Unpacking the teen mental health crisis: How we got here and what to do about it

We’ve been hearing a lot about a mental health crisis that’s affecting kids — especially teens — really hard. What’s behind this crisis? How is it playing out for kids with learning and thinking differences? And what can we do about it?

To help answer these questions, hosts Rachel Bozek and Gretchen Vierstra turn to Dr. Matthew Cruger. He’s the clinical director and a senior neuropsychologist at the Child Mind Institute. Learn how the crisis is showing up in his practice, especially with kids who learn and think differently. Hear Matt’s thoughts on when the crisis started — and why. Plus, get Matt’s advice on how families can help support their kids’ mental health. 

Related resources 

• Treatment for mental health issues 

• How to talk with your child about social and emotional issues

• Listen to this episode of The Opportunity Gap for more tips on supporting kids’ mental health 

Episode transcript

Gretchen: From the Understood Podcast Network, this is "In It," a podcast about the ins and outs...

Rachel: ...the ups and downs...

Gretchen: ...of supporting kids who learn and think differently. I'm Gretchen Vierstra, a former classroom teacher and an editor here at Understood.

Rachel: And I'm Rachel Bozek, a writer and editor raising two kids with ADHD. Today, we're talking about our children's mental health.

Gretchen: We've been hearing a lot in recent months about a mental health crisis that's hitting kids, especially teens, really hard. It was there before the pandemic, but we know the isolation and anxiety brought on by COVID-19 didn't help.

Rachel: And honestly, even if we weren't hearing about this crisis in the news, I think it would still be on our radar. Because speaking for myself, at least, I see evidence of it all around me.

Gretchen: I do, too. I mean, I see it in my own home. And I've been hearing from lots of parents in the community that kids just seem to be saying a lot of "What's the point? Why should I do it?" And they're just lacking some of that motivation that I think kids used to have.

Rachel: Yeah. Yeah. So I guess the question I have is: What's behind this crisis? How is it playing out in particular for kids with learning and thinking differences? And what can we do about it?

Gretchen: So to answer those questions, we're speaking today with Dr. Matthew Cruger.

Rachel: Dr. Cruger is the clinical director and a senior neuropsychologist in the Learning and Development Center at the Child Mind Institute.

Gretchen: In that role, he does clinical work, neuropsych exams, cognitive assessments, and other evaluations for gifted children, as well as kids with learning difficulties, autism spectrum disorders, and ADHD.

Rachel: We are delighted to have him here with us on the podcast. Matt, welcome to "In It."

Dr. Cruger: Thank you.

Rachel: We've been hearing for some time now about a mental health crisis for teens and even pre-teens. And we want to get into how this is showing up for our kids who have learning and thinking differences in particular.

But first, we thought it might be useful to look at the problem more broadly. Even before the pandemic, we were seeing a marked increase in depression, anxiety, and suicide among teens. Is that right?

Dr. Cruger: Yeah, I think that prior to the pandemic, we certainly recognized there's a couple of things that I think are factors. One is that we don't have enough clinicians to provide treatment for all the patients that need treatment. So families adjust to many of the struggles that their kids have, hoping that they'll get better, when some clinical intervention could be helpful in turning things around.

Gretchen: What about what we've heard about the impact of technology and social media? Has that had a negative impact on kids?

Dr. Cruger: I think so. Certainly, I think kids are spending a lot more time on technological devices. The impact of that is that they're not necessarily out interacting with other kids. Certainly, we want parents to monitor the kind of content that they're accessing as well, because there can be communications in that context that are problematic for kids and present a way of living in the world that's not as helpful. So the amount of engagement and the access to certain types of content on the on the internet I think is problematic and exacerbates things.

Rachel: Yeah, I definitely saw this with both of my kids that when the pandemic hit, the device usage just like went through the roof for so many reasons that we all know and understand. But can you talk a little bit about how that contributed to this crisis?

Dr. Cruger: Yes, I think that it was obvious because most of us were home and everything switched to remote platforms. Kids had to be on the computers every day for much of their schooling. And obviously many families couldn't also stop the work that they were doing. And so I think by necessity, some of the technology became — it served as a babysitter, right? For some of the time when kids had downtime. And it is less of an interactive experience, I think, even under the best circumstances.

So I think with those increased time screen usage going up, we have pretty good evidence that that can have negative effects on their mental health experience. And I think it's persisted. So even with the return to school, the situation has sort of led kids to have a decrease in their experience, right?

