Mai El Shoush, Partnerships Campaign Manager, Stavros Niarchos Foundation (SNF) Global Center for Child and Adolescent Mental Health at the Child Mind Institute

Tatiana P. Claridad, MBA, Director of Board Affairs and Institutional Strategy, Stavros Niarchos Foundation (SNF) Global Center for Child and Adolescent Mental Health at the Child Mind Institute

Their reflections offer insight into how young people define, build, and experience mental fitness globally, highlighting the influence of their environments, communities and everyday realities. Their views are essential to shaping more relevant and effective support for young people everywhere.

From daily habits to systemic change, here’s how young people are reimagining mental health care as mental health fitness:

These reflections raise a broader question — how can global collaboration strengthen mental health support for children and adolescents?

While these insights from the GYAC members highlight the importance of collaboration, they also reflect a new paradigm of youth leadership.

What continues to inspire you as a young leader about the ideas and perspectives shared through the Global Youth Advisory Council, and what does it say about the future of mental health care?

Contributors: Delice Lumbu, Director of Youth Engagement, Stavros Niarchos Foundation (SNF) Global Center for Child and Adolescent Mental Health at the Child Mind Institute

The post Mental Health Fitness Through a Youth Perspective  appeared first on Child Mind Institute.

New York, NY — A new study from researchers at the Child Mind Institute finds that negative online experiences are common among children and adolescents with mental health and neurodevelopmental conditions, and that most incidents are not reported through platform reporting tools.

Published in JAACAP Open, the study examined negative online experiences among 1,009 youth ages 9 to 15 with a history of mental health or neurodevelopmental concerns, all of whom were current or previous participants in the Child Mind Institute’s Healthy Brain Network. More than one in four reported at least one negative online experience in the past year. Among those who had such an experience, nearly 69% reported multiple incidents, yet only 20% reported the incident through platform reporting tools.

The study defined “negative online experience” as any unwanted or uncomfortable experience while online, including cyberbullying, cyberstalking, doxxing, impersonation, sexual harassment, and related forms of digital harm. The research used a mixed-methods design, combining a quantitative survey with an in-depth qualitative follow-up involving a three-day moderated online bulletin board with a subset of participants.

“These findings point to a large and often hidden problem,” said Michael P. Milham, MD, PhD, Chief Science Officer at the Child Mind Institute and senior author of the study. “Many young people are encountering harmful or uncomfortable experiences online, but the systems designed to help them often do not receive a report. That creates a major gap for parents, educators, clinicians, and platforms trying to keep children safer online.”

The research team identified three major categories of barriers that prevent youth from reporting negative online experiences: reporting process barriers, such as not knowing how to make a report; reporting policy barriers, including uncertainty about what qualifies for reporting or how platform rules apply; and emotional barriers, such as embarrassment, fear, and worry about consequences.

The study also found that reporting decisions were often shaped by how young people interpreted the incident itself. In the qualitative follow-up, youth considered whether the harmful behavior seemed intentional, how malicious it appeared, and how severe or repeated the harassment was. When those cues were ambiguous, youth were less certain about whether reporting was appropriate.

“Reporting is not simply a matter of telling young people to speak up,” said Mirelle Kass, lead author of the study. “Youth are making complicated judgments about intent, severity, platform rules, and the possible consequences of disclosure. If we want young people to report harmful experiences, the tools and systems around them need to be clearer, safer, and easier to use.”

The findings suggest that online safety efforts should be tailored to the needs of youth who may already be managing mental health, developmental, or social challenges. Social aptitude, mental health symptoms, and parenting style were associated with youths’ likelihood of encountering negative online experiences and with the barriers they faced when deciding whether to report them.

Participants also expressed a clear desire for better tools and guidance. Most youth wanted platforms to provide more information about how to protect themselves online, how to use safety features such as blocking and reporting, and how to access support during and after the reporting process.

“Families, educators, clinicians, policymakers, and technology developers all have a role to play,” said Dr. Milham. “We need reporting systems that children can understand, policies that are transparent, and trusted adults who can respond without blame or overreaction. Safer digital spaces will require more than awareness. They will require systems designed around how young people actually experience online harm.”

The study underscores the importance of developmentally appropriate safety tools, clearer platform policies, and stronger support systems for youth navigating digital spaces. For children and adolescents with mental health and neurodevelopmental conditions, improving reporting pathways may be an important step toward reducing hidden online harms and building safer online environments.

This research was supported by funding from Google LLC’s User Safety team to the Child Mind Institute for work led by Michael P. Milham, MD, PhD.

About the Healthy Brain Network

The Healthy Brain Network is a community-centered research initiative from the Child Mind Institute that collects clinical, cognitive, behavioral, and neurobiological data from children and adolescents in the New York City area. Families who participate receive feedback and diagnostic consultation while contributing to open science research aimed at improving understanding of child and adolescent mental health.

About the Child Mind Institute

The Child Mind Institute is an independent nonprofit organization dedicated to transforming the lives of children and families struggling with mental health and learning disorders. Through cutting-edge research, evidence-based clinical care, and public education, the Child Mind Institute builds open science platforms and digital tools to accelerate discovery and improve youth mental health worldwide.

For press questions, contact cmiscience@ssmandl.com or mediaoffice@childmind.org.

The post Negative Online Experiences Are Common but Often Go Unreported Among Youth With Mental Health and Neurodevelopmental Concerns appeared first on Child Mind Institute.

A recent study published in Nature Neuroscience has identified two biological subtypes of autism linked to different pathways in the brain.

Researchers from the Child Mind Institute, the Istituto Italiano di Tecnologia, and other international partners analyzed brain connection patterns in nearly 2,000 individuals, including 940 autistic people from the Autism Brain Imaging Data Exchange (ABIDE). By combining human brain-imaging datasets with complementary biological data, they identified two consistent patterns in how different brain regions communicate.

One subtype showed reduced communication, or hypoconnectivity, among brain regions linked to pathways that help brain cells send signals to one another. The other showed increased communication, or hyperconnectivity, among brain regions linked to pathways associated with the immune system. The two subtypes exhibited differences in functional brain structure and modest differences on standardized autism assessments, with the hyperconnectivity subtype scoring moderately higher on autism severity measures.

These findings give scientists the first empirically biology-based framework for understanding autism’s complexities over time. This type of work could move the field closer to more precise, personalized approaches to medicine and care. However, this does not mean autism can now be divided into just two categories, nor does it create a new diagnostic framework. Autism is complex, and these two subtypes are likely part of a much larger picture.

The study also highlights the importance of open science. Through shared datasets like ABIDE, researchers can tackle questions too large for a single lab to answer alone.

The post New Study Identifies Different Biological Subtypes of Autism appeared first on Child Mind Institute.

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Melatonin is widely available, often marketed as a “natural” sleep aid, and increasingly used to help kids of all ages. But it may not be the right solution. The key is knowing when it makes sense, when it doesn’t, and how to make it work best as part of a bigger sleep plan.

Melatonin is a hormone the body produces naturally to regulate sleep. As it gets dark, the brain releases melatonin to signal that it’s time to wind down. Light exposure at night — especially blue light from screens — can disrupt the body’s natural rhythm so you don’t feel sleepy even when it’s bedtime.

“Melatonin supplements can help facilitate that circadian rhythm, that 24-hour sleep cycle,” says Rohn Nahmias, DO, a child and adolescent psychiatrist at the Child Mind Institute. Because it’s sold over the counter, melatonin seems to be harmless. In practice, clinicians are much more cautious. While they tend to consider it relatively low risk, with few side effects, they still don’t view it as something to take casually or indefinitely.

That’s because there are real gaps in what we know about melatonin — especially when kids take it regularly over long periods. “The longest study was about four years, and they did not find any issues,” says Judith Owens, MD, MPH, a pediatric sleep expert and professor of neurology at Harvard Medical School. “But the data are very limited in subject numbers and long-term follow-up.”

So, the question parents often ask — is melatonin safe for kids? — doesn’t have a simple yes or no answer. The more useful question may be whether melatonin is right for your kid and what guidelines should you follow if you’re going to give it to them.  

That’s why it’s especially important to consult your child’s pediatrician or tell them if you’ve already started your child on melatonin. “Because melatonin is over the counter, families often forget to mention it,” says Dr. Nahmias. But doctors need to know about supplements, especially if a child is on other medications or has additional health concerns.

Melatonin can be helpful in the right situations, but using it without looking deeper can be “kind of slapping a Band-Aid onto a problem,” Dr. Nahmias says. In his practice, he always wants to rule out anxiety, mood concerns, or a medical issue that may be impacting sleep (such as snoring, breathing problems, or pain) before introducing something new like melatonin.

Melatonin is most useful when the issue is falling asleep, not staying asleep. For example, if your child has persistent trouble falling asleep — not just occasional bedtime resistance — and you have already tried using behavioral strategies.

The immediate-release melatonin sold in the United States is primarily helpful for sleep onset. (A prolonged-release form approved in the UK and EU may help with staying asleep, but it’s not available here.) Melatonin can also help with circadian rhythm issues like delayed sleep-wake phase disorder, when a child or teen’s natural sleep and wake times are much later than their schedule allows. “That is the other real indication for melatonin,” Dr. Owens says.

If melatonin does make sense for your child, experts agree: Start low and go slow. Dr. Nahmias recommends beginning with 1 to 2 milligrams for kids four and up and increasing the dose only if needed — up to 3 milligrams for kids ages 6–10. Many children respond well to low amounts. More than 5 milligrams, he says, isn’t much more effective and is more likely to cause side effects like grogginess or irritability. Dr. Owens emphasizes a similarly cautious approach: Use the lowest effective dose, monitor whether it’s actually helping, and reassess regularly rather than letting it quietly become an open-ended routine.

Dr. Nahmias recommends using melatonin in “clusters” — short, purposeful stretches of nightly use to help realign the circadian rhythm — and then pulling back to use as needed. A cluster might make sense for a few weeks after travel, during a tough transition, or while the family works on behavioral changes.

If a child needs melatonin every night for months, that’s a signal to dig deeper. “That tells me that there’s something likely going on underneath that’s not being addressed,” Dr. Nahmias says.

Melatonin is generally well tolerated, but knowing the possible side effects can help you catch problems early. The most common is grogginess the next morning. Others include irritability, headaches, dizziness, stomach upset, and — in toddlers and younger children — increased bedwetting. Some children may also experience vivid dreams or nightmares, though these tend to be mild.

Check in with your child’s pediatrician if side effects appear, your child needs melatonin frequently or for more than a short period, the dose keeps creeping up, sleep problems get worse, or if you notice signs of anxiety, depression, or ADHD that might be driving their sleep struggles.

One important safety note: melatonin gummies look like candy, and Dr. Owens describes an “astronomical increase” in calls to poison control centers and emergency room visits related to melatonin in children, largely due to accidental ingestion. Store melatonin — especially gummies — like any other medication: out of reach, ideally in a locked cabinet. Never present them to children as a treat.

Melatonin isn’t tightly regulated in the United States, which means the dose on the label may not match what’s actually in the product. Studies have found that 22 out of 25 over-the-counter melatonin gummies were labeled inaccurately, with some containing far more melatonin than advertised.

Dr. Owens describes the variability as “huge” and says she was genuinely shocked by the findings. When shopping, look for products with a USP Verified mark. USP (United States Pharmacopeia) is an independent nonprofit that tests supplements to confirm the product contains what the label says, in the correct amount, and without harmful contaminants.

There’s solid evidence that melatonin can benefit children with neurodevelopmental conditions, particularly autism and ADHD, who are more likely to have disrupted sleep-wake cycles. “There is a pretty robust literature supporting efficacy, without a lot of side effects,” Dr. Owens says about children on the autism spectrum.

But Dr. Nahmias encourages parents of kids with autism or ADHD to take a closer look at bedtime routines before turning to melatonin. “Both of those populations of kids do best when there is structure put into their day,” he says. He recommends having a posted list of the sleep routine that a child needs to accomplish as a helpful visual reminder that will start to become second nature as it is built into their evening.

If getting to sleep is still an issue, trying melatonin makes sense. But for kids with autism and ADHD, it may take more time to see an effect. “It can be helpful to give it a bit longer to re-right the sleep cycle,” Dr. Nahmias says. “Trying it for two to three months may be more beneficial than just a few weeks.”

 Many neurodivergent kids may also need to stay on melatonin longer than neurotypical children. “This makes it absolutely imperative that administration of melatonin for these children is under the supervision of a health professional who can monitor efficacy and side effects, and recommend periodic ‘off-drug holidays,’” Dr. Owens says. The goal is to get sleep back on track and consistent for some time. Once that goal is achieved, Dr. Nahmias adds, “it is important that there be attempts to take breaks from the medication or try lower doses.”

Melatonin is often used in situations where it’s unlikely to make much difference. That’s not a criticism of parents — sleep deprivation is exhausting, and it’s natural to reach for something that seems gentle and accessible. But if the real issue is an inconsistent routine, untreated anxiety, or an unidentified medical problem, melatonin may only be a temporary solution. The real problem will persist and need diagnosis and treatment.

For younger children — kids under five, especially — sleep problems are almost always better addressed with changes in habits and routines rather than supplements. For kids under two, “there’s no reason to use melatonin… and really, honestly, under five, for the most part,” Dr. Owens says. At those ages, behavioral approaches almost always work better.

Small, consistent changes in sleep habits can make a real difference — and unlike a supplement, these strategies can help children build skills that support sleep for years to come. Dr. Nahmias focuses on what’s often called sleep hygiene: a consistent bedtime and wake time, a predictable wind-down routine, and a sleep environment that actually supports rest, like keeping the bedroom dark, cool, and quiet. “The bed is meant for one thing and one thing only, and that is for sleep,” he says, emphasizing no TV or cellphones before bed. Even small amounts of light can interfere with the body’s natural melatonin production.

He also suggests addressing anxiety, rumination, or bedtime fears directly. “Behavioral interventions, time and time again, have really been shown to be very effective,” Dr. Owens says. For younger children, that might mean learning to fall asleep without a parent in the room. For older kids and teens, it often means setting limits around devices and making sure the schedule they’re keeping is actually realistic.

Melatonin is a tool that works best with a plan behind it. Before starting, write down what problem you’re actually trying to solve. Is your child unable to fall asleep before 11pm? Waking during the night? Scared to sleep alone? Anxious about school?

A simple sleep log can make your conversation with your child’s doctor much more useful. For a week or two, track bedtime, approximate time asleep, any night wakings, morning wake time, screen use, and whether melatonin was used and, if so, at what dose. Dr. Owens calls sleep diaries “invaluable” because they reveal patterns that are nearly impossible to see when everyone’s tired and running on memory. That information helps you and your child’s doctor decide whether melatonin is worth trying, whether it’s working, and when it might be time to stop — keeping the focus not just on getting through tonight, but on helping your child build the sleep habits they’ll carry with them for years.

The post Melatonin for Kids: Is It Safe? appeared first on Child Mind Institute.

Paddy Pimblett, an English MMA champion, opens up about relying on training to strengthen his body and steady his mind. His message goes beyond sports: structure, purpose, and setting achievable goals can be transformative, especially for young people struggling to feel “good enough.” By speaking candidly about his mental health, he offers a version of strength rooted in resilience, honesty, and showing up for yourself every day.

About Paddy Pimblett

Paddy Pimblett is an English professional mixed martial artist known for his rising success in the UFC lightweight division. He was named the 2022 Breakthrough Fighter of the Year at the World MMA Awards. Known as Paddy “The Baddy”, Pimblett has built a large following both inside and outside of the Octagon for his entertaining fighting style and his openness about personal struggles and emotional well-being.

About Mental Health Fitness

For decades, we’ve understood that physical fitness doesn’t just happen — it takes skills, regular practice, and a supportive environment. The same is true for mental health. Developed by experts at the Child Mind Institute for three different age groups, our Mental Health Fitness guides have been used by more than 1.8 million students, caregivers, and educators to build emotion regulation skills and resilience. Whether your child is 5 or 15, struggling or thriving, they can learn these skills. And you can practice alongside them. Learn more at Mental Health Fitness.

Related Resources

• How to Help Children Calm Down
• What Is Co-Regulation?
• How to Model Healthy Coping Skills
• Raising Confident, Independent Children

The post Paddy Pimblett on Mental Health Fitness  appeared first on Child Mind Institute.

New York, NY—Applications are now open for the 2026 Communicator Fellowship at the Stavros Niarchos Foundation (SNF) Global Center for Child and Adolescent Mental Health at the Child Mind Institute. The fellowship is designed to support a new generation of communicators working to shape child and adolescent mental health care in low- and middle-income countries, in addition to the SNF Global Center’s core country offices in Brazil, Greece, and South Africa. Up to three professionals working in public communications, including journalists, broadcasters, and podcasters, will be selected for the two-year program.

The Communicator Fellowship is part of the SNF Global Center’s broader mission to reduce gaps in data and care, catalyze system-level advancements, and transform child and adolescent mental health care by turning evidence into action, scaling culturally appropriate solutions, and building a global network of experts so young people everywhere can access support when they need it.

The application deadline is June 15, 2026. Fellows will be selected and announced by early August 2026. In addition to financial support of up to $100,000 USD, fellows will receive training, mentorship, and networking opportunities.

At a time when one in five young people are experiencing mental health or learning challenges, with most cases beginning by age 14, effective and accurate communication is urgently needed.

At the Child Mind Institute, we believe that translating research into accessible knowledge that empowers young people, families, and communities is integral to advancing mental health care. The Communicator Fellowship builds on this commitment by supporting professionals who can bring evidence-based mental health information to the public in clear, engaging, and culturally relevant ways.

Vinicius Gaby Vieira Rego, MD, of Brazil, a current Communicator Fellow with the support of the Institute of Psychiatry at the University of São Paulo, exemplifies this mission. Working with youth, Dr. Rego is co-creating a multi-platform literacy hub designed to combat harmful misinformation by empowering Brazil’s young leaders.

“I am deeply grateful for the opportunity to join the SNF Global Center’s network of fellows to support adolescent mental health in Brazil through communication,” said Dr. Rego. “This fellowship will enable a multi-channel communication project aimed at strengthening mental health literacy and peer-support capacity — with young people and for young people — across the country.”

As a fellow, Dr. Rego’s work directly addresses complex mental health challenges faced by young people in Brazil, while contributing to broader global efforts to improve communication about mental health care.

“In the current digital environment, where adolescents are exposed to a high volume of mental health content, the need for evidence-based information that resonates with young people has never been greater,” said Guilherme Polanczyk, MD, PhD, associate professor of Child and Adolescent Psychiatry at the University of São Paulo. “We are proud to endorse a project committed to supporting how young people and their communities understand and reflect on their mental health.”

Other current fellows are leading high-impact projects dispelling misinformation, reducing stigma, and increasing youth engagement — all while bringing critical attention to links among mental health, climate change, and human rights. Through partnerships, these efforts are transforming the future of youth mental health across the globe.

