one has fact checked it and edited it. As a society, if it's in writing, we take it as truth, it's a dangerous practice to be engaged in. So, I think education with your kids around that. Obviously, sometimes parents monitor the social media of their kids. While that might be helpful, and I'm not against it, kids are a lot smarter than the adults usually on how to come up with other outlets for that connection that we might not be quite as savvy in understanding and seeing. I think it's dangerous to assume just because we're monitoring that we're really picking up everything that we're seeing.

Host 1: I had an experience recently with one of my grandchildren, he's seven and I needed some help with my iPhone. It wasn't working right. And he solved the problem and went into my phone. And I realized he hadn't given it back to me and he was, you know, scrolling through things and he's much more adept at the technology and the skills. And he's faster and all that sort of stuff.

I realize that when you see a kid with that level of ability, technical ability, you tend to think that they have other abilities that go with it or I, as a troglodyte, think that. But really, the two aren't related very much. I mean, this is like learning to walk, but you shouldn't necessarily be driving because you don't have the skills you need. That's an important thing, it seems to me, for parents to keep in mind is that their abilities are way ahead of their judgment and their experience and their--

Henry Sachs, MD: Technical skills outweigh their analytic skills.

Host 1: Right. Starting about age five.

Henry Sachs, MD: That's probably true. Just a couple of non sequitur statements. I admit this is sort of non-sequitur. You know, one of the things we see is that one of the most common reasons children get admitted to our hospital, the triggering event is a parent taking away their telephone.

Host 2: Oh my God, yes.

Henry Sachs, MD: They become so reliant on this. This phone is their social identity. And to take it away, when you're an adolescent, when your social identity is so important to who you are, you're developing beyond the family to take away what they see as their only connection to that larger social circle is so threatening to them, that the level of a reactivity that we see is just one of our common jokes is that the cell phone is our job security. And that's a really unfortunate thing to say because, again, it does bring value in many ways. But unchecked and not thoughtfully used and appreciated can lead to real significant issues.

Host 1: So, given that situation and schools are absolutely, are actually considering banning cell phone use for the entire school day, that's going to spark a world war, right?

Henry Sachs, MD: Well, you wonder about that a little bit as far as I think we have to re-educate kids and create the comfort level that they can live without their phones. And it might not be a bad idea to have it in the schools that that is occurring as opposed to the households at 7:00 or 8:00 at night. You know, that everyone realizes, "I can survive for a few hours without my telephone, which right now there's a large segment of the population who doesn't seem to believe that." There's a certain adverse impact on the resilience of people that this brings when you take that, what should be internal control and move it to an external item. That seems to put you at a lot of risk in some of these interactions.

Host 2: I find myself thinking, you know, listening to the conversation, this has been so fascinating because I grew up in a time when, and this is going to sound so dated for me, I had a pager. That was my first access. I didn't have a cell phone when I was in medical school. And then, we got cell phones. And it's been fascinating to see how a device has taken such an important place and role in our lives. And when I see kids nowadays, it's a very important tool for their learning, socialization. And in many ways, it mimics what would be a social interaction at a younger age and gives them opportunities which previous generations haven't had. And what I'm hearing is if that use is not monitored, if we don't filter the content that's coming in and make sure that use is in a way that matches the child's ability to understand and their track of development, it can actually wreak a lot of confusion and havoc.

Henry Sachs, MD: Yeah. How do we make teenagers better consumers of this product that they use all the time? Smarter consumers, how do they understand what they're seeing and the impact that it has on them, I think is an important task that we have to undertake as a society.

Host 1: Let's mention a little bit about cyberbullying. That's really critical, I think. And what should parents do if they learn that their child is a victim of cyberbullying?

Henry Sachs, MD: Well, I'll make a comment, and again, this might be a little non sequitur just little bit. But, you know, you think about it when Greg, when you and I were growing up, we're a little bit on the older side. And, you know, if you were in a bullying situation, it was usually one on one, one child bullying another child. It's a problem, but it didn't involve usually numerous people. In today's world with cyberbullying, I mean, it's one child feels the entire world is attacking them. And they know about it and they start to engage in it and participate. And there is some evidence that the vitriol, the vehemence with which people will attack using virtual techniques is a little bit different than they would in person. Some of the social guardrails that actually prevent someone from going quite that extra step in what they'll say or do is lost when they're just typing as opposed to having to do it face to face. So, I think it's a real, much more dramatic impact on children and adolescents than we had in our day. And it seems like the entire world is now impacted. It's not just, "I'm having a bad interaction with one person." The whole world sees me as this loser, because I'm being bullied this way.

Host 1: Yeah, there are certainly cases of definite suicide attempts and completed suicides that have been precipitated by cyberbullying. And parents have to step in when they have concerns that their child is being bullied to that degree, I think, and contacting the school and figuring, maybe the police.

Henry Sachs, MD: Well, I mean, that's obviously the most severe of cases. But if you look at school avoidance, and kids again withdrawing from society and interactions, the cyberbullying is part of what enhances that situation. I mean, for the most connected generation ever, I think, it's fair to say, there's also plenty of evidence out there that it's also considered itself one of the most lonely, which is an odd juxtaposition. You know, you're connected and yet you feel very lonely, and some of this drives that.

Host 2: Yeah, I think what social media does is it makes it somewhat easier to say things virtually on a screen and just type out things that you wouldn't say to someone in person. And I hear the clock chiming. I guess that's a vehement yes in agreement. It's just sad to see some of the things people say to each other on social media. And kids will tell you stories about the comments they've heard. And just like you're saying, the amplification of the situation to involving people who have nothing to do with it, or just spreading that whole situation to another peer group who might never know if it was in person. And that does have a very dramatic impact, especially at a stage of development where what peers think about you and your social identity and your ability to become this individual person with respect and autonomy is so important. It provides that opportunity to make things much worse very quickly.

Henry Sachs, MD: And again, you know, we've said a fair amount of negative things here. There's also very positive things where there are kids who would otherwise be very socially isolated, who do create their own community. And it brings them a certain level of comfort and satisfaction that they might otherwise not have.

Host 2: Yep. And social media when used well, we've heard stories of how people have created very unique apps, ways to socialize using different social media apps in a way that might be healthy, connect with people who are similar to them because a lot of kids find themselves feeling very different. So, you connect with people who have interests that are similar to yours, or you meet people who you otherwise wouldn't have. But all, again, said and done, is important to do with adult supervision and having good safeguards around that kind of interaction.

Host 1: For sure. So, my takeaway is that, from all these great points and the discussion we've been having is that parents can empower their kids to make the right decisions when the time is right, but they still need to be the guardrails for the family, so to speak. So when it comes to social media, that responsibility is still there with the parents. And every family needs to do what's right for them.

So if you found today's episode insightful, check out our other podcasts at www.bradleyhospital.org./podcast. Until next time, take care and keep nurturing those bright little minds.