Gretchen: I think about engagement with the kids during this time period, right? Whether that was school or family. But like, really school, like I saw at home, at least for me, like engagement go down.

Dr. Cruger: Yes, I do feel like — and I'm reflecting on my own kids in particular, who were in third grade and kindergarten at the time. So there are special, unique challenges at those developmental time frames. Right? Kindergartners need to learn to read. That is such a great process to do in person with a teacher who is helping you sound out words, who has books and content right there for you.

And third grade when you're really starting to like apply yourself for deeper thinking. That's something where a mentor, a sort of coach, someone who's there as your champion to support you like a teacher could and give you direct feedback. That kind of engagement is really essential to the learning process that we are all used to. So there's no doubt that that was much harder to do. So I think that that clearly had an effect.

Gretchen: Yeah, I mean, in my house I had a fifth grader going into sixth grade. So in middle school. That's such a social time for kids. And to be isolated from your peers during all of that, it was really hard.

Dr. Cruger: Yeah. I think that during that time frame, the group of kids I was most worried about were kids that were in middle school heading to high school or in the early phases of high school. It's a time of really serious reflection on the material that you're working with in school. And really it's where a lot of those social advancements happen. Really learning where you stand in relationship to others and more complex social encounters and interactions were so important to develop in that time frame. And a lot of those kids I do think suffered. They were sad.

Gretchen: So what does all of this look like and sound like in your practice? What have you been hearing from the kids who come into your office these days?

Dr. Cruger: Yeah, I think maybe the first piece of things is like a low-level sort of sadness or anxiety about some experience that's sort of persisted. I do feel like kids benefit from the sense that they are going through some of these experiences for a purpose. And I think it's been very hard for us to know how to explain to them why things are organized the way they are. What's the higher purpose, what are they striving to achieve?

So that reflects a little bit of the engagement piece, like to be fully engaged in the content of material. But also to feel like school happens in a certain way and we're headed for a certain destination. That seems to me to have been lost.

Gretchen: Yeah, like I would say, like in my house, I've heard a lot of "What's the point?"

Dr. Cruger: I think that's true. I think there's an apathetic sort of response. It's sort of like it doesn't really matter so much what I do. And I've heard it for a long time, you know, where in focusing on academic work with kids, you know, kids might have for a long time have said to me, like learning math doesn't really matter because I won't use it in my future.

But it's maybe like a broader response to the time, like, I guess a feeling of like, I don't really know what the point is or what the goal is of what I'm being asked to do. That's a little bit of a helplessness towards the task and activity.

Gretchen: Rachel, I want to step back for a second here and just pick up on something that Matt just said. He's talking about how kids responded to the time. What's that time? All the time Is the pandemic, right? When things really shifted. And I think it's worth unpacking a little bit about what that time was and what it did.

Rachel: Yeah, right. Definitely. It's easy to forget from a little distance how just upside down our world was when the pandemic first hit. All of a sudden, a lot of kids discovered that their parents, their teachers, and maybe other people that they always would look to for answers really didn't have much to offer or know what to do.

Gretchen: Yeah, I mean, it must have been — I know it was hard for kids to see rules changing all the time, adults complying, not complying. To see, you know, your parents who used to like get up and go out the door to work are now sitting at home in their pajamas on the screen all day. And what's happening there?

Rachel: And and the rules about screen time kind of went out the window and, you know, some other rules, too, just because we were all just trying to get through the day. That's a lot.

Gretchen: Yup. So it seems like all of a sudden kids are like: All these structures that you have in place are arbitrary and made up. And I'm not going to go along with this anymore.

Rachel: Yeah, we got called out. So let's get back to our conversation with Matt.

Rachel: We know that you work with a lot of children who have learning and thinking differences. Can you talk about how all of the stressors that we're talking about here may be affecting them in different ways?

Dr. Cruger: Yeah. I mean, I think that if you — I guess I reflect on the learning differences that I see. The kids who are struggling with academics, in particular, the inputting of new ideas, new processes for solving problem. They need real guidance on how to manage that material. And that can sometimes come from family involvement, but often comes from direct instruction. They really need teachers who are able to guide them in that process of learning.

Kids are struggling to find a source of motivation that they can direct their efforts to. And sometimes they feel like it's hard to know: Will their efforts pay off? And that can sometimes lead to sort of decreased motivation.

Rachel: You know, we've been talking a lot about the impact of the pandemic on mental health. But I know there are a lot of other sources of anxiety and depression for kids these days. Things like school shootings and climate change. Do you hear about those kinds of things from the kids that you see?