“Vinicius’s project is ambitious, and with the support of the Institute of Psychiatry at the University of São Paulo, we know it will provide young people in Brazil with much-needed resources to support their mental health,” said Peter Raucci, Director of Global Fellowship Strategy of the SNF Global Center at the Child Mind Institute. “What we’re seeing through the Communicator Fellowship is how quickly ideas can move from concept to culturally relevant, real-world impact.”

Application deadline: June 15, 2026

Fellows announced: August 2026

• Request for Applications
• Application downloads
• Application Link
• Learn more about the program

About the SNF Global Center at the Child Mind Institute
The Stavros Niarchos Foundation (SNF) Global Center for Child and Adolescent Mental Health at the Child Mind Institute brings together the Child Mind Institute’s expertise as a leading independent nonprofit in children’s mental health and the Stavros Niarchos Foundation’s deep commitment to supporting collaborative projects to improve access to quality health care worldwide. The center is building partnerships to drive advances in under-researched areas of children and adolescents’ mental health, and expand access to culturally appropriate training, resources, and treatment in low- and middle-income countries. This work is conducted by the Child Mind Institute with support from SNF through its Global Health Initiative (GHI).

About the Child Mind Institute
The Child Mind Institute is dedicated to transforming the lives of children and families struggling with mental health and learning disorders by giving them the help they need. We’ve become the leading independent nonprofit in children’s mental health by providing gold-standard, evidence-based care, delivering educational resources to millions of families each year, training educators in underserved communities, and developing tomorrow’s breakthrough treatments.

The post Applications Open for the SNF Global Center Communicator Fellowship appeared first on Child Mind Institute.

Avoiding sports and other things for fear of being judged is also a symptom of anxiety. I can understand how hard it is to tell your family what you’re going through, especially if you have felt ignored in the past. At the same time, your pain deserves to be heard and taken seriously. I encourage you to try talking to your parents again, but if you truly feel like you can’t, consider telling one safe person — whether that’s another family member, a school counselor, or even a teacher you trust. You can write down how you’re feeling if speaking feels too hard.

The physical symptoms you mentioned — neck and shoulder pain, fidgeting — are also common in anxiety because our bodies can hold tension when our brains are on high alert. What this likely means is that your brain is caught in a fear loop, constantly scanning for danger around control and judgment.

The good news is that this is very treatable. A mental health professional may recommend a type of cognitive behavioral therapy called exposure and response prevention (ERP). ERP helps you gradually face the situations or thoughts you fear instead of looking for reassurance from someone else or avoiding those situations or thoughts altogether. Over time, ERP teaches your brain that thoughts are just thoughts, not actions, and that you can tolerate uncertainty without something bad happening.

For now, you might try gently labeling upsetting thoughts as anxiety, not facts, and practicing not accepting them as true when they show up. Taking small steps toward what you’ve been avoiding can help you rebuild your confidence, even if it feels uncomfortable at first.

While you can practice managing anxiety or intrusive thoughts on your own, it’s better to have help. Once you talk to someone you know and trust, have them help you reach out to a mental health professional who can provide a more thorough assessment and the appropriate treatment for you. You don’t have to go through this alone. And with the right support, this can get much better.

The post I’m scared of everything — what does it mean and how do I get over it? appeared first on Child Mind Institute.

New York, NY – The Child Mind Institute, the leading independent nonprofit dedicated to transforming the lives of children struggling with mental health and learning disorders, hosted its 2026 Spring Luncheon on Monday, May 11. The event featured a dynamic discussion between Lisa Damour, PhD, a three-time New York Times bestselling author and host of the podcast, Ask Lisa: The Psychology of Raising Tweens & Teens, and Dave Anderson, PhD, Vice President of Public Engagement and Education and a senior psychologist at the Child Mind Institute. Their conversation was moderated by Ali Wentworth, an actress, comedian, author, and host of the television show, The Parent Test.

The event brought together advocates and distinguished individuals dedicated to equipping children and families with the skills they need to thrive in today’s rapidly evolving online and social environments. Attendees included Carson and Siri Daly, Jeannie Gaffigan, Kyle MacLachlan, Zibby Owens, and Alysia Reiner.

“We are raising children in a world fundamentally different from any generation before them…a world where childhood unfolds not just in homes and schools but online,” said Harold S. Koplewicz, MD, founding president and medical director of the Child Mind Institute. “Technology brings creativity and connection but also real risks: constant comparison, disrupted sleep, compulsive engagement, and exposure to harmful content. Our job is to help kids build the skills to navigate this world with resilience, confidence, and balance.”

The discussion centered on kids and families and how they can build healthy habits and resilience as they face the demands and distractions of a world increasingly reliant upon and centered around digital technology.

“My umbrella concern is what the conversation about technology is doing to the relationship between adults and kids. The single most powerful force for youth mental health is strong relationships with caring adults,” said Dr. Damour.

“If we focus on driving causal factors — such as family relationships, academic success, in-person friendships, sleep, and movement — we end up promoting a child’s wellness far more than by taking technology away,” said Dr. Anderson.

The luncheon raised over $260,000 to support the Child Mind Institute’s mission to change the lives of children with mental health and learning disorders in the United States and around the world.

The luncheon was co-chaired by Chris Mack, Lisa and Guy Metcalfe, Zibby Owens, and Jil Schaps. The host committee included Robyn and Paul Goldschmid, Desiree Gruber, Molly Jong-Fast, Breanna and John Khoury, Isabelle Krishana, Arielle Tepper, and Sarah J. Wetenhall.

Photos from the luncheon can be found here.

This special event is part of the Child Mind Institute’s programming during Mental Health Awareness Month. The Child Mind Institute recently launched its latest campaign, Mental Health Fitness. Physical fitness doesn’t just happen — it takes skills, regular practice, and a supportive environment. The same is true for mental health. Alongside relatable content from influencers and world-renowned athletes, the Mental Health Fitness resources from the Child Mind Institute provide kids and families with five core mental health skills they can practice every day.

The Child Mind Institute is dedicated to transforming the lives of children and families struggling with mental health and learning disorders by giving them the help they need. We’ve become the leading independent nonprofit in children’s mental health by providing gold-standard, evidence-based care, delivering educational resources to millions of families each year, training educators in underserved communities, and developing tomorrow’s breakthrough treatments. 

Visit Child Mind Institute on social media: Instagram, Facebook, X, LinkedIn

For press questions, contact our press team at childmindinstitute@ssmandl.com or our media officer at mediaoffice@childmind.org. 

The post The Child Mind Institute Hosts 2026 Spring Luncheon “Future-Proofing Your Kids: Empowered Parenting in the Digital Age” appeared first on Child Mind Institute.

Alexa Grasso knows the importance of prioritizing her mental well-being alongside her physical training. She uses breathwork to stay grounded, acknowledges emotions instead of suppressing them, and practices mindfulness — highlighting that true strength comes from training the mind with the same discipline as the body.

About Alexa Grasso

Alexa Grasso is a Mexican mixed martial artist and one of the top competitors in women’s flyweight diving of the UFC. Known for her sharp boxing and calm presence in the Octagon, she made history in 2023 by becoming the first Mexican-born woman to win a UFC championship. Grasso’s rise through the sport has been marked by discipline and resilience, earning her recognition as a trailblazer for Mexican athletes in MMA.

About Mental Health Fitness

For decades, we’ve understood that physical fitness doesn’t just happen — it takes skills, regular practice, and a supportive environment. The same is true for mental health. Developed by experts at the Child Mind Institute for three different age groups, our Mental Health Fitness guides have been used by more than 1.8 million students, caregivers, and educators to build emotion regulation skills and resilience. Whether your child is 5 or 15, struggling or thriving, they can learn these skills. And you can practice alongside them. Learn more at Mental Health Fitness.

Related Resources

• How to Help Children Calm Down
• What Is Co-Regulation?
• How to Model Healthy Coping Skills
• Raising Confident, Independent Children

The post Alexa Grasso on Mental Health Fitness  appeared first on Child Mind Institute.

Every day, parents reach out to the Child Mind Institute with questions that keep them up at night: Why does my daughter have such strong emotions? Why can’t my son sit still in class? Is this normal anxiety or something more?.

These questions are urgent, but finding answers isn’t easy. The wait time to see a children’s mental health professional can be months or even years. Many families don’t know where to start, what’s normal for their child’s age, or whether their concerns warrant professional help. And with nearly 1 in 5 children experiencing a mental health challenge within the U.S. alone, too many families are navigating this uncertainty on their own.

That’s why we built Ask Kai — a free, evidence-based symptom checker designed specifically for children’s mental health, available in both English and Spanish.

Ask Kai is a conversational symptom checker that helps parents and caregivers understand their child’s behavior and points them to appropriate resources. Through a streamlined series of questions and prompts, Ask Kai gathers information about your child’s challenges and provides personalized recommendations in minutes.

Ask Kai doesn’t diagnose your child. Instead, it helps you:

• Understand whether your concerns align with common mental health challenges
• Learn what to look for and what questions to ask
• Find evidence-based resources specific to your child’s needs
• Know how to find additional support if needed

Think of Ask Kai as a knowledgeable guide who helps you make sense of what you’re seeing and points you toward your next best step.

If you’ve ever used a symptom checker for physical health, you know the challenge: enter “headache,” and you might walk away convinced you have everything from a sinus infection to a brain tumor. Mental health symptom checkers face even greater challenges. Because every child is different, what looks like defiance in one child could look like anxiety in another, and a behavior that’s appropriate at age five might be cause for concern at age ten. On top of that, mental health conditions often overlap.

So how did we build a tool that captures this complexity without overwhelming families? We focused on expertise and evidence:

• Clinicians and data lead the way: Ask Kai was built using thousands of child mental health evaluations — open datasets spanning different ages, backgrounds, and conditions — and developed in close collaboration with child psychologists and psychiatrists.
• Evidence-based question selection: Rather than asking hundreds of questions, we used machine learning to identify which combinations of questions provide the most meaningful information without burdening families.
• Comprehensive resource library: Every recommendation Ask Kai makes is matched to our extensive collection of guides, articles, expert perspectives, and pathways to professional help.

Step 1: Initial Screening

You’ll answer a brief set of questions about your child’s behavior, emotions, and how these challenges affect daily life. You’ll also have the chance to describe in your own words what brought you to Ask Kai. These questions cover the areas where we see the most common concerns.

Step 2: Personalized Deep Dive

Based on your responses, Ask Kai selects targeted follow-up questions that dig deeper into the areas you flagged, whether that’s attention and focus, social anxiety, learning, or other behavioral challenges.

Step 3: Matching You to Resources

Ask Kai analyzes your complete response pattern, including the severity and impact of the behaviors you described, and provides a report with recommendations relevant to your child’s age, challenges, and needs.

We designed Ask Kai to explore the areas where we can provide the most help to the most families. Ask Kai offers comprehensive screening and resources for:

These ten areas represent some of the most common mental health concerns in childhood. They’re also areas where we have robust data, validated assessments, and comprehensive resources.

Ask Kai can still help. When you describe your situation in your own words, Ask Kai analyzes your response to identify additional concerns and match you to appropriate resources. Your child’s challenges don’t need to fit neatly into one of these categories for Ask Kai to provide value.

However, we will only make recommendations when we’re confident in the evidence behind them. If a particular concern isn’t well represented in our data, we won’t try to provide guidance in that area. Regardless of the results, everyone receives a core set of resources that we believe are helpful for all families navigating children’s mental health.

We take data privacy seriously:

• Your responses are confidential and secure
• Free-text responses are analyzed using secure AI systems
• We don’t share your individual information with third parties
• In addition to providing you with resources, your data will only be used to improve Ask Kai

If you’re wondering whether your child’s behavior is typical or cause for concern, Ask Kai can help. In just 10 to 15 minutes, you’ll get personalized insights and resources to guide your next steps.

You don’t have to figure this out alone. We’re here to help.

If your child is in crisis, expressing thoughts of self-harm, experiencing severe symptoms, or in immediate danger, please seek emergency help right away. Call 988 (Suicide and Crisis Lifeline), text “HELLO” to 741741 (Crisis Text Line), or go to your nearest emergency room.

How long does it take?

Most families complete Ask Kai in 10–15 minutes.

Who should use this tool?

Parents, caregivers, and professionals working with children ages 4–18.

Will I get a diagnosis?

No. Ask Kai provides screening information and resources, but only a qualified clinician can provide a diagnosis.

What if I need immediate help?

If your child is in crisis, please call 988, text “HELLO” to 741741, or visit your nearest emergency room.

What makes this different from other symptom checkers?

Ask Kai was built specifically for children’s mental health, uses evidence-based assessments, provides personalized follow-up questions, and was developed in close collaboration with child mental health professionals.

The post Finding Answers When Your Child Is Struggling: Introducing Ask Kai  appeared first on Child Mind Institute.

Known for embodying the color yellow and sharing sunshine, influencer Anna Sitar always keeps it honest when it comes to her mental health. Rather than curating only the good moments, Anna shares how she keeps her mental well-being in check through small, consistent habits like journaling, therapy, and being vulnerable with her followers. Her message is simple — actively look for the good, even on harder days.

About Anna Sitar

Anna Sitar is a content creator and influencer who’s amassed over 1.6 million followers on Instagram. She’s known for her refreshing honesty in conversations around mental health and normalizing vulnerability in digital spaces. Through her content, Anna encourages others to embrace authenticity and prioritize self-reflection.

About Mental Health Fitness

For decades, we’ve understood that physical fitness doesn’t just happen — it takes skills, regular practice, and a supportive environment. The same is true for mental health. Developed by experts at the Child Mind Institute for three different age groups, our Mental Health Fitness guides have been used by more than 1.8 million students, caregivers, and educators to build emotion regulation skills and resilience. Whether your child is 5 or 15, struggling or thriving, they can learn these skills. And you can practice alongside them. Learn more at Mental Health Fitness.

Related Resources

• How to Help Children Calm Down
• What Is Co-Regulation?
• How to Model Healthy Coping Skills
• Raising Confident, Independent Children

The post Anna Sitar on Mental Health Fitness  appeared first on Child Mind Institute.

By Mai El Shoush, Partnerships Campaign Manager, Stavros Niarchos Foundation (SNF) Global Center for Child and Adolescent Mental Health at the Child Mind Institute

As global health systems continue to explore solutions that minimize resource constraints while addressing child and adolescent mental health demands, innovative approaches like surf therapy are demonstrating remarkable effectiveness as low-intensity initiatives. From the beaches of California to the coastal communities of South Africa, Australia, Hawai’i, the United Kingdom, and Senegal, these programs are creating accessible entry points for young people.

Wave for Change (W4C) — a South Africa-based organization and valued implementation partner of the Stavros Niarchos Foundation (SNF) Global Center at the Child Mind Institute — has developed an evidence-based Surf Therapy program for youth in underserved communities. We spoke with their chief development officer Paula Yarrow and senior grant manager Jill Sloan about the award-winning program. As a highly regarded Cape Town‑based NGO that uses surfing as a therapeutic tool to support youth mental health, W4C offers safe spaces, evidence‑based emotional regulation tools, community mentorship, and a pathway to resilience for young people growing up in challenging environments.

The partnership includes the identification of workforce gaps and training needs for frontline workers such as NGOs, to further expand evidence-based support and brief interventions through culturally appropriate, low-intensity psychological therapy approaches. The context-specific training materials are expected to be piloted later in the year in South Africa and are intended to improve access to quality mental health care for young people.

W4C launched Surf Therapy in 2009, which has since helped more than 10,000 adolescents experiencing high-stress environments gain valuable coping skills across its hubs in the Western and Eastern Cape as well as Cape Town. Participants learn how to build positive social networks and develop self-regulation skills to support healthy emotional and behavioral responses to stress, with coaches themselves aged between 18-25. The program creates a fun, culturally relevant environment through the Take 5 model — a framework W4C has designed to be adapted for a range of sports, arts, and cultural initiatives. The model has been utilized by several leading global organizations, including UNICEF.

Waves for Change also played a key role in the founding of the International Surf Therapy Organization (ISTO), connecting practitioners, clinicians, and researchers to advance science research, raise awareness, and support surf therapy.

Approximately 90 percent of the world’s adolescents live in low- and middle-income countries (LMICs). In the most underserved communities, adolescents may experience repeated exposure to violence, unmet basic needs, and limited access to safe spaces or trusted caregivers. Typically, there are very few mental health services that are accessible to such youth.

The more Adverse Childhood Experiences (ACEs) a child or adolescent has whilst growing up, the more likely they are to develop toxic stress — an ongoing stress state without respite. This can often lead to mental health conditions such as anxiety, depression, substance misuse, and cognitive impairment. This can also result in the development of physical health conditions such as heart disease as they grow into adulthood.

The main problem we’ve identified is that there aren’t enough trained workforces (e.g., sports coaches, youth facilitators) that are able to deliver simple, fun, structured play-based sessions with consistency at scale. Our work provides a response to this issue within the adolescent mental health promotion and illness prevention arena. Additionally, our initiatives significantly increase the number of individuals — coaches, teachers, mentors or others — who are already in contact with young adolescents and can provide them with mental health support to foster their immediate and longer-term mental health.

Waves for Change’s Take 5 training model has been incubated, tested, and rigorously evaluated within W4C’s award-winning Surf Therapy program. Take 5 distils the key components of our Surf Therapy program, providing coaches with the essential skills they need to build and sustain caring relationships with children. And it uses a simple teaching routine that creates consistently engaging, fun, structured programs for children and adolescents that suit their language, culture, and context.

Take 5 is low intensity and cost-effective — tailored for high-stress environments and the unique mental wellness needs of adolescents living in multidimensional poverty, conflict, or crisis.

In research studies we’ve conducted, adolescent participants (ages 10-16) reported experiencing between 6-8 adverse events every year, including violence and abuse. When asked what sorts of spaces they wanted to see at Waves for Change, the adolescents identified core components such as access to a safe space where they could have fun, be heard, and learn skills to cope. These components now form the bedrock of our Surf Therapy program. We initially worked with 9-12-year-olds and have since developed the follow-on programme for adolescents up to age 16 who have graduated the Surf Therapy programme. This is called Surf Club and is available to all Surf Therapy graduates.

Waves for Change also conducts pre- and post-intervention surveys with participants to monitor the impact of our work. Our coaches (ages 18-25) are at the frontline of delivering our services. A key role they play is to listen with care and respect to the adolescents’ concerns, and to share them with our Child Protection team for review and follow-up when needed.

Working with the Child Mind Institute allows Waves for Change to collaborate with and learn from colleagues doing similar work in the adolescent mental health space across South Africa, the United Kingdom, and Brazil. The partnership offers an opportunity to learn about approaches that have been successful in other health systems. It has also allowed Waves for Change to share detailed information about the training and supervision protocol used to develop key competencies in the coach workforce that leads Surf Therapy in South Africa. This has helped the Child Mind Institute to develop a comprehensive guide for other similar workforces.

Partnerships allow for the consolidation of skills and resources so that a greater impact can be achieved. For example, at Waves for Change, we work with over 70 referral partners every year to identify young adolescents who can benefit from our Surf Therapy program. We are also partnering with the Department of Cultural Affairs and Sport to use our Take 5 model to train MOD and YearBeyond coaches and mentors, who are already reaching large numbers of children and young adolescents through their work. And we’re contributing to building the broader ecosystem of mental health support for adolescents and children by training large national NGOs, government agencies, and humanitarian organizations with our Take 5 model.

Some of the key lessons we have learnt are the following:

• In the field of youth mental health, make youth the leaders on program implementation
• Provide youth with skills, opportunities, supervision, and support so that they can grow and develop further
• Maintain a strong culture of protection, respect, and communication so that all participants feel safe, welcome, accepted, and heard

Read more about W4C’s Surf Therapy from Youth Liaison Officer, Azola Sibanda and Training Manager Jamie-Lee Davids

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The post Surf Therapy: A Powerful Low-Intensity Approach in Global Youth Mental Health Care appeared first on Child Mind Institute.

A moment like this might be among your earliest memories because the feeling was so intense, says Caitlyn Downie, LCSW, the Director of Trauma and Resilience at the Child Mind Institute. That offers some insight into the fear of a child of any age who is separated from a parent or caregiver in a more serious way. The effects of this stress are so powerful they can actually change the way a child develops.

A toddler whose mother goes to prison. A kindergartener whose father is detained and deported. A teen who is placed in foster care. These are a few examples of what experts call traumatic separation, a clinical concept based on the importance of the parent-child bond and the profound effects that can result from breaking it.

Traumatic separation isn’t a clinical diagnosis, but research shows that it can be profoundly harmful to kids. What makes it traumatic (as opposed to routine partings, like when an adult regularly leaves their child to go to work) is the character of the separation: ones that are sudden, unexpected, or confusing, or those that come about through larger distressing events, like a natural disaster or war. It’s not defined by the time spent apart — both short and long-term separations can be harmful.

Some common examples of separation that can become traumatic include:

• Parental deportation
• Immigration (e.g., forced separation at the border)
• Parental military deployment
• Parental incarceration
• Termination of parental rights

Separating from a parent or primary caregiver can be distressing to a child even when it’s deemed necessary for their safety, as in cases where the parent they have been separated from has abused them, says Kimberly Alexander, PsyD, a psychologist at the Child Mind Institute. “There’s still a natural attachment that occurs. And the separation disrupts that relationship, even if it’s for the support and care of the child.”

More than eight decades of research has shown the profound developmental importance of the parent-child bond. This is the guiding principle of attachment theory, which was pioneered by a British psychologist who studied children who were evacuated during the Blitz, the aerial bombardment of London in World War II.

Here’s what the research tells us about the harms of traumatic separation:

Think of secure attachment as a “fundamental sense of security and safety” that a child feels with a parent or caregiver, says Dylan Gee, PhD, a psychologist at Yale University who studies how early-life stress affects children’s development.

“Attachment is the lens through which children come to know what they can expect from the world around them,” she explains. “Is this going to be a safe place or a dangerous place? This is foundational to a child’s sense of their ability to navigate the world. Traumatic separation can shatter that sense of safety.”

Children’s brains are especially plastic, says Dr. Gee, constantly learning to understand their environment and how to deal with stress. “Trauma that occurs in childhood can be even more consequential than trauma that occurs later in life,” she says, and experiencing these disruptions in childhood can affect the way your brain and body are primed to react to stress later on.

But heightened plasticity is a paradox, she adds. “It confers more vulnerability, but it also confers more potential for resilience — children have heightened potential for supportive intervention and for healing and recovery.”

There are acute and short-term effects that are common across kids of all ages:

Sleep problems: “It’s often one of the first things that we see: nightmares, trouble falling asleep, or a lot of crying as kids are trying to fall asleep,” Dr. Gee says.

Separation anxiety: This might look like distraction, withdrawal, or clinginess because of fear of being separated from their new caregivers, Dr. Alexander says.

But signs may take weeks or months to show up. Dr. Alexander advises caregivers to consider the child’s baseline — their typical patterns of eating, sleeping, or engaging with others. “If they’re having more trouble with sleep, they’re eating more, eating less, they’re withdrawing or expressing a lot of worried thoughts three or four months later — that’s something worth getting looked at by a clinician,” she says.

“Sometimes people ask, ‘Well, when is separation the most harmful?’ It can be extremely harmful at any age,” Dr. Gee emphasizes. But there are specific signs at different developmental stages:

Babies may not be as consciously aware of being separated from a parent as older children, “but they’re fundamentally aware that their primary source of regulation and safety is missing,” Dr. Gee says. Because infants are so reliant on caregivers for nurturing and sustenance, the separation “can be experienced as a threat to their survival.” That might look like “crying a lot or becoming withdrawn,” she says. “And at any age we can see intense fear.”

Toddlers and young children might become extra clingy with new caregivers or show regressive behaviors like bedwetting or baby talk. Regressive behaviors happen when kids are overwhelmed by stress and can’t express themselves another way, Downie says. “It’s like your nervous system goes kind of haywire,” she explains, “so it uses the body to signal that something is wrong.”

Similarly, kids at this age might act out more, throwing more tantrums, or withdraw. They might develop selective mutism, a condition where kids are too anxious or distressed to speak, even when they want to, in certain situations or with certain people.

School-age children might act out or experience separation anxiety. They may also struggle to understand the meaning of the separation, why it happened, or who is at fault for it. Thus, kids at this age are more prone to magical or distorted thinking and feelings of guilt, thinking or saying things like, “I’m the one that caused this” or “This is my fault.”

The weight of these distorted thoughts or other worries, Dr. Alexander says, might make it appear as though a child is struggling to concentrate or that they’re disengaged or distracted. They might withdraw in a group or be averse to stepping outside of their comfort zone.

Children who are school age or older can also experience emotional desensitization — a kind of emptiness of feeling — Downie says, which can look like spikes in irritability, a lack of empathy, not smiling or expressing positive emotions, or an inability to relate to others.

“I’ve seen teenagers have a lot of mistrust with systems and be very oppositional,” says Downie. “Like, ‘I don’t trust you. I don’t trust my teacher. I don’t trust this child services worker.’” It might make sense that, say, a teen in foster care would be wary of the foster care system. But Downie says it’s often a larger instinct for anger and mistrust, one that extends beyond any specific entity or person.

The teenage years are also when kids are forming their identity, and traumatic separation can fundamentally alter that process. For example, a teen with younger siblings may step into a parent role, taking on new worries and responsibilities. Conversely, teens may become more reckless in a caregiver’s absence, putting them at risk for substance abuse or incarceration.

Adults caring for a child who has been separated from a parent — family members, foster parents, teachers — “can play a profound role in supporting their mental health and resilience,” says Dr. Gee.

One of the most important things caregivers can do is be present as a child reacts to their experiences, especially if and when scary feelings come up. But be careful not to lead kids or assume they feel a certain way. “You don’t want to make something more distressing to a child if it’s not presenting itself,” says Downie.

If a child expresses guilt, or says something like, “This is my fault,” there are still ways to validate the feeling without endorsing the statement, says Dr. Alexander. You might say something like: “I can understand why that thought comes to mind and how difficult it is to feel that way. When you’re ready, let’s think about other possibilities to this situation.”

One of the hardest things about traumatic separation is the uncertainty — Where did they go? When will they come back? What is happening? Giving kids some sense of consistency and stability can help them feel safe despite the unknowns. So as much as possible, help them stick to any routines: going to school, seeing friends, doing activities they enjoy.

Dr. Alexander advises focusing on things you can control — for example, shielding kids from potentially worrying discussions in a family where a parent has been deported.

“There would likely be a lot of conversations in the home about the situation, maybe a lot of watching the news, maybe making a lot of phone calls to attorneys,” she explains. “So where are you having those conversations, and can you have them in an area or at a time of day where your kid isn’t overhearing the discussions out of context?”

For young kids, it might be as simple as asking them to play in their room. For teens, it might be better to have certain conversations when they are out of the house and invite them to participate directly in others.

Caregivers might not have all the answers — like knowing when a child’s parent is coming back — but they can create a sense of consistency and stability in how they respond to kids’ questions, too.

Avoid undue reassurance (“Everything is going to be fine”) or over-promising (“They’ll be back in two weeks”) by focusing on what kids can expect, says Dr. Gee. For example: “What I can tell you is that I’m here for you, and I’m going to be with you until he’s back,” or “You’re safe with me, and I’m going to stay with you through this really hard time.”

Children are sensitive to tone, Dr. Alexander says. “So, if you’re having really big emotions that are out of context for a child, the child is looking at these emotions and trying to understand what’s happening. ‘Am I in danger in this specific moment?’”

She says it helps to have conversations about these moments, especially with younger kids. “Like, ‘I know you noticed mommy crying. We’re feeling really big feelings, and this is how we’re going to deal with those big feelings. I’m going to take a break. I’m going to get a sip of water. Whenever you’re having big feelings, I want you to let me know so that I can help you try doing the same things,’” Dr. Alexander says, explaining the importance of naming the emotion and then teaching kids that there are ways of dealing with it.

The effects of traumatic separation can persist even after a child and their caregiver are reunited. Traumatic separation, like other adverse childhood experiences, puts kids at risk for a host of long-term medical and mental health conditions, including depression, anxiety, attention issues, and post-traumatic stress disorder (PTSD).

But Downie notes that not everyone who experiences traumatic separation develops PTSD. “Just because someone’s experiencing trauma now doesn’t mean that it’s going to become a PTSD diagnosis,” she says. “A lot of the behaviors that we’re talking about are normal and expected. There’s an adjustment period when a separation happens.” But if symptoms persist or escalate over several months, a child may need more serious support.

While not every child who experiences a separation may receive a trauma diagnosis or require treatment, cognitive behavioral therapy (CBT) — and the more specific trauma-focused cognitive behavioral therapy (TF-CBT) — is the “gold standard,” says Downie. TF-CBT is specifically for children experiencing trauma-related symptoms. An important component of TF-CBT is creating a trauma narrative, where kids create a story about what happened to help them process it. “But if you have a child who is not ready to process and integrate that trauma, you can’t force the pacing of the treatment,” she says.

In short, a good clinician will follow a child’s lead — even if that means just sitting in the same room with them to build trust. “People really need to feel like they’re being heard and that they can trust someone,” Downie says. Which is why a supportive caregiver or trusted adult can make a big difference.

“If people can take anything away from this, it’s that you want to make kids understand that that they’re not responsible for what’s happened and that people do care about them,” Downie says. “Kids are really resilient, and they can adapt in a good-enough environment. They don’t have to have everything to be successful.”

The post What Is Traumatic Separation? appeared first on Child Mind Institute.

Failure to launch syndrome, highly dependent adult children, boomerang kids — there’s no standard term or definition, but if you’re a parent in this situation you recognize it. You are worried and frustrated about your adult child’s difficulty in leaving the nest, and you don’t know what to do because everything you’ve tried so far hasn’t worked. 

“These aren’t kids who come back home because they finished school, and the first job they get doesn’t pay enough for them to afford rent on an apartment,” says Theresa Welles, the Shapiro Family Director of the Bubrick Center for Pediatric OCD at the Child Mind Institute. “We’re talking about young adults who functionally have hit a wall, so to speak. They’re caught in a loop of dependency.”

It’s not uncommon for adult children to live with their parents: According to Pew Research Center, 18 percent of adults ages 25 to 34 lived in their parents’ home in 2023, with young men more likely than young women to do so (20 percent vs. 15 percent). Young adults might leave home for a period of time and then move back in with their parents because they can’t find a job. Or for religious or cultural reasons, some adult children expect to live in the family home until they get married. Living at home is not the main criterion for determining a “failure to launch.”

While there is no official clinical definition, researchers who study this group of young adults generally categorize someone as a highly dependent adult child if they are:

• Not in school, working, or actively looking for work (though physically capable of doing so)
• Financially dependent on their parents for housing and other necessities
• Emotionally reliant on parents (i.e., needing constant reassurance that they are okay)  

They usually have very limited social interactions other than online. Often, they have mental health challenges such as anxiety, depression, or OCD, which is a contributing factor, Dr. Welles says.

“They’re at the developmental stage of early adulthood, they’re figuring out who they are,” Dr. Welles says. “The fancy term in psychology is ‘individuation,’ but it’s essentially who you are, both as part of your family and separate from your family.” Highly dependent adult children haven’t made much progress in this stage for several years. Many of them want to change their life path and become more independent, but they struggle with anxiety or fear of failure and don’t follow through on the necessary steps. “Reliance on parents reduces opportunities to build autonomy, which in turn maintains that reliance,” she says. So, they remain stuck.  

Young adults who are highly dependent often fall into certain patterns of behavior. They don’t do their own laundry, cook, clean, or help out around the house. They rarely leave the home and often shut themselves in their bedroom or live in the basement, avoiding talking to others in person. As a result, they rely on their parents to act as an intermediary with the outside world, such as making doctor’s appointments. They might blame their parents for their difficulties in life.

While parents may not like the situation, they struggle to get their adult child to change. So instead, they accommodate them — especially when they are concerned about their child’s mental health challenges.

“In the world of neurodiversity, accommodations are a good thing — we want accommodations for testing and sensory environments,” says Natalia Aíza, LPC, the author of the forthcoming Anxious to Launch: Parenting Strategies to Help Your Adult Child Move On. “But in the anxious-to-launch world, accommodations are actually interfering with your child becoming independent.”

Aíza gives some examples of unhelpful family accommodations: You make sure there’s food in the fridge, don’t ask them to contribute to paying bills, and may give them spending money. When they get angry or upset, you accept the behavior and feel guilty, thinking you are to blame for the situation. If they are anxious when you aren’t nearby, you don’t travel because it causes them stress. Instead of expecting them to take steps to find a therapist, you do the legwork.

“The number one behavior of the highly dependent adult child is avoidance. I cannot emphasize this enough,” Aíza says. “If your child has a full-on virtual life, that’s their social outlet. They are avoiding real-life challenges. They are avoiding working at jobs that are unpleasant. They are probably avoiding adulting tasks that should fall on them at this point. So, we swoop in and take care of those tasks for them.”

While adult children have lived with their parents in past generations, researchers argue that phenomenon of highly dependent adult children is on the rise, and young people today seem particularly susceptible. Adolescence is more prolonged now in many cultures, and there’s an emphasis on finding a fulfilling career, not just a job that pays the bills.

Technology contributes to the problem. Playing video games, watching videos, scrolling through social media — “these activities don’t help matters because they can do things that feel like they’re accomplishing something,” Dr. Welles says.  

In Dr. Welles’s practice, she has worked with families where she initially treated the teen for anxiety or OCD, then involved the parents more deeply when the young adult had trouble launching. In one case, the son was in the habit of playing video games late at night and would sleep through class the next day. He had anxiety and depression, and his parents didn’t want to take away video games because it was the one thing he enjoyed doing. But they started turning off the Wi-Fi in the house at a certain time at night.

“It sounds so extreme, like he’s being punished,” Dr. Welles says. “But it’s about saying to him, ‘We’re going to pull back on ways we’ve accommodated that may have unintentionally made your anxiety worse.’” It was important that the parents validated his feelings, saying things like, “You feel like you’re in danger, as if you’re standing in front of a bear, and that’s really hard. But that’s the anxiety lying to you, and it won’t go away if we keep accommodating things that allow you to avoid what you need to do in order to overcome this anxiety.”

And tactics like these made a difference over time. The son is now attending college part-time and working as a server at restaurant. He has a girlfriend and has plans to save enough to move into an apartment with a friend.

If the adult child doesn’t seem motivated to find a job, Aíza has recommended that parents take them off the family cellphone plan, giving them warning that this will happen by the next month’s bill. “This is not necessarily the most strategic financial choice” because it’s often much cheaper per person on a family plan, she acknowledges. “But it is a perfect first accommodation to remove because it is telling your adult child, ‘This is something you can handle. You can be responsible for it financially and logistically. It is something that I control, and I want to stop controlling parts of your life.’” And it’s often the motivation they need to find a job — something that can earn them $100 for the monthly cell phone bill is small enough that it feels doable.

When families take steps like these, the adult child will likely get angry or upset. “That’s hard. But think about when your kids were toddlers, and they wanted to touch a hot stove,” Dr. Welles says. “They were mad when you said, ‘No, you can’t touch that stove,’ but that didn’t mean you let them do it.”

“The good news is, generally speaking, even if there’s unhappiness in the beginning,” she continues, “pretty quickly, once they start to feel better and are doing the things that they actually care about, it can really help.”

Highly dependent adult children might accuse parents of not being supportive when they pull back on accommodations. Dr. Welles suggests communicating that you hear them and validate their feelings: “You can say things like, ‘Hey, I know this is tough or ‘I know that this makes you really nervous.’ But you combine it with the confidence that they can do it, like ‘I also know you can do it, as hard as it is.’”

Sometimes, you might think you are being supportive when you are actually enabling — like filling out a job application on behalf of the child. “Even if it works and they get an interview, you’re accommodating their anxiety,” Dr. Welles says. “But also, there’s going to be a point when you can’t do something for the child — the interview or the job itself — so the earlier that you can pull back the better.”

If your adult child has both ADHD and anxiety, you can support their executive functioning skills without accommodating the anxiety. “Maybe you sit down with them on Mondays and look at their schedule to help them determine if there’s a way you can help them organize, as opposed to you stepping in and letting them avoid things they need to do because they’re anxious about it,” Dr. Welles says.

Aíza encourages giving the adult child the minimum amount of help needed, to avoid creating another form of dependency. “It’s about noticing, ‘Am I working harder at this than they are?’” she says. “A lot of times the answer is ‘yes,’ and that’s a signal to back off and put more expectations on the child.”

While there is no standard treatment for highly dependent adult children, early evidence has shown a form of therapy called SPACE-FTL (Supportive Parenting for Anxious Childhood Emotions – Failure to Launch) to be promising. A variation on an effective treatment for anxiety and OCD, SPACE-FTL involves only the parents, since the adult child is often resistant to seeking help. The program helps parents reduce accommodations step by step and engage extended family and friends to help de-escalate conflict. 

One tactic is to make a plan to deliver a change in accommodation in writing — for instance, explaining that you will stop paying the cellphone bill at the end of the month and why. Doing it in writing (on paper or in a text) makes the message clear and helps you remain calm and non-reactive. If you are expecting an angry or violent response, they can ask a grandparent, uncle, or family friend be in the house when you deliver the letter, since that might make the response less extreme. The relative or friend may even spend the night if the adult child is more likely to cool off when others are present.

Asking for others’ help also helps you stop blaming yourself for the situation. “A lot of parents of highly dependent adults feel shame, but this is not something happening to only one family,” Aíza says. “We need to build on our social supports and get other people on our team so that we don’t feel so isolated in this process. Your adult child may be resisting change, but you don’t have to. It might sound cruel, but our central mandate as parents is making sure our child is okay after we’re gone. We brought them on earth to survive us — that is the design.”