Dr. Cruger: Well, I think you bring up, Rachel, like a set of things that are on my mind. There's a bunch of global issues that kids confront. So it's very common for me to hear kids talk about sort of what we think of as like climate anxiety. You know, that worry that the world is on a crash course towards not being able to exist in the way that we know it. And that is a like a low-level worry and source of preoccupation for kids, even though they're highly motivated many times to do something about that.

I think violence and safety is another thing that kids spend their time thinking about. And I certainly also think a lot of teenagers are focused on their own identity development. That's a developmental goal for that age range. And there's so much information about choosing your identity. What are acceptable identities? What are identities that others will not accept? That makes that process, I think, even more complicated for them. So those preoccupations, I think, sort of derail them from knowing how to invest time in the things that they need to do.

Gretchen: Right they're figuring out all those questions around sexuality and gender identity. Not to mention, for older kids, they're thinking about what they want to do with their life. Is that something kids come to you for guidance on?

Dr. Cruger: Yeah, I mean, I think that a lot of teenagers think there might be only like four or five jobs that a person can have in life, or that college is the only choice.

Rachel: Yeah, totally. Although they all seem to have gotten the memo that professional video game player is a thing.

Dr. Cruger: There is no doubt.

Gretchen: Or YouTuber.

Dr. Cruger: Yes. YouTuber Influencer Professional Video Player. Yeah. Yes. I think I did say to my son at one point, not that many people get paid to play video games.

Gretchen: Right.

Dr. Cruger: He did not believe me. So.

Gretchen: You know, not to bring us back to doom and gloom, but for one more moment, I do want to ask about something else has been in the news. Is this whole idea of loneliness — that we have a loneliness problem in the U.S. Are you seeing that come up in your work with kids?

Dr. Cruger: I do think that it's worth sort of questioning what are the ways that kids have contact with others outside of school? When do they get to play with each other? I sound like, you know, I have a lot of gray hairs in my beard, which I do. But like, I remember being outside on the street playing football. And we just don't see kids out and engage with each other in unstructured play activities quite as much.

And, you know, I do also think like going to your friend's house to play video games when I was younger was sort of boring. You could only play Atari 2600 for so long. But now they're much more engaging and activating processes that the kids immerse themselves in. And so I think it leads to some challenges in how to have contact.

Rachel: So how can we best help our young people, you know, as parents, as caregivers, as teachers, whoever's listening. What makes a difference for them? You know, in all of these things, loneliness and the other things we've been talking about.

Dr. Cruger: Yeah. I mean, I think most parents decided that they were going to have kids sort of set their kids up for the best future and the best life. So I think just reminding ourselves again of the importance of the parental involvement with kids, I think is the first piece of things. Right?

It's been hard to, I think, over this past period of time, to keep our values front and center in our mind because we've had to adjust to what's required in the moment. And so to return again to the idea of, like, what are the most important things for me and my family? I do think there's value in families sort of trying to think of is there a motto that they could have for their family that sort of captures that moment, like "We Crugers stick together" or something like that? It sort of captures the family spirit, but also like a positive element of we're all in this together and we have values that we're trying to achieve.

I do think spending more time together is a clearly like an antidote. As annoying as it was for my kids to learn to play pinochle, that was the thing that we focused on learning. Because it gave us time to get away from the screens, to sit down together, to challenge each other. And I think those kind of activities where you're really engaged with each other and having a good time are very important.

There's no doubt family meals are also something that we should invest in. It's not always possible and it's not always easy when you're catching things on the fly. But that time where you're sitting down together as a family I think is really worthwhile.

I won't say family meetings because everybody calls family meetings and the only people that show up are the parents. But I mean, but that idea that there's time to work together to align your interests. And then I think helping support your kids to find, you know, the one or two or three good friends, and making traditions and routines that they can sort of establish with their peers that are reliable. Like if they, you know, the friends all come over on Friday for pizza or something like that, that might be something that's like low investment but really worthwhile.

Rachel: Yeah. I feel like our family meetings always, there's an expectation that there's some, like, amazing surprise. It's like, hey, we're going to have a meeting and it's like, oh, we're going to Disneyworld. Like, No, we actually need to talk about something that's going on in school.

Dr. Cruger: That's right.

Rachel: They backfired.

Dr. Cruger: Taking out the garbage. Yeah.

Gretchen: Right. The chore list.

Dr. Cruger: Yeah, exactly.