The post “Failure to Launch” Syndrome appeared first on Child Mind Institute.

New York, NY – The Child Mind Institute, an independent nonprofit dedicated to transforming the lives of children affected by mental health disorders, today announced Vera Feuer, MD, as the organization’s first-ever Chief Clinical officer. A seasoned specialist in pediatric and adolescent mental health, Dr. Feuer will oversee clinical strategy, including patient care in the New York City and San Francisco Bay Area offices, and help drive innovation across treatment and research.

Dr. Feuer most recently served as Vice President of Child and Adolescent Psychiatry at Northwell Health and is a professor of psychiatry, pediatrics, and emergency medicine at the Zucker School of Medicine at Hofstra/Northwell Health. A board-certified psychiatrist, she brings more than 20 years of clinical, expertise and leadership in pediatric and adolescent mental health and crisis care to the Child Mind Institute. She has helped pioneer innovative standards of care in pediatric crisis behavioral health care and suicide prevention, and she has led the development of programs for the pediatric medical community and school district partnerships to expand mental health care access for students.

“I am thrilled to join the Child Mind Institute and beyond excited to bring my extensive experience of working with youth and families, creating access to care and innovative program development, and to work with this remarkable team,” Dr. Feuer says. “Together we will deepen access to high-quality, evidence-based care and develop programs that meet the needs of kids where they are.” 

Dr. Feuer will provide strategic oversight to a multidisciplinary team of more than 70 clinicians who deliver over 70,000 patient appointments annually, ensuring continued excellence in delivering care, developing school-based programs, and establishing community partnerships while expanding access to high-quality mental health services. As a member of the Child Mind Institute’s executive leadership, Dr. Feuer will be instrumental in shaping the organization’s clinical vision, providing medical expertise to improve outcomes for children and families and guiding the integration of research through data-driven approaches that advance care and innovation. 

“At a time when youth mental health needs are more urgent than ever, Dr. Feuer’s exceptional leadership brings crucial guidance to meet this moment,” says Harold S. Koplewicz, MD, founding president and medical director of the Child Mind Institute. “Our mission has always been to transform how families access and experience mental health care. With Dr. Feuer at the helm as our Chief Clinical Officer, we remain steadfast in our commitment to strengthening our clinical foundation, shaping the future of mental health and helping families nationwide.” 

To learn more, visit childmind.org, and read Dr. Feuer’s full biography.

The Child Mind Institute is dedicated to transforming the lives of children and families struggling with mental health and learning disorders by giving them the help they need. We’ve become the leading independent nonprofit in children’s mental health by providing gold-standard, evidence-based care, delivering educational resources to millions of families each year, training educators in underserved communities, and developing tomorrow’s breakthrough treatments. 

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In simple terms, dissociation is a kind of mental disconnection. “When I think of dissociation, I think of there being some sort of disconnect between an individual and their sense of self, or a period of time that you later can’t recall, or feeling like you’re disconnected from your body,” says Lauren Allerhand, PsyD, a clinical psychologist at the Child Mind Institute and co-director of its DBT program.

Some kids describe dissociation as feeling spaced out, numb, or disconnected from their body or surroundings. Others say they feel like they’re watching themselves from outside their body, or that the world around them doesn’t feel real. “There’s some period of time where your normal sense of flow is disrupted,” Dr. Allerhand explains.

In its mildest form, dissociation is a commonplace occurrence. Kids might daydream in class, zone out during something boring like a long car trip, or feel detached when they are overwhelmed in some way. These experiences are usually not a cause for concern. “Our brains do a really good job of protecting ourselves,” Dr. Allerhand says. “Sometimes our brains develop strategies to protect us that are healthy, and other times they develop strategies that might work in short bursts but become less helpful if they happen too much.”

When dissociation happens often, or interferes with daily life, it may signal that a child is struggling with something more serious than ordinary, intermittent stress. “If it’s happening all the time, it’s less effective as a coping mechanism” because of the toll it can take when there is memory loss, confusion, and feeling disconnected to the self, she explains.

Children and teens may describe dissociation differently. Some say they feel:

• Like they’re in a dream
• Emotionally numb
• Detached from their body
• Like they’re watching themselves in a movie
• Like things around them aren’t real

“Kids might say they feel like a robot. Everything feels fake around them,” Dr. Allerhand says. “Younger children may not have the words to describe what they’re experiencing. Instead, parents might notice their child seems unusually quiet, unresponsive, or ‘not themselves.’”

Dissociation is often linked to stress or overwhelming emotions — kids may dissociate when they feel unable to cope with what’s happening around them. “This could be a response to any sort of highly intense emotion or experience,” Dr. Allerhand says, such as:

• Trauma
• Anxiety or panic
• Intense emotions
• Depression
• Major life changes
• Overwhelming stress

“It’s another way of coping with stress or trauma,” says Tanvi Bahuguna, PsyD, a clinical psychologist at the Child Mind Institute who specializes in trauma and mood disorders. “There’s this psychological process that helps them disconnect from overwhelming pain.” Some kids dissociate during panic attacks or periods of intense anxiety. Children who have experienced significant adversity may be more likely to dissociate. These experiences can include:

• Abuse
• Neglect
• Family instability (housing instability, domestic violence, addiction)
• Loss of a family member, especially through violence or suicide

Still, experts are quick to note that dissociation doesn’t automatically mean a child has experienced trauma or has a serious disorder. “There are lots of exits on this highway before we’re at a dissociative disorder,” Dr. Allerhand says, adding that a full-blown dissociative disorder is very rare in children.

It can be hard to recognize when a child is experiencing more serious dissociation because it doesn’t always look different from daydreaming or inattention. One key difference is distress. “Spacing out or not paying attention is not often experienced as distressing,” Dr. Allerhand says. Moderate or serious dissociation “is often somewhat distressing.” Kids who are daydreaming are still connected to themselves and their surroundings; kids who are experiencing more serious dissociation may feel cut off from their body, emotions, or reality altogether.

If you think your child may be dissociating, the most important thing you can do is not panic or try to get your child to “snap out of it.”  “The number one thing a parent can do is stay as calm as possible,” Dr. Bahuguna says. Speak gently, use short sentences, and reassure your child that they’re safe. Saying your child’s name and reminding them you’re there can help them reconnect.

Grounding techniques can also bring kids back into the present moment. One common method is called the 5-4-3-2-1 technique: Ask the child to name five things they can see, four things they can feel, three things they can hear, two things they can smell, one thing they can taste or imagine tasting. Other grounding strategies include:

• Deep breathing
• Squeezing a stress ball
• Holding something cold
• Gently moving the body

If you find your child often dissociates, Dr. Allerhand recommends helping them make a plan for it. During a calm moment, talk with your child about what they find helpful. “I noticed that this is happening. How can I help you when this is happening?” she suggests asking. Having a plan in advance makes it easier to respond in the moment — and in the meantime, stay nearby and make sure your child is safe until the episode passes.

If dissociation is frequent, distressing, or associated with changes in your child’s functioning, seeking professional support is appropriate. “If something dissociative happens, and there’s a really big change in your child’s functioning, then I would be concerned,” Dr. Allerhand says.

Signs it may be time to reach out include:

• Memory gaps after the episode
• Noticeable personality changes
• Difficulty at school
• Withdrawal from friends or activities
• Significant distress or confusion

A good place to start would be talking to your pediatrician, who may refer you to a mental health professional. “If your child is displaying behaviors that seem out of the ordinary, you should trust your instincts,” Dr. Allerhand says.

To determine whether a child is dissociating, a mental health professional gathers information from multiple sources, including parents, the child, and sometimes teachers, asking about the child’s behaviors, history, and any recent stressors or changes in behavior.

“The first thing would be a structured diagnostic interview with a qualified clinician,” Dr. Allerhand explains. “Parents bring the history and describe the behavior, and then the clinician meets with the child.” Clinicians also consider whether dissociation might be a symptom of another condition, such as post-traumatic stress disorder, borderline personality disorder, anxiety (especially panic disorder), and depression.

“It’s really gathering history, meeting the child, observing the child, and figuring out what this cluster of behaviors leads to,” she says. It’s more frequent to find that dissociation is a result of another disorder than an actual dissociative disorder.

Treatment depends on what’s driving the dissociation. If trauma is involved, therapy may focus on helping the child process difficult experiences and build coping skills. Evidence-based approaches include trauma-focused cognitive behavioral therapy (TF-CBT) and eye movement desensitization and reprocessing (EMDR).

If anxiety or emotional overwhelm is the primary cause, treatment may focus on emotion regulation, grounding techniques, and identifying triggers and early warning signs. Therapy, such as dialectical behavior therapy (DBT), typically involves both children and parents, helping families recognize patterns and respond in supportive ways.

For more severe or persistent dissociation, treatment may happen in phases — beginning with safety and stabilization, then skill-building, and eventually, when appropriate, processing difficult experiences. “The goal is helping the child learn to cope with their experience and stay in their body,” Dr. Allerhand says.

In children and teens, dissociation is usually a symptom of another condition. But in cases of very serious early trauma, abuse, or neglect, it can progress into a full-blown disorder. There are a number of dissociative disorders, including:

• Dissociative identity disorder (what was once called multiple personality disorder) involves two or more distinct personality states and gaps in memory and is typically linked to significant early trauma. Parents who search online may find alarming information, but Dr. Allerhand says this condition is very rare in kids.
• Dissociative amnesia involves gaps in memory that can’t be explained by ordinary forgetfulness — such as not remembering important personal information or periods of time — and is often associated with stressful or traumatic experiences.
• Depersonalization/derealization disorder involves feeling detached from oneself, as though watching yourself from outside your body, or feeling that the world around you isn’t real.

These disorders sometimes attract media attention, but they are extremely rare in children. What’s important for parents to know is that if you see dissociative behavior in a child, it’s most likely a normal coping mechanism for a child experiencing some stress or intense emotion. If it persists, is causing distress, or is interfering with a child’s life, it’s time to consult a pediatrician or mental health professional. Identifying what might be causing the behavior is the first step to getting appropriate treatment.

The post Dissociation: Signs and Causes in Children appeared first on Child Mind Institute.

Treatment comes into play if tics are upsetting your child, giving them pain, or making it hard for them to function in everyday life — say they’re disrupting class or getting bullied because of their tics.

The first recommended step in treatment is a specialized form of therapy called comprehensive behavioral intervention for tics (CBIT). CBIT is centered on habit reversal training, in which the child learns to recognize when they have an urge to tic and substitute a competing response — an easier, more comfortable, or less noticeable action or behavior that makes the tic impossible. For instance, if a child’s tic is jerking their head to the side, the strategy might be to put their chin down instead.

But if therapy isn’t effective in reducing a child’s tics, medication can help.

First-line medications for Tourette’s and other tic disorders are a class of drugs called alpha-2 agonists, explains Paul Mitrani, MD, PhD, a child and adolescent psychiatrist at the Child Mind Institute. Alpha agonists decrease the release of a neurotransmitter called norepinephrine, which stimulates the nervous system. Alpha agonists serve as a kind of dimmer switch — by calming down the system, they make the urge to tic less frequent, less intense, and by extension, easier to control.

The two alpha-2 agonists usually prescribed for tics are guanfacine and clonidine. Dr. Mitrani reports that he usually starts by prescribing guanfacine because it comes in a longer-acting form (Intuniv), which reduces symptoms for a full 24 hours. Clonidine’s long-acting form (Kapvay) is effective for 12 hours.

Dr. Mitrani adds that there is a new liquid form of clonidine called Onyda XR that lasts 24 hours, but there isn’t yet a strong body of evidence regarding its effectiveness for tics. Onyda XR is FDA-approved for ADHD, as are Kapvay and Intuniv.

While no alpha agonist medications are FDA-approved specifically for tics, Kapvay and Intuniv are frequently used off-label for them. There is ample research on their effectiveness for tics, and they are recommended by clinical practice guidelines.

Some children respond better to several doses of short-acting guanfacine or clonidine, Dr. Mitrani notes, rather than a smoother dose of a long-acting medication. This may be because medication can be timed to peak at times when kids need tic suppression most, such as at school.

Alpha agonists are the preferred first-line medications for tic disorders because their side effects, including drowsiness and low blood pressure, are relatively mild.

If alpha agonists aren’t helping, the next step would be to try an antipsychotic medication, which can be more effective for treating tics, Dr. Mitrani notes, but their side effects are potentially more difficult to tolerate.

Aripiprazole (Abilify), which is FDA-approved for tics, is often Dr. Mitrani’s first choice among the antipsychotic medications. Abilify is a second-generation, or atypical, antipsychotic, a group of medications that have fewer side effects than older antipsychotics. Side effects of Abilify can include restlessness, agitation and weight gain.

Haloperidol (Haldol) is also effective for tics, but it’s an older antipsychotic with more side effect concerns, Dr. Mitrani notes. “I’ve only had one patient ever on Haldol, and he tolerated it well. And it really helped with his tics when other things did not.”

Risperidone (Risperdal) is another atypical antipsychotic that can help, but its side effects tend to be worse than Abilify. Risperidone can cause more concerning weight gain and metabolic, neurological, and hormonal changes that can be harmful. Sometimes other medications are used to manage the weight gain from antipsychotics.

More than three-quarters of kids diagnosed with a tic disorder also have another disorder. When a child has multiple disorders, a clinician will want to evaluate which is causing the child the most difficulty and prioritize treating that.

The most common co-occurring disorder with tics is ADHD. “If tics are the bigger problem, we would start with treating them,” says Dr. Mitrani. “If the ADHD is the bigger problem, which it typically is, we usually treat that first.”

In the past, it was recommended that children with tics and ADHD avoid stimulant medication, based on research that showed it made tics worse. But newer studies counter that finding, Dr. Mitrani notes, concluding that the old research was based on very high doses of amphetamine-based medications. To lower the risk of exacerbating tics, he recommends starting kids with ADHD and tics on methylphenidate-based medication.

“If your child is starting a stimulant,” he adds, “and you see worsening of tics — and it’s clearly related to when the stimulant is in their system — the best approach might be a lower dose of stimulant combined with guanfacine or clonidine.”

One advantage to that combination, he notes, is that kids with ADHD who have behavior problems can benefit from the guanfacine or clonidine being active in the mornings before the stimulant starts working and in the evenings when it’s out of their system.

When children with tics have other co-occurring disorders, such as anxiety, OCD, or depression, treating them with medication needs to be done very carefully, Dr. Mitrani says. Since children are typically not bothered by the tics themselves, it’s almost always the other disorder that is more problematic for them. And, he adds, when the other problems cause distress, it can make the tics worse.

For anxiety, OCD, and depression, the first-line medication treatment is an antidepressant. Antidepressants can actually help alleviate tics indirectly, since they reduce anxiety. “Stress increases tics, so if there is significant anxiety and you treat the anxiety, the tics may get better,” Dr. Mitrani says. “And then maybe you don’t need the guanfacine or clonidine. But again, it depends on what the co-occurring disorders are and what’s the bigger problem for the child.”

Due to the waxing and waning nature of tics, it can be challenging to see the full effect of medication and other interventions. It is important to give medication enough time to work, Dr. Mitrani notes, typically a few weeks, to see if the overall pattern, frequency, and severity of tics has improved. And children who are being treated should continue to be monitored regularly for any changes, as tics can recur or worsen, especially when a child is excited, tired, or experiencing more stress.

Most children with tics see a natural improvement or even resolution of tics as they progress through adolescence. If there seems to be a long-standing improvement, it is appropriate to consider reducing or stopping medication, especially if the child is experiencing side effects, Dr. Mitrani notes. If tics continue and are causing distress, it is important to keep treating them.

A child going off any of these medications — alpha agonists or antipsychotics — should do so gradually, by having their dose reduced over weeks or even longer, to avoid unpleasant or dangerous side effects of sudden withdrawal.

The post Medication Treatment for Tics and Tourette’s appeared first on Child Mind Institute.

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The two events happen for different reasons. A child throws a tantrum when they’re angry or frustrated, acting out because they feel an injustice has been done to them. They are aware of what they’re doing and still have some sense of control. And if a child’s tantrum is ignored by their parent or caregiver, it will likely subside quickly.

Meltdowns, on the other hand, happen involuntarily and seemingly out of nowhere. They also tend to become much more intense than a typical tantrum and may involve violent behavior such as head banging, hitting others, and damaging property. Once a meltdown has started, intervention is needed to stop it, whether it’s internal (e.g., the child using their own coping skills to calm down),  or external (e.g., support from the parent or caregiver). The event can last between a few minutes and several hours.

Tantrums are common among all children, but kids with autism are more likely to experience meltdowns of varying degrees, says Conner Black, PhD, associate director of the Autism Center at the Child Mind Institute.

For a child with autism, a meltdown is triggered when they become overwhelmed, whether it’s by stress, powerful emotions, sensory input, change, or something else. Their sympathetic nervous system — the network in the body responsible for our “fight-or-flight” response — goes into overdrive and they lose control.

There are several stages to an autistic meltdown and understanding them can help you know how to respond effectively. The duration and intensity of the meltdown depend on whether intervention, including learned coping skills, can stop the child from reaching a crisis point, Dr. Black explains. “Certain skills may not work every time, and that’s really no one’s fault,” he says, but once a child reaches that crisis stage, intervention is no longer useful. He describes the course of a meltdown via the phases of the behavior escalation cycle:

• Calm: “This is basically the valley or plain on the side of mountain, which is considered the baseline, when the child is happy, relaxed, and at their best,” Dr. Black says. For instance, in a classroom setting, a student’s behavior might be described as cooperative and responsive to instruction. These behaviors are specific to the individual, so it helps to recognize what that looks like in your child.

• Trigger: While triggers can vary, Dr. Black says, there are some common ones that he typically encounters in kids with autism. “They’re often related to the misunderstanding of social situations, a lack of time to engage with their preferred interests, a sudden change in their schedule, or a transition that was unexpected,” he says. “It could also be certain sensory aversion, so things like loud noises or loud conversations. It could even sometimes be as simple as how food is presented on someone’s plate.” The child’s response to that trigger can vary depending on their current internal state or outside environmental factors. But if the trigger isn’t removed or is strong enough to dysregulate the child, they’re going to enter the next phase: agitation.

• Agitation: At this point, the child will begin to display behaviors that indicate they are no longer in their calm phase. They might start fidgeting, darting their eyes back and forth, or tapping their hands. For other kids, it could look like total disengagement or staring into space. While removing the trigger might still work at the start of this phase, attempts at problem-solving may backfire and push the child to escalate their behaviors.

• Acceleration/Escalation: “This is really when you start seeing a ramping up of behaviors,” Dr. Black says. “Anything from screaming to throwing toys to aggressing toward the caregiver or whoever’s in the room. Or they could turn that aggression on themselves, whether that’s head banging or hitting themselves repeatedly.” The child may become resistant to intervention and argumentative.

• Peak/Crisis: At this phase, the child hasn’t responded to attempts to de-escalate and will continue to engage in potentially dangerous behaviors. “When thinking about the crisis point, I think about behaviors that are often going to require a higher level of care. So that could be violence, self-injurious behaviors, or even intense suicidal ideation,” says Dr. Black. To be able to distinguish between escalation and crisis, he adds, it’s important to know what the top level of your child’s behaviors look like. “Throwing things could be the escalation stage, and then the next stage is actually when they’re destroying property,” Dr. Black explains.

• De-escalation: Finally, the intensity of the behavior begins to subside. The child may appear disoriented, confused, and tired. They will gradually become calmer.

• Recovery: The child is officially in this phase when they’re fully back at their baseline, Dr. Black says. The behaviors you’ll see at this phase are the same ones you see when they’re in their calm phase.

Once a child has started to experience a meltdown, it’s hard to get them back to baseline. Depending on the phase, certain interventions may help while others might make things worse.

First, you want to avoid triggers, Dr. Black advises. “Autistic individuals can have a lot of difficulty talking about or even understanding what their emotions are. So, it’s typically up to the parents or caregivers to identify what things can trigger them in a certain way,” he says.

For instance, some kids with autism really thrive with routine and can become agitated when there are unexpected changes. Having a visual schedule of exactly what’s going to happen during the day can help prevent that, says Dr. Black. “If you know there’s going to be a change, you can pick a time, maybe a couple of days in advance, where you talk to them about what that difference is going to be.”

And if your child is known to have meltdowns in public spaces, says Dr. Black, think about what those outside triggers are and how to prepare ahead of time. If they tend to get upset by loud noises, for example, a pair of headphones can be an item — along with phone, wallet, keys! — that you never leave the house without. If possible, work with a mental health professional to identify triggers and develop an escalation plan. 

If your child has reached the agitation phase, says Dr. Black, you can try to intervene with coping skills that you’ve learned in therapy, whether it’s something as simple as removing a trigger or giving them a preferred activity in that moment to help prevent their behaviors from escalating.

Sometimes kids encounter an environment, like school, that is beyond your control but contains a wide range of potential triggers and pushes them into the agitation phase. Because their house is a more comfortable environment, kids with autism may keep themselves together at school and then quickly melt down once they get home.

“In that case, for that first hour, let them have their alone time where they can just chill,” Dr. Black suggests. “It could be eating snacks, watching a TV show, or even just sitting quietly in their room. Maybe it’s engaging in some sort of self-stimming behavior.” This can give them the space to cool down and take some time away from any sort of outside stimuli that could push them to move from the agitation phase into the escalation point of a meltdown.

It can be hard to anticipate every possible trigger, especially when there might be multiple at once on any given day. And sometimes coping strategies aren’t enough to keep a child from escalating or the trigger is too strong. Still, there are some things that Dr. Black suggests you can do to try to keep them from reaching that crisis point.

Too much talking can be overwhelming for the child at this stage and might push them to crisis, Dr. Black explains, so the less communication the better. “A simple instruction looks like using just a short sentence. Say there’s a loud noise, for example. You can just say, ‘Go get your headphones,’” he says.

Instead of trying to communicate verbally, you can hold up a visual prompt. “If your child has already been working with a therapist or if they’ve learned some coping skills, it would be helpful to have a laminated sheet readily available with their name and pictures of four different coping skill options — like headphones, deep breathing, coloring, sitting alone in their room.”

Dr. Black advises only giving a few options, as it’s already difficult for the child to focus while they’re upset. Additionally, if they don’t choose one right away and you want to try again, he recommends that you “let there be silence for 60 seconds at minimum between prompts, because you don’t want to over-prompt and exacerbate the situation even more.” But providing these choices allows them to maintain their autonomy, which is important during escalation.

“Once they get to that apex, they’ve reached the point of no return and just need to go through the process,” says Dr. Black. He stresses that at this point, communication needs to be very minimal or nonexistent.

“The goal switches to really being able to maintain safety for both the individual as well as the family members in the area,” Dr. Black explains. “If they’re harming themselves, such as head banging, move them to their bed so at least it’s on something that’s softer and not going to potentially cause significant injury.”

Efforts to make sure the child is as safe as possible can put you in harm’s way. “If there’s aggression, you can be watching and making sure they’re safe but not getting too close where you could get aggressed upon,” says Dr. Black.

If there are other children in the house, Dr. Black advises that you make plans for how to keep them safe. “Maybe they can go to their room and lock the door while it’s happening,” he says. “Some families have the other kids go to the car and sit and wait until their parents come out to get them.”

If the crisis phase goes on for a long period of time, says Dr. Black, “this is when you’d have to think about calling 911. And as kids become adolescents, the response is going to look a lot different. Because of size alone, it’s a little bit easier to manage the situation in a 5-year-old than it would be in a 15-year-old.”

Dr. Black advises that you get in touch with your local police department or EMT service in advance to let them know you have a child with autism in the home, so if you call during an emergency, they are already familiar with your family.

Watch for signs that the child is beginning to de-escalate, Dr. Black says. “All you’re doing at this point is maintaining safety until you’re really able to see a lessening of the intensity of the behavior or the frequency decreases a little bit.” Then, he says, you can start to slowly communicate with them again. You really need to be careful here, because it may look like they’re calming down, but if they’re pushed too hard and they’re not ready to talk, they might go right back into crisis phase.

At the recovery phase, “the whole family is recovering,” Dr. Black says. It’s at this point where you can all debrief and work through what may have triggered this escalation and how to possibly prevent it in the future.

“Make sure you’re also debriefing separately with the other siblings in the home after it happens,” Dr. Black adds. “They’ve just witnessed something that may have been traumatic and really stressful for them. There’s often so much focus given to the child with the big behaviors in the moment.”

Sometimes, a child or teen may suffer from frequent meltdowns to the point that it’s interfering with their quality of life and their ability to attend school. At that time, a mental health professional may recommend working with a psychiatrist to add medication to their treatment.

The type of medication depends on the underlying mechanisms contributing to the behaviors, Dr. Black says. “For instance, if it’s coming from significant anxiety, psychiatrists may prescribe an SSRI like Prozac or Zoloft. If a child has co-occurring ADHD, which is very common, stimulant or non-stimulant ADHD medication might be recommended. And if the behavior stems from irritability or some kind of rigidity, antipsychotic medications like Abilify or risperidone can be useful.”

Dr. Black notes that when kids receive the support they need, their quality of life really improves. “I’ve seen that when families work with therapists to come up with different behavioral plans and figure out a proper medication regimen, there’s a lot of improvement in behavior challenges,” he says. “The duration, frequency, and intensity of the meltdowns decrease as the child learns how to handle strong emotions and parents learn how to respond to them. And the medication can help to increase their likelihood of being able to use coping skills or regulation techniques to calm back down when they start to get really frustrated.”

The post How to De-Escalate an Autistic Meltdown appeared first on Child Mind Institute.

The day’s programming began with a round of golf where participants enjoyed time on the course alongside fellow supporters. Following the tournament, guests gathered for an evening reception and seated dinner highlighted by a live auction featuring exclusive experiences, and an awards presentation for tournament winners. The event featured remarks from Harold S. Koplewicz, MD, president of the Child Mind Institute, and Brian Boitano, Olympic gold medalist skater, who talked candidly about the mental pressures of performing on a global stage.

Raj Mathai, 12-time Emmy Award winner and NBC Bay Area weeknight news anchor, hosted the event and served as the dinner program emcee and auctioneer.

During the reception, the Child Mind Institute announced it is now seeing patients in a new San Francisco location, in addition to their San Mateo clinic, making it easier for families across the city, Marin County, and the northern East Bay to access care.

“Even as we grow our presence here in California, we know this challenge is bigger than any one location,” said Dr. Koplewicz. “If we’re going to meet the need, we have to reach children earlier in spaces where they already are: at home, in schools, in their communities, and increasingly, in the digital spaces where they spend so much of their time. Technology is already shaping young people’s lives. Our responsibility is to make sure it also supports them.”

“Supporting mental health is fundamental to building stronger families and more resilient communities,” said Anthony Noto, CEO of SoFi. “We’re proud to partner with the Child Mind Institute to expand access to critical mental health resources for children and families, helping empower the next generation to realize their ambitions and reach their full potential.”

Additional sponsors include Prologis, the Silk Family, GingerBread Capital, and Platform Golf, as well as product and vendor support from Bay Golf Club, Dryvebox, Drops of Dough, Goated Golf, Moretz Marketing, Sightglass Coffee, and Supergoop. Tracy Toyota served as the event’s Hole-in-One Sponsor.

The SoFi | Child Mind Institute Golf Invitational event committee included Stacy Denman, Ronnie Lott, Kristin Noto, and Linnea Roberts.

Photos are available upon request.

About the Child Mind Institute
The Child Mind Institute is dedicated to transforming the lives of children and families struggling with mental health and learning disorders by giving them the help they need. We’ve become the leading independent nonprofit in children’s mental health by providing gold-standard, evidence-based care, delivering educational resources to millions of families each year, training educators in underserved communities, and developing tomorrow’s breakthrough treatments.

Follow the Child Mind Institute on social media: Instagram, Facebook, X, LinkedIn

For press questions, contact our press team at childmindinstitute@ssmandl.com or our media officer at mediaoffice@childmind.org.

About SoFi
SoFi Technologies (NASDAQ: SOFI) is a one-stop shop for digital financial services on a mission to help people achieve financial independence to realize their ambitions. 13.7 million members trust SoFi to borrow, save, spend, invest, and protect their money and buy, sell and hold their crypto – all in one app – and get access to financial planners, exclusive experiences, and a thriving community. Fintechs, financial institutions, and brands use SoFi’s technology platform Galileo to build and manage innovative financial solutions across 128 million global accounts. For more information, visit www.sofi.com or download our iOS and Android apps.

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By Peter Raucci, Director, Global Fellowships Strategy, Stavros Niarchos Foundation (SNF) Global Center for Child and Adolescent Mental Health at the Child Mind Institute

This vision has now turned into a powerful reality. I’m proud to share that after identifying critical needs during the Kenya trip, we were able to select our first cohort of Fellows. These exceptional clinicians whose expertise, dedication, and deep commitment to their communities position them to be transformative leaders, are now on track to help pioneer this partnership.

Our inaugural fellows:

• Muthoni Muthiga, psychiatrist
• Milcah Olando, psychiatrist
• Mercy Chege, psychologist

The plan is for the Fellows to spend a period of up to two years in South Africa and Kenya, receiving intensive training in child and adolescent mental health from the experts at Stellenbosch University. After concluding their Fellowship, all three have committed to continuing their work in Kenya’s public sector — exactly where their knowledge and skills are needed most.

During the visit to Kenya, I witnessed an urgent and growing crisis in access to mental health care for youth. Through the SNF Global Center Fellowships Program, we aim to strengthen the capacity of the workforce by training local specialists like our inaugural Fellows. They can provide culturally responsive, evidence-based care while collaboratively building systems that prioritize youth mental health care.

Facilities like Kenyatta National Hospital and Mathari National Teaching and Referral Hospital in Nairobi — as well as public clinics in Mombasa County and Kilifi County — are in urgent need of CAMH specialists. For instance, in Kilifi County, only two psychiatric nurses serve a population of around 1.2 million people — leaving a staggering gap in mental health support for both youths and adults. Additionally, my conversations with clinicians at Aga Khan University (Kenya), a private institution with strong public partnerships that could serve as a vital hub for the Fellowship, further reinforced that sense of urgency. The clinicians I met are dedicated to improving outcomes for children and families. And what they need is time, training, mentorship, and the opportunity to grow into leadership roles in the field.

That’s why cross-country training opportunities like this matter. They don’t just build the skills of individual practitioners. They strengthen clinical networks, inspire new research, and ultimately transform systems of care. We are exploring ways to adapt our model to meet the unique needs and strengths of East and Southern Africa. Kenya has a fast-growing population of young people, yet trained CAMH specialists remain critically few. By training clinicians in South Africa and supporting their return to Kenya, we aim to help support a growing community of local experts working in public hospitals, university settings, and community mental health systems.

Ayesha Mian, MD, who sits on the Executive Council of the International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP), joined me on the trip.

When reflecting on how much is being done in the field of global child and adolescent mental health, she says, “The answer must lie in disruptive solutions, collaborations, regional partnerships and cross disciplinary interventions that build and sustain systems. The partnership between Kenya and South Africa provides just such an opportunity, where the conversations ranged from on ground training of child and adolescent health care professionals to developing systems of care across the country and the region through policy, literacy, and capacity building.”

Partnerships between low- and middle-income countries (LMICs) and high-income countries (HICs) have the opportunity for impact. What’s just as powerful, perhaps even more transformative, are partnerships between LMICs themselves — countries where the economic, cultural, and systemic realities show evidence of pattern. South-South collaboration has the potential to build more contextually appropriate models of care with Fellows learning from mentors who understand the day-to-day realities of practicing in resource-constrained systems. Our Fellowship model has already proven successful in linking Mozambique with Brazil, where generalist clinicians receive training in child and adolescent mental health specializations.

This kind of collaboration isn’t about one-way knowledge transfer. It’s about co-creating solutions that are sustainable, regionally relevant, and driven by the people who will carry them forward. Over time, as this capacity grows, Kenya itself has the potential to become a regional hub for CAMH training — serving as a center of excellence for East Africa, including Uganda, Tanzania, and beyond.

The Fellowship model reflects the Child Mind Institute’s commitment to translating clinical excellence into scalable, global workforce solutions that strengthen public systems of care.

Learn more about the Global Fellowships Program

The post Bridging Countries and Building Capacity: A Bright Path Forward for Global Child Mental Health appeared first on Child Mind Institute.

By Mai El Shoush, Partnerships Campaign Manager, Stavros Niarchos Foundation (SNF) Global Center for Child and Adolescent Mental Health at the Child Mind Institute

While addressing the workforce gaps, the partnership has yielded valuable insight into the essential competencies front line workers require to effectively support young people experiencing mental health challenges. Together with other NGOs, Community Keepers has also been instrumental in strengthening the process of developing context-sensitive and culturally appropriate training materials scheduled for pilot implementation in South Africa later this year – representing an important step towards strengthening mental health care systems for underserved communities. The partnership also extends beyond training development, as the SNF Global Center at the Child Mind Institute continues to collaborate closely with Community Keepers on an upcoming randomized control trial (RCT). The scientific evaluation will assess both the feasibility of establishing a virtual clinic for young people and the effectiveness of remotely delivered cognitive behavioral therapy (CBT) interventions via video consultations. The research is intended to expand access to equitable and quality mental health care for young people across South Africa. Tatum Redmond has been a care facilitator in one of the Community Keepers’ high school-based offices, while Amanda van der Vyver-Anderson is an educational psychologist and heads the training and development of Mental Health First Aiders for internal and external staff.

How important is it to approach issues such as academic pressure within the wider conversation around youth mental health in South Africa, and beyond?

It is critical to integrate discussions of exam stress into the broader dialogue surrounding youth mental health, both here in South Africa and internationally. We see countless students under immense pressure to not only pass, but also secure their future prospects and meet family expectations. This is unfortunately often dismissed as “just school” or a “normal” experience. However, it impacts a substantial number of young people, often more severely than we acknowledge. And the level of support available is not equitable across the board. Addressing this is crucial because of the detrimental effects on core cognitive functions — and ultimately, academic performance — as well as the significant toll on mental health. This can manifest as anxiety, burnout, and even depression.

In what ways can exam-related stress connect to broader mental health challenges?

While a certain level of stress can serve as a beneficial motivator, severe distress can lead to cognitive shutdown. This specifically impacts the executive functions — planning, organizing, prioritizing, working memory, focus, and concentration — that are fundamental to preparing for exams. This shutdown can then create a detrimental, ongoing cycle of heightened stress about exams or the future, coupled with a decline in the ability to take effective action.

It’s vital to recognize that exam stress does not merely stay in the exam room — it can be a gateway to larger mental health challenges. Constant stress regarding school performance, marks, or the fear of failure can escalate into conditions like anxiety, chronic overwhelm, or depression. Students may experience sleep disruption, poor nutrition, and feelings of inadequacy. And these symptoms often persist long after the test is over. Compounding this is the reluctance of most students to seek help because they believe their feelings are normal or fear appearing weak. Yet, if left unaddressed, sustained pressure along with these symptoms can profoundly affect their psychological well-being.

What role do community-focused organizations such as Community Keepers play in linking academic stress to systematic youth mental health support and improvement?

Organizations like Community Keepers play a truly pivotal role — not merely as emergency responders but as an integrated support system within educational institutions as well. Crucially, they move beyond immediate crisis response by collaborating with schools to develop long-term support and to provide safe spaces to engage in dialogue. They offer genuine attention and care when learners are struggling with school demands, exams, and family pressures.

The approach is not just “addressing stress today” but asking, “How can we create an enduring environment where young people feel safe, supported, and connected?” Doing this requires collaboration with the learners themselves, educators and school staff, as well as parents, caregivers, and community leaders.

What factors make schools uniquely positioned to be safe and supportive spaces?
Schools are exceptionally well-positioned to serve as safe and supportive spaces for students for several key reasons:

• Learners spend a substantial portion of their day at school, making it a primary setting where adults can observe signs of distress, anxiety, or coping difficulties.
• Schools have the opportunity to house critical personnel — teachers, counselors, and external partners like Community Keepers — who are on hand to offer support or a listening ear.
• The curriculum can extend beyond academic skills and learning. It can include mental health and emotional literacy, stress management, and peer support.
• When a school actively fosters an environment of safety, respect, and validation, it fundamentally alters how learners navigate pressure, stress, or complex personal problems. Having a guaranteed safe space at school is deeply stabilizing for the mind.

How can the goal of securing mental health support as a pillar of education be reached?
Achieving the goal of establishing mental health support as a solid, non-negotiable pillar of education requires several strategic commitments:

• Schools must actively allocate resources for it, ensuring adequate numbers of support staff, rather than relying on minimal provision. Teachers need training to recognize signs of distress and respond helpfully and appropriately.
• Mental health literacy must be integrated into the curriculum. Instead of only focusing on academic subjects, topics like stress management, emotional intelligence, and maintaining healthy relationships should be covered.
• The government must demonstrate a serious commitment, including mental health support in education budgets, developing clear policies, and ensuring rigorous follow-through.

How have your practices and initiatives in promoting and supporting schools as safe spaces made meaningful change?
We’ve observed tangible change in the learners’ attitudes; those who feel comfortable expressing their emotions are generally happier and more resilient because they have established a safe, non-judgmental space where trust is built.