Gretchen: So if you think your own child may be anxious or depressed, but they aren't talking with you about it, what can you do as a parent? How do you figure out if they're at risk in some way or if they're just going through a fairly typical high and low of life as a teenager, for example?

Dr. Cruger: Yeah, I mean, I think parents need to trust their instincts. I do think that when we have concerns about our children, it's not often just because we're worrying needlessly. It means that we're noticing something that our intuition is sort of telling us we better check in with them about.

I think that a safe space for talking for kids is one that sort of models what we know good friendships are about. Right? It's sort of a model of a place where you can share information without someone making designs on how you should improve. Right?

Some of the things that might make it easier if you're, you know, the teenagers turning away from you, if there's two parents involved, maybe it's time for the other parent to try to take over. And getting away from the house, going out to eat for breakfast, carefully bringing up a topic that you have concerns about. I think all of those things. You know, a nice soft start works well for all of us. Don't start with a heavy hand when we're raising a concern with someone that we love. And I do think that kids who are going through some struggles do desire solace for those struggles. So if they know that you're available for that, that's helpful.

Anxiety is maybe a tricky one because anxious people try to get out of the situations that provoke anxiety. So even talking about the thing that makes you anxious, you really sort of are mobilized to seek to avoid it. The problem is, is that if you avoid it, it just sort of gets worse. And so I think that's one thing that parents should sort of keep in mind, that when your child is feeling anxious, it might make them sort of naturally more reticent to share with you the details of that.

And, you know, some mind reading is very problematic. Like, if you say, I know you're thinking something negatively about it, the person you say that to is bound to get irritated with you. But if you say, I've been noticing that you look sort of sad and I want to help with that, you know, can you tell me more about what's going on for you? That kind of mind reading might convey interest and sincere desire to understand. That kind of mind reading is affectionate and maybe positive and might yield a good result.

Gretchen: You know, getting back to making a safe space to talk to kids about what's going on. I've really been trying to do that. And I know I've mentioned before that I do a lot of this in the car, which doesn't work for everybody. But the other thing I've been trying hard to do, which is very difficult for me, is not be the advice giver, is to kind of just sit and listen and let them vent. And then when I don't give advice, every once in a while, my daughter will give me this look like, Well, where's your advice? I'm looking for it now. And then I give it.

Rachel: Right. But you have to wait for that cue for sure.

Gretchen: Yeah.

Rachel: Yeah, I think that's great. And I try to do that, too. I definitely have some work to do there because I often jump in with like, well, it sounds like.... And I just offer my read on what happened, which isn't necessarily why the conversations happening.

Gretchen: Yeah.

Rachel: I do like that approach. and I think they do get to that point where they still want to know what we think.

Dr. Cruger: Yeah.

Rachel: So what do you wish people better understood about this crisis and how we get out of it?

Dr. Cruger: I think my biggest wish would be really thinking about how they can, you know, parents can develop or teachers can develop like a deeper, more personalized understanding of the people that they're interacting with. So time is always tight, but a way to really show sincere interest and engagement, I think is important. Otherwise, it's sort of like almost like commuting culture. We're just sort of passing each other by, sort of missing those moments and opportunities to make deeper contact. So that's why I think what I would wish for it, you know, time and opportunity to take a moment to find out what's going on, I think that would be a real boon for people.

Gretchen: That sounds like a good plan.

Rachel: Thank you so much for this. It was such a great conversation.

Gretchen: Yeah. Thank you so much.

Dr. Cruger: Well, thank you. I appreciate being able to talk to you both. I enjoyed the conversation and I appreciate what you're doing.

Gretchen: You've been listening to "In It" from the Understood Podcast Network.

Rachel: This show is for you. So we want to make sure you're getting what you need. Email us at init@understood.org to share your thoughts. We love hearing from you.

Gretchen: If you want to learn more about the topics we covered today, check out the show notes for this episode. We include more resources as well as links to anything we mentioned in the episode.

Rachel: Understood.org is a resource dedicated to helping people who learn and think differently discover their potential and thrive. Learn more at Understood.org/mission.

Gretchen: "In It" is produced by Julie Subrin. Briana Berry is our production director. Justin D. Wright mixes the show. Mike Errico wrote our theme music.

Rachel: For the Understood Podcast Network, Laura Key is our editorial director, Scott Cocchiere is our creative director, and Seth Melnick is our executive producer. Thanks for listening.

Gretchen: And thanks for always being in it with us.