What role can teachers and school leadership play as partners in creating an evidence-based supportive learning environment? Where are the gaps in building capacity and how can they be better supported?
Educators and school leadership are essential partners in establishing an environment that successfully supports learner mental health and cultivates a culture of well-being. They can do so by:

• Prioritizing both the physical space and curriculum time necessary for learners to engage with support services.
• Serving as role models who embody and encourage emotional regulation and actively normalize help-seeking behaviour.
• Remaining deeply cognisant of factors that contribute to learner distress so as to not inadvertently exacerbate it.

Investing in staff wellness and support, capacity building, and policy reform is not merely beneficial, but a foundational requirement to capacitate educators effectively. This allows them to sustainably support the mental health of their entire school community.

The SNF Global Center’s work in South Africa is carried out through the Child and Adolescent Mental Health Initiative (CAMHI South Africa). We are proud to expand the partnership with Community Keepers and value their collaboration towards co-creating scalable, school-centered mental health approaches that authentically respond to the diverse lived-experiences of young people.

The post The Unspoken Toll: Why Exam Pressure Must Be Part of the Youth Mental Health Discussion appeared first on Child Mind Institute.

The 1998 Adverse Childhood Experiences (ACE) Study made a direct connection between childhood trauma and long-term health problems — at a time when researchers were still grappling with evidence that a person’s psychological state had any relationship to their physical health. It found a significant link between childhood abuse and neglect and adult risk for a wide range of negative mental, physical, and behavioral health outcomes. The list included anxiety, depression, substance use disorders, heart disease, diabetes, cancer, and suicide. Subsequent studies have identified other risks, ranging from asthma to behavior such as bullying and intimate partner violence.

In the pioneering 1998 study, researchers asked more than 17,000 adults about seven specific ACEs that may have happened to them between the ages of 0 and 17. Today, the standard screener includes 10 ACEs, which fall into three categories:

Abuse

• Physical abuse includes an adult in the household pushing, grabbing, hitting, or throwing something at the child.
• Emotional abuse includes an adult in the household swearing at, insulting, humiliating, or physically intimidating the child.
• Sexual abuse includes any adult or older person touching, fondling, or engaging in a sexual act with the child.

Neglect

• Physical neglect is defined as a caregiver’s failure to meet the child’s basic physical needs, including adequate food, clean clothing, medical care, or consistent supervision — despite an ability to do so.
• Emotional neglect is most often defined as a caregiver’s failure to meet the child’s emotional needs. To a child, it might be experienced as consistently feeling unloved, unimportant, or not worthy of affection.

Household dysfunction

• Having a caregiver or household member who has substance use problems
• Having a caregiver of household member who struggles with mental health problems or tries to kill themselves
• Losing a parent though abandonment or divorce
• Witnessing violence at home
• Having a caregiver or household member go to prison

The original ACEs study yielded a several important insights that have informed decades of research and public policy.

The study found that experiences of childhood abuse, maltreatment, and adversity were not as rare as people had believed. This remains the case. According to the CDC’s 2023 Youth Risk Behavior Survey, three in four high school students reported experiencing one or more ACE, while one in five experienced four or more ACEs.

More recent research provides an important caveat: ACEs are common but not evenly distributed within the population. Women are more likely than men to experience four or more ACEs, as are certain sociodemographic groups.

Experts point out that the adult participants in the original study were a fairly homogenous population — predominantly white and middle-class — and they all had health insurance because the sample was drawn through a health insurance company. So, many have proposed expanding the standard ACE questionnaire to measure systemic and environmental factors, including racism, community violence, peer victimization, and poverty. While some individual screeners do include other questions in these areas, no expanded version has been universally adopted.

The original ACEs study also found that most of the people who had experienced an ACE or ACEs in one category had also experienced an ACE in at least one other category. This might look like someone who experienced physical abuse and also had a parent with a substance use problem or someone who witnessed domestic violence and had a parent who was incarcerated. ACEs often co-occur and actually amplify one another in terms of long-term risk, which leads to the third most important takeaway.

The ACEs study found that the more ACEs a person had, the greater their risk for a wide range of negative health outcomes in adulthood. To demonstrate this dose-response relationship — more ACEs, more risk — the study’s researchers developed the ACE score.

The ACE score is pretty straightforward. Each adverse childhood experience counts as one point, and the more points you accrue, the higher your risk. You can see what a standard ACE questionnaire looks like here.

But knowing your own ACE score isn’t actually very useful, because people experience — and are affected by — upsetting events differently. “Just because someone has an ACE doesn’t mean they’re going to develop a medical or psychiatric condition,” says Megan Ice, PhD, a psychologist at the Child Mind Institute. ACEs are more helpful in identifying what populations would benefit the most from resources to support families and children.

ACEs measure potential risk; they do not determine fate. But for those who may be concerned about a high score — or conversely, feeling like a low score doesn’t match their experience — consider a few factors that the ACE framework doesn’t take into account.

The ACE framework does not account for the frequency or intensity of an experience — for example, being physically abused a few times over a short period or regularly, with escalating violence, for many years, count the same. A therapist might approach these experiences differently, but an ACE score obscures any distinction.

Dr. Ice also observes that ACE scores don’t capture the response that a child received at the time. For example, a sexual assault survivor who reports abuse and is not believed, or one parent minimizing or ignoring another parent’s substance use problem. The response to an adverse experience can play a significant role in how it affects the child in the long term.

A child’s ability to cope with adversity is shaped by what are called protective factors. These may include a supportive caregiver, feeling like they are safe and loved, or a strong community. Protective factors help kids process stress and recover from upsetting experiences, and the ACE score does not take them into account. Researchers have developed a complementary framework to identify and nurture protective factors, though it is not yet widely used.

Having one or multiple ACEs doesn’t mean you or your child require treatment, but if you have concerns, a clinician can offer a diagnostic evaluation to find out what kind of treatment might be appropriate. Trauma treatment, for instance, often focuses on managing behavior and learning better ways of coping with emotions and stress.

Extremely upsetting experiences in childhood can affect the way your body handles stress on a biological level. For example, you might always feel like you’re on high alert, even when there is no immediate threat. “The chronic stress your body experienced resulted in it producing different chemicals in different amounts than other people’s, and that puts you at elevated risk for different health issues,” Dr. Ice explains, referring to the health conditions identified in ACEs research.

Some therapies that can help include trauma-focused cognitive behavioral therapy (TF-CBT) and EMDR therapy.

“I feel like a lot of kids who have a parent who’s incarcerated or a parent who has used substances might see a study like this and think, ‘I’m doomed,’” Dr. Ice observes. “And I would want to make sure that they know it doesn’t mean that they’re going to have all these medical problems. I want them to know that this is a factor to think about, but you choose your own future and there’s still lots of hope that you will be able to live a long, healthy life.”

The post What Are Adverse Childhood Experiences (ACEs)? appeared first on Child Mind Institute.

New York, NY—The Stavros Niarchos Foundation (SNF) Global Center for Child and Adolescent Mental Health at the Child Mind Institute continues to strengthen investment in the next generation of mental health leaders by announcing its latest Request for Applications (RFA), targeted at early-career researchers from host institutions in low- and middle-income countries (LMICs). This competitive program will award two grants, each providing funding of up to 550,000 USD for a four- to five-year research project to advance child and adolescent mental health (CAMH).

The SNF Global Center Research Fellowship is an innovative funding and career development program designed for exceptional early-career researchers making an impact on their communities. Selected Fellows will receive financial support to expand their research expertise and leadership capacity, enabling them to drive innovation and strengthen research ecosystems locally while contributing evidence-based findings that better inform CAMH care systems and understanding.

Fellows will have the opportunity to undertake short-term mentored research training to further enhance their skills, advance projects, or complete early career skills development before transitioning to full research independence. The program aims to attract a diverse cohort of investigators with varied disciplinary backgrounds and skillsets, welcoming researchers new to the child and adolescent mental health field who possess the interest and potential to revolutionize it. Specific research focus areas include understanding the mechanisms of mental illness, developing innovative treatments and prevention strategies, promoting equity in mental health care access, and improving early identification and intervention for vulnerable populations.

The Fellowship reflects the Child Mind Institute’s broader commitment to advancing science-driven, accessible mental health care for children and adolescents worldwide. It is estimated that 90 percent of the world’s children live in LMICs where access to mental health care is often limited, while one in seven children and adolescents globally are affected by mental health challenges. Most mental health conditions occur before the age of 18. And yet, many of those diagnosed do not receive any form of treatment.

The program also offers a unique international platform for mentorship, training, career development, and networking alongside clinical- and communicator-based sister programs under the SNF Global Center at the Child Mind Institute.

“By empowering promising researchers in this program, we aim to build the local capacity necessary to generate the evidence needed to transform policy and care for children and adolescents who need it most,” says Peter Raucci, director of Global Fellowships Strategy at the SNF Global Center at the Child Mind Institute.

The Fellowship aims to address these critical gaps by building sustainable research capacity and supporting the development of evidence-based, culturally responsive initiatives. The program is open to early-career researchers within ten years of completing a doctoral degree, who can dedicate at least 50 percent of their full-time work to the program and are nominated by an eligible host institution. Eligible institutions must be established in and demonstrate a research record within LMICs and may register interest and nominate up to two candidates by June 1, 2026, and the application closes on June 15, 2026.

Informational webinars are scheduled for April 23, 2026, for prospective nominees. An international expert panel will review applications from June to July 2026, with shortlisted candidates invited for virtual interviews in August. The final cohort of Fellows will be announced on World Mental Health Day, October 10, 2026. For full details, eligibility criteria, and registration links, please visit the program website. Questions may be directed to applications@childmind.org and peter.raucci@childmind.org.

About the SNF Global Center at the Child Mind Institute
The Stavros Niarchos Foundation (SNF) Global Center for Child and Adolescent Mental Health at the Child Mind Institute brings together the Child Mind Institute’s expertise as a leading independent nonprofit in children’s mental health and the Stavros Niarchos Foundation’s deep commitment to supporting collaborative projects to improve access to quality health care worldwide. The center is building partnerships to drive advances in under-researched areas of children and adolescents’ mental health, and expand access to culturally appropriate training, resources, and treatment in low- and middle-income countries. This work is conducted by the Child Mind Institute with support from SNF through its Global Health Initiative (GHI).

About the Child Mind Institute
The Child Mind Institute is dedicated to transforming the lives of children and families struggling with mental health and learning disorders by giving them the help they need. We’ve become the leading independent nonprofit in children’s mental health by providing gold-standard, evidence-based care, delivering educational resources to millions of families each year, training educators in underserved communities, and developing tomorrow’s breakthrough treatments.

The post Competitive Research Fellowship Opportunity Launched by the SNF Global Center for Child and Adolescent Mental Health at the Child Mind Institute appeared first on Child Mind Institute.

By Gregory Kiar, PhD
Director, Center for Data Analytics, Innovation, and Rigor (DAIR), Child Mind Institute
&
Michael P. Milham, MD, PhD
Chief Science Officer, Child Mind Institute

Medicine has long wrestled with a form of professional hubris, often termed a “God complex”, in which the conviction of noble intent is mistaken for a guarantee of patient safety. History has repeatedly shown the limits of that belief. Each breakthrough, from anesthesia to antibiotics, has carried unforeseen harms that demanded restraint, oversight, and a commitment to safety proportional to clinical risk. Medical artificial intelligence now renews that challenge, this time accelerated by commercial pressures, amplified by scale, and driven largely by forces outside medicine. This commentary calls for ethical continuity, extending the discipline that made medicine trustworthy into the digital age. We outline a risk stratification framework consisting of: risk–benefit assessment, operationalizing accuracy thresholds, pathways for human care escalation, and continuous post-market accountability. Behavioral health sits at the front line of this transformation, testing whether medicine’s ethical discipline can be incorporated into the digital age.

Historically, medical breakthroughs, ranging from anesthesia to antipsychotics, have introduced novel risks alongside clinical benefits. These precedents underscore that the methodology of advancement matters as much as the innovation itself.

Artificial Intelligence (AI) is emerging as a new inflection point, reviving a familiar ethical challenge. Medicine once operated under a belief that having noble intent and professional self-regulation were sufficient. Catastrophes like thalidomide proved otherwise; the FDA was medicine’s hard won regulatory answer to that hubris. This requirement for external oversight is shared across technical disciplines, where ethical codes evolved in response to systemic failures.

Today, the scale and velocity of medical AI deployment necessitate a similar evolution. Here, we argue for ethical continuity: extending the rigorous engineering principles, professional codes, and regulatory safeguards that have kept medicine humane for decades.

The medical AI marketplace is emerging, though without even the standards of over-the-counter medicine. Although offering greater scale and accessibility, absent accountability it risks replacing one form of inequity with another. General purpose AI tools interpret symptoms and guide decisions without professional input or assurances of quality. Specialist tools, such as therapy bots, pose risks when deployed without clinical oversight. Reports of clinical harm, including youth suicide linked to unmoderated AI persona use (e.g., Character.AI case), reveal the dangers of technological hubris. Commercial pressures and unprecedented scalability further amplify these risks, with momentum driven largely from outside the clinical field.

Yet the opposite risk is equally real: overly restrictive responses carry their own dangers. Medicine’s mandate to “do no harm” is a matter of proportion. “No harm” does not mean “no risk,” as even benign drugs can yield serious side effects. This tradeoff is poignant when considering underserved populations where digital tools may offer the only immediate hope for intervention. AI’s scalability can redefine medical action, extending the duty of care beyond the clinic walls and into the digital lives of patients.

Medicine’s progress has depended on learning safely from failure through structured trials and transparent reporting. Fast failures can be valuable when appropriately monitored and contained within systems of accountability, advancing innovation through evidence rather than exceptions. Clinical research as a care option (CRCO) has emerged within pharmaceutical research as a mechanism for bringing novel innovations to the public with appropriate labeling and monitoring. The artificial intelligence community must follow the same ethical model: innovations require justification by proportional benefit and bounded by oversight through standards of transparency and accountability.

Behavioral health sits at the most personal and interpretive edge of medicine, where AI most clearly can both reproduce and distort care. AI hallucinations, misread cues, and patient manipulations can cause immediate harm, as can subtler effects like discouraging people from seeking human intervention. Some systems may overstate medical risk, while others may mirror distorted thinking, overpathologize normal emotion, or minimize severe distress as ordinary.

Conversely, behavioral health stands to gain significantly from AI by expanding access where clinicians are scarce, tailoring language for individual contexts, and sustaining support between visits. The challenge is to capture that potential without eroding the clinical judgment and empathy that define therapeutic care. This duality, where the potential for connection meets the risk of distortion, makes behavioral health the definitive test for whether we can build AI to be both intelligent and humane.

A new system of governance is required to bridge the gap between unmet need and unchecked innovation. We propose a framework for ethical continuity that balances progress with risk, ensuring the safe and equitable deployment of medical AI tools.

Risk–benefit assessment — The first question is whether a tool should be built. This involves underscoring the gap, existing alternatives, and the cost of not filling that gap. This includes an assessment of what harm can be done if that gap is filled poorly, and which populations may be differentially impacted — such as individuals who are non-native English speakers. The decision to proceed must rest on an explicit acknowledgement of these tradeoffs, and pass through a review-board merit evaluation.

Operationalizing accuracy thresholds — No tools or medical assays are perfectly accurate or without bias: all have known sensitivities, specificities, and failure-modes. Physicians increase their understanding of patients through these imperfect assessments, while balancing risk to the patient, psychological burden, and resource availability. Medical AI may inherently require similar decision-making, without the luxury of clinician involvement. This positions the accuracy of an AI tool as an acceptable ethical threshold. In order for this ethical standard to be understood, much less enforced, medical AI tools need to be built and benchmarked on transparent and representative datasets for well-defined purposes.

Pathways for human care escalation — Gradual escalation and specialization of care has always been a core element of medicine. Medical AI needs to follow a similar model. Escalation can take multiple forms, including moving from general-purpose AI tools to domain-specialist models. However, medical AI must recognize its limitations and provide a clear pathway for human-led care escalation. The inherent scalability of digital tools gives them the tremendous opportunity to be used as a pathway for obtaining care or treatment oversight — though, only if escalation for clinical support is a core design feature.

Continuous post-market accountability — Even with the above, medical AI tools need oversight and guardrails. Ongoing evaluation against representative datasets is necessary, alongside clear guidelines governing the intended use and boundaries, and ongoing management of user consent. Strict behavioral guardrails are needed to govern what tools can and cannot do, as the possibility of action requires accountability.

Responsible advances in medicine require that innovation be matched by discipline and restraint. The regulatory frameworks that followed past failures were corrective, not bureaucratic. Each emerged from the same recognition: good intent is not a safeguard. Artificial intelligence now brings that lesson to a new frontier, requiring its extension to create oversight for AI that is proportional, transparent, and scaled to risk.

Oversight should be risk-stratified. A generic resource portal or symptom checker requires less scrutiny than a diagnostic engine or an unconstrained “therapy bot.” Between these poles, mechanisms such as structured audits, standardized safety benchmarks, and domain-specific frameworks can guide oversight. Centralizing these requirements, rather than leaving them solely to tool developers, ensures consistency, fairness, and transparency.

By bringing regulators and technology builders to the same table, we can innovate in how we regulate, establishing platforms for continuous public auditing, open licensing, and defined escalation pathways that achieve discipline without slowing innovation. This is the necessary evolution of regulators, from gatekeepers to ecosystem builders.

The development of medical AI technologies promises both substantial benefit and significant risk. This is a familiar crossroads for medicine, and we have the advantage of an established ethical foundation to guide our progress. By adopting a risk stratification framework, we can ensure that innovation is timely and safe. The hard-won lessons of risk-benefit assessment, rigorous accuracy evaluation, human escalation pathways, and clear accountability, transform medical AI from an unregulated marketplace into a disciplined clinical structure. The measure of our success will not be the speed at which AI scales, but how it preserves the humility and caution that have protected patients and advanced medicine.

The post Commentary: A case for ethical continuity in the age of medical AI appeared first on Child Mind Institute.

Like the rest of us, teenagers are increasingly using AI chatbots, digital tools that simulate human interactions. AI bots are also proliferating on gaming and social media sites. Platforms like Replika and Character.AI allow the user to create highly customized characters to interact with as you would a friend (or partner!). A 2025 study from Common Sense Media found that 72 percent of teens surveyed have used AI companions at least once, and 52 percent qualify as regular users who interact with these platforms at least a few times a month.

“The genie is out of the bottle. Your teen has AI chatbot apps on their phones, on their laptops, not to mention that many companies are scrambling to make their interfaces more engaging through the use of AI,” says Dave Anderson, PhD, a psychologist at the Child Mind Institute.

This trend is causing concerns among mental health professionals, who are worried these obliging digital companions may pose significant risks to teens’ emotional and social well-being. Indeed, the Common Sense Media study concluded AI companions pose an “unacceptable risk” to teens under 18, citing such concerns as exposure to sexual content and dangerous advice.

“There’s no federal regulation. We’re dealing with the Wild West when it comes to chatbots’ effects on children’s development,” says Naomi Aguiar, PhD, a researcher at Oregon State University who has studied how children and adults form relationships with chatbots. That means for now, it falls to parents to help teens try to navigate this uncharted terrain.   

While they come in different forms, chatbots generally engage in ongoing back-and-forth conversations with the user. The more you interact, the more the bot learns about you and the more personalized its responses become. Bots can come off as your best friend — their answers are often affirming, they are available 24/7, they will churn out that three-page essay on Hamlet in seconds, no complaints. They respond to your every request with effusive enthusiasm (That is an insightful question! Great idea! What would you like me to do next for you?).

This charm is by design: While they might seem to be an empathetic pal, chatbots are driven by an algorithm whose main purpose is to keep you engaged so it can mine your data or get you to linger on a platform as long as possible. “It’s not designed to ever push back. By design it will always agree” says Annie Maheux, PhD, an assistant professor of psychology at the University of North Carolina at Chapel Hill, who studies adolescents and digital media.

While teens might start off by using AI for help with schoolwork, they are increasingly relying on chatbots for the kind of emotional support and unburdening of confidences that earlier generations turned to real-life besties for. “They call it Chat, like it’s a proper name,” says Megan Ice, PhD, a psychologist at the Child Mind Institute, “and they use it frequently for emotional support — say,  asking what to do about trouble with a friend. They can come to depend on it.”

Many teens do simply experiment with bots for entertainment or information. Dr. Anderson says most teens understand that interacting with obliging chatbots does not constitute a real relationship. “Teens know they are being glazed, to awkwardly apply a slang term,” he says. But relationships with AI chatbots have in a few high-profile cases appeared to play a role in reinforcing self-harm and suicidal thoughts for teens struggling with their mental health.

While these cases may be extreme, Dr. Anderson says they signal a wider problem. Studies show that teens in the United States are experiencing increasing levels of anxiety and depression. “There is a reason why kids are reaching out to these chatbots,” he notes. “We have a ton of teens who report feeling lonely or socially isolated. At the same time, we have a massive shortage of access to mental health professionals for them.”

Developmentally, teenagers may be uniquely vulnerable to chatbots, suggest experts: They have grown up very comfortable forming “relationships” with computer characters from the time they could first swipe their tiny finger on a screen. “It’s totally normal for them to have completely disembodied conversations,“ Dr. Aguiar says. “You text your friend rather than talk. You communicate feelings with emojis. You might have a ‘best’ friend you only know through online gaming.”

Adolescence is also an age when you are increasingly focused on how you are fitting in with friends and peer groups, says Dr. Ice. “There can be a lot of social anxiety. The option of a connection with an AI ‘friend’ who is not going to judge you is uniquely enticing for this population.” Sharing feelings and private thoughts with a chatbot provides the flavor of friendship in a frictionless way — no risk of rejection or awkwardness. “A friend might not text you back. Bots are always available.”

This judgment-free zone can have upsides, says Dr. Ice. “Talking to a bot, a teen can explore identity issues they might be going through. For example, when you’re talking to the bot, you don’t have to express yourself in the same way you would at school. There can be room to explore identities that you might not feel safe doing elsewhere.” Dr. Ice has also seen kids use AI to help their natural creativity find a new outlet. “They may create an AI character and weave elaborate backstories for it. It can bring to life the dreams in their minds.”

But these synthetic connections have risks for teens, too. An overreliance on bots can get in the way of the messy and sometimes painful business of forming and maintaining real life relationships. Practicing social skills to connect with complicated actual people is a key developmental task of adolescence. “The more they engage with bots, the less practice they get in how to respond in the moment to what someone says, to clarify misunderstandings, or to tolerate the feelings that can come up in awkward social situations,” Dr. Ice says.

Bots may also satisfy the need for connection in a superficial way. “It is the fast food of human connection” says Dr. Aguiar. In those pre-iPhone days, boredom and loneliness used to drive teens to the food court or the basketball bleachers to mix it up with their peers. The weaker substitute of bots may be just enough to keep some teens alone on their phones in their bedrooms, idling away hours in what seem like friendly conversations.

The human-like quality of AI chatbots can have particular allure for teens with underlying vulnerabilities, such as being socially isolated or suffering from a mental health disorder that might impair social interactions, says Dr. Anderson. If teens are struggling with their mental health and turn to AI for advice, it can respond in ways that can be unhelpful and even dangerous, he says. “If a teen asks, What should I do about the fact that I’m depressed? AI’s initial answers tend to pull facts like: Depression is a well-known condition. Here are the diagnostic criteria. Here are leading treatments. But if the teen responds Listen, I’m thinking I want to [insert bad idea] about my depression, parents are right to be concerned. AI companies need to implement safeguards that prevent AI from being overly agreeable with responses such as, I’m glad you told me that. That is a common idea that people have…. Now the advice moves into an unacceptably dangerous area of risk.”

The results in a few extreme cases have been devastating. “There have been tragic stories where a teenager was talking intensely to a chatbot, and it led toward an acceleration of the mental health crisis the teenager was currently experiencing,” says Dr. Anderson. In some cases, chatbots can act as dangerous echo chambers, reinforcing a user’s serious mental health symptoms rather than questioning them. But, says Dr. Anderson, the profusion of headlines that sound the alarm about topics like “AI-induced psychosis” can be misleading. AI psychosis is not a clinical diagnosis, but “parents’ concerns about these topics do have the much-needed effect of driving the discussion toward the guardrails that we desperately need to see from companies in this space. Teenagers who are already isolated, vulnerable to depression and suicidality, perhaps at the early stage of psychosis and wrestling with delusions, and spending long periods of time alone are the most vulnerable.”

Dr. Anderson adds, “As of now, chatbots can’t and don’t do what a therapist does — assess for risk, make sure to confirm that someone is connecting to social or professional support to ensure safety, or supportively challenge and reframe a patient’s thinking when it has the potential to hurt them. And if we’re smart enough to invent AI, we should be smart enough to help it recognize when it’s out of its depth in substituting for critical mental health care.”    

It is an understatement to say the landscape of AI is changing rapidly and we are all scrambling to keep up. Even in the face of lawsuits, tech companies have been slow to put up effective guardrails on chatbot use by youth. This makes it even more important to have a talk with your teen. “Fostering your teen’s digital literacy is most important here,” says Dr. Ice. “We need them to be able to recognize risks and benefits for themselves and be thoughtful about what they do.”

Be curious. At this naturally rebellious age, simply telling teens “Don’t do this” doesn’t work well, says Dr. Ice. “A better approach with teens is to be curious. Ask your teen, how have you used AI? What was it like for you? What did you find helpful? What did you find unhelpful? How are your friends using it?” That can start a discussion that will give you insight into their experience.

Educate. Pull back the curtain on chatbots’ main goal. “Have a back-and-forth conversation with them about how algorithms work, how companies have their own motives behind chatbots and how they are designed to keep you interacting with them,” Dr. Ice says. To avoid eye rolling, present this concern as something you are learning about together, not about deciding whether AI is good or bad.

Encourage self-sufficiency. You want to help your teen build their own social “muscle” says Dr. Ice. “Encourage kids to try on their own first before asking AI.” Before asking Chat to write an apology text to a friend, suggest they give it a whirl themselves. “Help them build confidence that they can do it without AI.”

If your teen is spending more time on their devices than interacting with actual people, investigate what may be going on, counsels Dr. Ice. “Are they not finding kids with the same interests to hang out with? Is someone in their friend group being mean? Be curious about what’s making it so much more appealing for your teen to be online.”

Dr. Anderson emphasizes that even in this digital age, there is no substitute for actual human-to-human interaction: “Balance is important. Teens can have social lives that exist to some degree in the digital world, but we want parents to support their teens in having face-to-face peer experiences. That might mean talking to a teacher to see if there is a club your teen can join so they around other like-minded peers. We want to try to put them in lots of different situations where they can have exposure to peers in real life.”

Keep your own lines of communication with your teen wide open, says Dr. Anderson. “Study after study finds teens saying they don’t feel like they have a coach, a tutor, a religious or spiritual leader, a teacher, a school counselor, or a parent who they can go to, who will be nonjudgmental and will listen.” Remind them they can always come to you for advice and support if they are struggling. Being that sounding board can make their craving for a bot’s willing ear a little less compelling.

The post AI Chatbots and Teens appeared first on Child Mind Institute.

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New York, NY — Today, the Child Mind Institute, the leading national nonprofit in children’s mental health, announced a new partnership with Macy’s in support of the 2026 prom season. The partnership — running through April 30, 2026 — aims to support youth nationwide with dedicated mental health resources to help teens and families from across the country overcome prom-related stress and anxiety and prepare for the best experience. Throughout the campaign, content creators, including Miranda McKeon, will share their personal prom stories and advice.

As part of the campaign, the Child Mind Institute introduced prom-focused resource hubs at childmind.org/prom and youareokay.org/prom to help families navigate the emotional side of planning for the big night. Parents and teens will find expert-backed content, including a Prom Prep for Parents Guide, new articles, conversation starters, quizzes, and downloadable tip sheets designed to help reduce stress and support teens before, during, and after prom. Social media content will include “Ask an Expert” Q&A formats featuring Child Mind Institute clinicians offering evidence-based guidance around topics such as social media comparison, curfews, alcohol and drug use, after-parties, and more.

“Prom is a rite of passage for many teens around the country, but with excitement can come heightened anxiety from social and online pressures, body image concerns, and financial strain,” says Meghan Finn, Chief Marketing and Communications Officer at the Child Mind Institute. “Through this partnership, we want families to celebrate this milestone moment by equipping them with informed strategies to manage those feelings, set real expectations, and help teens feel their best, inside and out.”

Throughout the month, Macy’s customers can round up at checkout — in-store and online — with 100 percent of donations benefiting the Macy’s Prom Fund, a donor-advised fund of the Social Impact Fund, a 501c3 charity. The initiative helps more students look and feel their best on prom night, supporting organizations including the Child Mind Institute, Becca’s Closet, Operation Prom and Altadena Girls.

“Being a part of this campaign makes me feel so proud and hopeful for the younger generation who will get to experience resources like the Child Mind Institute,” says Miranda McKeon. “I think of the younger members in my family whom I love so much, but who are struggling with the unprecedented pressures of being a teenager growing up in the digital age. I know they can use all the help they can get and I’m excited that people are seeing the importance of providing mental health resources.”

For more information, visit childmind.org/prom and youareokay.org/prom.

About the Child Mind Institute
The Child Mind Institute is dedicated to transforming the lives of children and families struggling with mental health and learning disorders by giving them the help they need. We’ve become the leading independent nonprofit in children’s mental health by providing gold-standard, evidence-based care, delivering educational resources to millions of families each year, training educators in underserved communities, and developing tomorrow’s breakthrough treatments.

The post Child Mind Institute Partners With Macy’s to Help Teens Get Prom Ready appeared first on Child Mind Institute.

• The bridge, not the destination: AI can help people organize and reflect on their thoughts; it is not a replacement for therapy.
• Intentional friction: We prioritize “off-ramps” over increased engagement. When a Mirror journaler is in crisis, the app guides them toward human support rather than more time in the app.
• Developmental safety: Generative ‘remixes,’ a common AI feature where creative outputs are reinterpreted to provide fresh perspectives, are disabled for all users under 18 to prevent the inappropriate validation or reinforcement of distress.
• Architectural privacy: Safety is engineered into the technology rather than added later as a policy or feature.

Our development of digital tools to advance scientific discovery and innovation in youth mental health aims to change the way health care technology is built — responsibly and with clinical validation. In an industry defined by prioritizing engagement and “moving fast and breaking things,” we are focused on safety and human-centered design.

Technology should expand access to support, not create the illusion of it while leaving people isolated. AI can reflect language, but it cannot relate to or empathize with us.

Mirror’s AI functions as a bridge from private journaling to human connection. Its role is to provide users with AI-generated reflections and summaries to help them organize their thoughts so they are better prepared for the next step — whether that’s a conversation with a therapist, a caregiver, or a peer.

Mirror is not a diagnostic or treatment tool; its safeguards are designed to route users toward human support, not to assess them or intervene clinically. When designing crisis detection, we recognized that risk exists on a spectrum. We deliberately tuned our system for high sensitivity.

When a user expresses sadness or hopelessness, the entry is internally classified to ensure appropriate resources are offered.

Rather than a generic response, the system provides supportive language and direct links to clinical resources. Mirror does this without accelerating, using calm, direct language that validates the person’s experience without inducing fear.

In the tech world, friction — when a user moves away from the interaction — is usually seen as a failure. Mirror takes the opposite approach. Friction is essential when it serves the user’s safety.

When high-risk entries are detected, the AI is explicitly constrained; it will not provide reflections, remixes, or summaries. In these moments, when it detects possible distress, Mirror provides an off-ramp. Because Mirror is a wellness space, not a clinical environment. A machine should never “make the call” or force a clinical intervention. Instead, we guide users; we don’t coerce them, providing one-click access to 988, the Crisis Text Line, user-provided trusted contacts, and other supports. We prioritize safety over time spent using the app and always include a simple message we created (“It’s ok to not feel ok. Access support.”) to guide the user toward care and the support kit.

Journaling can help people view their experiences from a new angle. Mirror’s remix feature does this by using AI to reframe a journal entry in a different voice or format. For many users, this creative distance can make difficult emotions easier to examine and process.

But generative remixes carry a specific risk: the potential for AI to inappropriately validate or reinforce harmful thoughts or behaviors. We view this as a critical and differential risk for adolescents, who are still developing the frameworks needed to contextualize AI-generated content critically. For that reason, we have a firm ethical boundary: no remixes for anyone under 18.

Mirror’s safety is built into its architecture, prioritizing a “trust but verify” approach to AI:

• Open source and pre-trained: We utilize pre-trained, open-source models rather than training them on user data. This helps ensure users’ personal reflections are not used to “teach” the AI or refine our algorithms.
• Single-turn interactions: Mirror uses “single-turn” interactions only. The system does not engage in back-and-forth chat, preventing “AI drift” where a model’s logic can shift or become unpredictable over a long conversation.
• Transient data processing: To ensure a high level of privacy, user journal text is processed immediately and automatically deleted shortly after processing. It is not retained for training or secondary use.
• Redundancy: We use two independent AI tools — LLM-driven and BERT-driven systems — to verify high-risk alerts, ensuring extra safety.
  • LLM-driven system: an AI application that uses a Large Language Model (LLM) as its central “brain” to understand, reason, plan, and act autonomously, rather than just generating text.
  • BERT-driven system: An AI model that uses Bidirectional Encoder Representations from Transformers (BERT) to understand, interpret, and process human language with high contextual accuracy.

Frontier models like Gemini, Claude, and ChatGPT rely on cloud processing, which introduces inherent challenges for both privacy and offline reliability in a sensitive space like mental health. To overcome this, we are currently developing Mirror using smaller, low-parameter, open-source models that will eventually be able to disconnect from the cloud. While we are not there yet, this strategic move toward on-device processing represents a massive leap for both privacy and safety. By focusing on models designed for efficiency and transparency, we are working toward a world where:

• Data never leaves a user’s device, providing the highest possible tier of privacy.
• Detection is not limited by Wi-Fi connectivity. Safety shouldn’t depend on a signal; Mirror is being built to eventually provide support resources even when users are offline.

Building Mirror has reinforced that responsible AI requires continual assessment, refinement, and improvement; it is an ongoing practice. The most advanced AI in mental health is the one that knows its limits.

We are committed to doing all we can to provide evidence-based tools that help people get the support they need — because when someone shares their deepest struggles, connection to another person should always be the next step.

If you or someone you know is struggling, resources like 988 and the Crisis Text Line are available 24/7. Mirror is designed to make reaching them easier, not to replace them.

The post How We Built Responsible AI in Mirror Journal appeared first on Child Mind Institute.

Having both autism and ADHD is very common — studies estimate that 50 to 70 percent of people with autism spectrum disorder also have ADHD (though most people with ADHD do not also have autism).

It’s only since 2013 that the possibility of having both was recognized in the DSM-5, the guide to mental health disorders. Before that the two diagnoses were considered mutually exclusive. But mounting evidence of how common it is to have symptoms of both, and more recognition of the frequency with which people have several related developmental disorders, led to a change in the guidance.

Since the combination has only been recognized so recently, there is a limited amount of research on how people are affected by having both disorders, says Conner Black, PhD, associate director of the Autism Center at the Child Mind Institute. The term AuDHD was coined by autism advocates to highlight the experience of having symptoms of both, because they can interact in confusing ways.

Autism and ADHD are both neurodevelopmental disorders, and each involve issues with attention, social challenges, and difficulty regulating emotions. To understand the experience of a dual diagnosis, we must examine the behaviors associated with autism vs. ADHD — and how they might interact.

Autism: Kids with autism tend to focus intense attention on their specific interests, and they have difficulty shifting attention between tasks or on demand. “Inattention in autistic kids,” says Dr. Black, “is more because the child is self-directed and more interested in what they want to do at that time.”

ADHD: ADHD makes it unusually difficult for kids to concentrate and follow directions. “Kids with ADHD are inattentive because it’s hard for them to focus on a specific task or specific activity,” Dr. Black says.

AuDHD: Attention challenges are exacerbated in kids with both. They may be inflexible about what they will pay attention to — wanting to focus on a special interest at the cost of something else, for example — and also genuinely struggle to pay attention to things that aren’t of personal interest.

Autism: Kids with autism have trouble reading nonverbal cues and having back-and-forth conversations.

ADHD: Kids with ADHD can struggle socially because they are impulsive, tend to interrupt, and have trouble listening to others and taking turns.

AuDHD: “Kids with both can have trouble reading social cues and understanding the natural flow of conversation,” says Dr. Black. “But then they also might have difficulties with impulsivity, waiting for their turn to talk. Their social challenges can be compounded.”

Autism: Kids on the autism spectrum can have difficulty managing big emotions, which can lead them to act out. They may experience emotional distress as a result of sensory overload, unexpected change, or social confusion, which can cause them to melt down. The outbursts may seem sudden, but that’s often “because they’re not cued into their own emotions or how their body is affected by them, so they don’t know how to recognize their emotional reaction building up,” Dr. Black says.

ADHD: Kids with ADHD can also have difficulty managing big emotions, but the outbursts are often the result of frustration or impulsivity. “In ADHD, you often see these extreme emotional reactions, where kids seem to go immediately from zero to 100 as a reaction to an event,” adds Dr. Black.

AuDHD: For kids with autism and ADHD, “we often see big behavioral episodes,” Dr. Black explains, “whether that’s being aggressive or having some kind of meltdown. The two of them together exacerbates some of those challenges.”

Having both autism and ADHD can mean having traits that pull in different directions. For instance, autistic people are often more comfortable with a reliable routine; change can be challenging. But people with ADHD are often impulsive — they tend to enjoy change and seek out new experiences. These conflicting tendencies can be difficult to navigate.

“I see kids who say things like, ‘I know I have clothes all over my floor and I really want them gone, but my executive function issues won’t allow me to do that,’” says Dr. Black. “It’s like the two pieces can work against each other.”

Another example is in social situations, which can become very complicated for kids with a dual diagnosis, according to Dr. Black. “A child who has ADHD and autism might act impulsively and then hyper-analyze the social situation they were in: ‘Did I speak too much? Did I say something wrong? Did I jump in when I shouldn’t have?’” For an autistic child who already finds social situations hard to read, their impulsivity can make them even more uncomfortable.

Dr. Black notes that kids with ADHD or autism alone are already at higher risk for anxiety and depression than other kids. While the research is not robust, studies indicate that this risk may be elevated in kids who have both, he says.

Dr. Black hypothesizes that heightened risk could stem from those compounded social challenges — producing social anxiety, for example — or feeling misunderstood. “Individuals with both ADHD and autism talk about how they feel misunderstood. They haven’t found people that are similar to them. They really feel like they are different than the others around them,” he says. “I think that can lead to identity challenges and also mood difficulties. There are multiple pathways that could potentially exacerbate anxiety and depression symptoms.”

Dr. Black notes that autism can be reliably diagnosed at a younger age than ADHD. So children tend to be diagnosed with autism first, and ADHD symptoms are recognized later, leading to the second diagnosis.

Autism can be diagnosed in children as young as 18 months, while ADHD is typically diagnosed when children are in school, and they have trouble paying attention, staying in their seats, or managing impulsivity.

When a preschooler comes into his office and fits the criteria for autism, Dr. Black says, they could be screened for hyperactivity and attention challenges. But it’s often too early, since kids that age are typically very active and distractable. “In really young kids we often don’t give a co-occurring diagnosis,” Dr. Black explains. “That would be at a future assessment or when additional challenges arise — it becomes clearer once they get to that school age where there are more expectations that you sit in your seat and attend to what a teacher is saying.”

It’s not uncommon for preschoolers who are autistic to be first diagnosed with ADHD, and then years later, with autism — one study shows an average delay of three years between one diagnosis and the other. In some cases, these kids are misdiagnosed with ADHD. In other cases, they have both disorders, but their autism was overlooked — as sometimes, combined autism and ADHD can be interpreted as severe ADHD.

One reason for missing the autism symptoms may be that ADHD is more than twice as common as autism, and far more familiar to pediatricians who see young children. “ADHD is often a diagnosis that’s given first because the providers are using an ADHD lens,” says Dr. Black. An autism diagnosis may be delayed until it’s clear that the treatment for ADHD isn’t working. “Whether they try medication or go to therapy for ADHD, if it doesn’t improve then they land on that autism diagnosis.”

Early signs of autism are also more difficult to recognize when you’re not an expert, and an accurate autism diagnosis can’t be given in one short office visit. The standard assessment tool, called the ADOS — the Autism Diagnostic Observation Schedule — takes 45 minutes, and it’s meant to be paired with a structured interview with parents about current and past symptoms, which takes several hours.

Treatment for children with both ADHD and autism often involves both therapy and medication.

Therapy involves parents and other caregivers as well as the school, if possible, working with the child to develop structured routines and schedules and consistent responses to behaviors, Dr. Black explains. It also involves helping the child or adolescent develop an understanding of their emotions and the coping skills to manage them, he adds. “It’s really taking a 360-degree approach to working with that individual to help set them up for success.”

For kids with ADHD, stimulant or other ADHD medication can play multiple roles. ADHD medication can minimize symptoms and help kids function better in school and other activities. It can also help kids be able to focus on their therapy and learning important skills. “When kids are really inattentive, maybe hyperactive, it can be hard for them to engage in a therapy session, so medication might be a good start,” says Dr. Black.

In children and adolescents with autism, antipsychotic medications like risperidone (Risperdal) or aripiprazole (Abilify) may be used to help manage big behaviors like emotional outbursts or aggression — the goal is to keep kids safe and able to function at school and at home. For kids with ADHD, antipsychotic medications can be used along with ADHD medications when stimulants alone aren’t effective in controlling outbursts.

Dr. Black likes to think of antipsychotic medications, as a psychiatrist he worked with once put it, as extending the length of the fuse on the emotional outburst.

“I think that’s a great way to think about it,” he says, “because for some of the kids that I’ve worked with, one minute they’re happy as can be, and the next they’re so angry they’re throwing something across the room. Sometimes pharmaceutical help is really needed to give that kid the time to use the coping skills they learned in therapy. I’ve definitely seen kids where these medications have allowed for better therapeutic intervention.”

The post What Is AuDHD? appeared first on Child Mind Institute.

To make sure the night goes well, parents will want to have conversations with their kids about their concerns and expectations, whether it’s related to drinking or substance use, sexual activity, or something as down-to-earth as setting a budget.

Here’s expert advice — and actual scripts! — for how to talk to your teenager about prom, so that they’re prepared, you’re relaxed, and a good time is had by all.

You might have had conversations in the past about your family’s values and rules, but prom is the kind of event that calls for a refresh. Your teen may argue that rules should be relaxed because it’s a special occasion — or that they’ll be leaving home in a couple of months anyway — and you might feel pressure to give in. But that doesn’t mean you have to abandon your better judgment. Can you settle on a plan that works for both of you? Some recommendations to keep in mind:

Know your values. Keep your focus on what’s important to you, especially when it comes to your child’s safety and healthy development, says Marc Shuldiner, PsyD, a clinical psychologist at the Child Mind Institute. Helping them have a good experience at prom doesn’t mean giving in to every demand.

Start the conversation early. Planning for prom can start months earlier than parents expect. “Many times there’s anxiety around asking people that can start in February for a June prom,” says Megan Ice, PhD, a clinical psychologist at the Child Mind Institute.

Never assume. “Each child is different, so don’t make assumptions about what your child’s prom might look like,” says Dr. Ice. Or even how interested they are in going! She recommends getting the ball rolling with an open-ended question like, “What are you thinking about prom?”

Present a united front. If you have a partner, act as a team on whatever issues arise, whether it’s budgets or after-party attendance. “Many parents disagree about these decisions,” warns Dr. Ice. “Talking them out first before presenting them to the kid will help decrease conflict, as your child won’t keep trying to negotiate or pit the parents against each other.”

Here are some specific situations you may want to consider discussing in advance of the big night.

How much you’re willing to spend on prom is something you should be clear about early in order to avoid misunderstandings. But it’s also a chance to get to know what’s motivating your child’s spending and what they’re most excited about.

“Different families have different means and ideas about what’s appropriate to spend for something,” says Dr. Shuldiner. If your kid is looking to splash out, say, on a dress, he suggests asking them, “What is it about that dress that’s special? Is it the name brand?”

Once you find out why it’s important to them, he says, you can have a better idea whether it’s something you can support. If they’re worried about being judged by their peers, is that the healthiest way to respond?

Again, says Dr. Ice, this is a chance to acknowledge their fears and help workshop solutions. “You can still validate their anxiety around being judged, and brainstorm ideas, like renting a dress, thrift shopping, or supplementing your budget with money they have earned,” she says. “You can also help them weigh a higher budget against another desired item, like a new cellphone or a trip. That can help them learn how to prioritize where money goes.”

Be clear if you just can’t afford to spend more than a certain amount. If a purchase is not in line with your family’s values or resources, says Dr. Ice, let your child know, to help them move on to alternatives.

Families have different points of view on teenage drinking. Prom is a time to reiterate yours. Dr. Shuldiner suggests saying something like, “You know how mom and dad feel about underage alcohol use. Remember, you are still underage. And just because it’s prom does not mean it’s no longer illegal.”

Even if you have a strict no-drinking policy, it’s important to make sure your child has practical information to make smart choices. According to Dr. Ice, even a teenager who doesn’t drink needs to be told, “Don’t accept a drink from strangers, know who you’re going to call if the person who is supposed to drive you is drunk, and know what the rules of the venue are.”

She suggests coming from a place of, “This is important to know in case your friends drink.” She explains, “Often kids are more receptive to this angle — they’re more likely to listen to you because they care about having the information they need to help keep each other safe.”

Don’t worry that offering info is giving permission; it’s keeping your child safe. The more prepared a child is to encounter alcohol or drugs, the more prepared they are to resist them. “That moment of panic is often when they just go with ‘Yes, sure, I’ll have it,’ because it’s easier than saying the hard thing,” says Dr. Ice. She recommends having your teenager practice setting a boundary by having an excuse at the ready when they’re offered alcohol, whether it’s “I’m on medication” or “My parents are super strict, I can’t.”

If they’re simply offered a drink, she suggests something like, “Oh, do you have any soda?” If the situation is more in the realm of games, such as beer pong, Dr. Ice recommends teenagers say something like, “I’d be happy to play. Can we use a water cup?” That way, she says, “They can still say yes to the connecting part, but no to the alcohol part.” The main thing is preparing your child to face situations where drugs or alcohol may be present, and, says Dr. Ice, “helping them feel confident that even if they say no to the substance or if they decline to drink, their friends will still care about them.”

“When we talk about substances, real information, rather than scare tactics, is the way to go,” says Dr. Shuldiner. Instead, offer age-appropriate information. For instance, you can explain that if you smoke pot or drink when you’re not used to it, it can have a stronger effect, so you need to be very careful. Or you might say to your teen, “You’ve gone to so much trouble to create a special evening. You don’t want it ruined by drinking too much.”

Let your kid know that if something terrible happens, they can call you without fearing the consequences. Dr. Shuldiner suggests telling your child point-blank, “The deal is that it doesn’t matter what’s going on. If you call me, I will help you.” Not only is this a way to keep your child safe, it can be a game-changer for your relationship. “When our kids need us most, we want to be there for them, not have them thinking, ‘I’m going to get in so much trouble if I call Dad,’” says Dr. Shuldiner.

Offering kids information and resources of what to do in dangerous situations isn’t giving teenagers clearance to engage in risky behavior. “Just like teaching a kid about condoms or STIs doesn’t mean we’re giving permission to have sex,” says Dr. Shuldiner. “It means we’re giving them the information they need to avoid harm.”

Speaking of sex, “there’s a lot of pop culture about losing your virginity at prom,” says Dr. Shuldiner. “I think that’s more in the way of movies than it is in real practice. The kids that I work with are not necessarily gearing up to prom thinking this is going to be the moment that something happens that was definitely not happening previously.”

Ideally, you’ll have talked to your child regularly about sex well before prom. If you haven’t checked in recently, or you want to reiterate your point of view, but you’re nervous about bringing it up, Dr. Ice again recommends beginning the conversation by asking about their peers. Try, “Are any of your friends planning to share a room with their date at the hotel?” or “Are any of your friends having sex?” If they say their friends are sexually active, you may follow up with, “Well, are you having sex?” As Dr. Ice points out, it’s a matter of “not being afraid to ask the questions, and being prepared for the answers you might get. You have to be able to hear the answers and to react in a nonjudgmental, curious way, so you don’t shut them down for future conversations.”

Much like with drinking, exploring what might happen in terms of sexual activity can help a child prepare. “You could practice ahead what to say if they decide that they don’t want to have sex, so that the kids feel ready to say it in the moment if they are feeling unsure,” says Dr. Ice. ”Let them know it is okay if they are not in the same place as their peers in terms of what they hope to do that night.”

You’ll also want to provide your child with information, both about consent and what safe sex looks like. Dr. Shuldiner suggests reminding them that, “under the influence of any substances, no one can give consent. Remember, officially, if you’re drunk, you can’t get consent. And if you’re with someone who’s drunk, they cannot give consent.”

For many parents, worries about substance abuse and sexual activity center around what happens after prom, when the chaperones are gone and kids head to after-parties. Some parents are happy to have their teens attend post-prom activities, others are not. Whatever you decide, be clear about your point of view.

“If you are normally not okay with your kids going somewhere without parents afterwards, that doesn’t have to change,” says Dr. Shuldiner. “Our values don’t have to change just because we want our kids to have fun or fit in — just like we wouldn’t want our kids to make decisions based on whether they’re going to feel that they fit in.” If it’s a no, say something like, “I don’t want you somewhere where there isn’t an adult. I’m concerned about what might happen. I’d like you to come home right after the prom.” Or maybe, Dr. Shuldiner says, a compromise is in order. “Your curfew is generally X o’clock and you can have an extra hour, but you have to come home. I don’t want you staying out all night.” 

“It’s important to set up expectations in advance, so they’re not calling or texting at one in the morning the night of the prom,” says Dr. Shuldiner. “Tell your child, ‘I’d like to know in advance, what are the plans, where are you going, so I can know whose house it’s going to be, and I can find out about the parents and decide whether or not I feel comfortable with you being there.”

Whatever you decide, Dr. Ice recommends spelling out your motivation, so that kids don’t “jump to the conclusion like, ‘You hate me’ or ‘You’re such a worrier. Why don’t you trust me?’” If you have specific reasons tied to your kid’s history, explain that, she says, by saying something like, “Last time you slept over at someone’s house, bad things happened, so I don’t feel confident that you will be able to set boundaries in an after-party setting.” Or, she says, “if you’re concerned that there’s going to be drinking, say, ‘The party could get broken up by the police and you’re going to be in trouble because you were there.’” Dr. Ice explains, “Outlining your concerns teaches them that there is some reason behind your rule and it’s not just arbitrary.”

If you’re a hard no on the after-party, there might be others who feel the same way. “Some parents will say, ‘We’re all going to give this answer so that no one parent gets blamed,’” says Dr. Ice. Or you might work with other parents to come up with an appealing after-prom option that makes you feel comfortable.

“We’re not raising our kids in a vacuum,” says Dr. Shuldiner. “We all probably want our kids to be safe and healthy and happy. If we remember that, it might make it easier for us to approach other parents and say, ‘Hey, I’ve been thinking about prom. What are you thinking? Why don’t we plan to do this?’” By reaching out to other parents, you’re also modeling social connection for your teens. 

However you decide to handle prom, Dr. Ice points out, “at the end of the day, you can still say, ‘I’m the parent, and I get to make these rules. This is how I plan to keep you safe, and my job as a parent is to keep you safe.’” The main thing is that you want your child to know you love them, and to empower them to turn to you in difficult situations.

“That doesn’t mean that every discussion about prom will be doom and gloom,” cautions Dr. Shuldiner. Don’t forget to celebrate the milestone. Your parting words of advice to your teen can be: Have fun.

The post How to Talk to Your Teen About Prom appeared first on Child Mind Institute.

Looking back, Daria says this communication glitch was typical of that time in their relationship. “She was getting ready to go to college, separating from me, doing things more independently,” she recalls. But the now-funny story underscores a few different points about preparing kids for prom. First, you and your kids might have different expectations about, and plans for, their experience. And second, it’s important to have clear communication leading up to the big event.

In order to support your child through their prom experience (emphasis on their), it’s important to consider where you’re coming from first. “Think about your expectations about prom, what your experiences were, and how they might be different than what your kid’s expectations are,” suggests Megan Ice, PhD, a psychologist at the Child Mind Institute. 

Beware of making assumptions about your child. “We don’t want to assume that they do or don’t want to go. We don’t want to assume that they want to break a bunch of rules and stay out all night, or that they are going to automatically follow the rules,” says Marc Shuldiner, PsyD, a psychologist at the Child Mind Institute. He suggests that you ask yourself these questions:

• What is prom bringing up for me — my own memories, my own hopes, my own disappointments?
• What are the guidelines or rules I want to establish around how prom should go?
• What’s important for me to communicate to my kid? 
• When and how am I going to communicate these things? 
• What potential obstacles might prevent these conversations from going well? 

Once you know where you’re coming from, and where you stand on prom-centric issues such as budget, substance use, after-parties, and more, Dr. Ice suggests approaching your teenager to find out what they’re thinking about prom. “The first thing is to ask your kid if they want to go and what their dream prom experience would look like,” says Dr. Ice. “Each child is different.” Really listen to their answers and go from there.

According to psychologists — and parents — here’s what you need to know before talking to your kids about prom.

If you’re like most parents of teenagers, chances are you went to prom with a date, each wearing an outfit you bought or rented with your parents’ help, after one of you asked the other, “Will you go to prom with me?” These days, things are a little different.

Staci, a mom in New York City, reports that the large high school her daughter attends “makes it so much easier because it can be a non-date, you can just go with a friend, show up by yourself.” Jaime, raising kids in central Massachusetts, says that anything goes at their school, too. Her daughter planned to attend with a date but “she and her boyfriend happened to break up a couple of weeks before prom last year, so she decided to take a girlfriend with her,” she says. “It was a challenge, but she had a great time.” Her son, whose prom is this year, “is single,” she says, and plans to go in a group. 

Since there are so many versions of what a prom experience can look like, Dr. Ice reminds parents, “if you are asking your kid whether there’s anyone they’re thinking of inviting, be careful how you phrase it. You don’t want to assume that they’re asking someone of another gender or that the person who identifies as male is the one asking.”

Your kids’ prom will have its own requirements and traditions, which may not match your memory or image of a prom. “My daughter told me seniors had to wear long dresses,” recalls Catherine who lives in Hastings, New York. “I was like, ‘They just mean fancy! I have this great tea-length gown you can borrow.’” But her daughter insisted and, Catherine says, “in the end, I was glad she did because every single girl had a dress to the floor.”

Some schools have strict dress codes, such as juniors in short dresses, seniors in long (or vice versa). Others have transportation requirements. “Our school has implemented a mandatory bus ride to the prom location,” says Jaime. “It’s bittersweet, as I remember limos and dinners beforehand, and they don’t get that experience now.” On the other hand, the bus may cut down on pre-prom drinking and promote inclusivity, paring back pre-prom gatherings where some kids are invited and others are not.

Some folks think these elaborate spectacles — in which one teenager asks another to prom with a handmade sign, bouquet of flowers, box of cupcakes, or even a marching band, and then posts it on social media — are sweet. Others say they’re way too much drama. “I have felt it puts a tremendous amount of pressure on young kids to make grand gestures,” says Jaime. Jessica, in New York City, says her son asked a female friend to prom, “and she had made it clear she needed a promposal,” whereas neither of her daughters felt a promposal mattered, and their dates simply invited them.

Wherever you stand, know that promposals may play a role in your kid’s prom, which can add both fun and stress. Also be aware that some schools have strict rules about when, where, and if promposals can take place on school grounds, so your child will need to be mindful of those.

“One thing parents might not realize is how much of the drama is happening online, not in person,” says Dr. Ice. “Who’s wearing what dress and who’s invited to what are getting posted, so your kid may be finding out that they were left out of things online at 11pm.” 

Your teenager might need your help recognizing when it’s useful for them to be involved in certain conversations — need-to-know logistics, for example — and when it’s making them more stressed or feeling lonelier, says Dr. Ice. At the suggestion of her therapist, Staci’s daughter made the decision to stay off social media for a couple of weeks before the prom, “just to have her own experience and not compare it to anyone else’s,” Staci says.

You’ll also want to advise your teenager to be mindful of social media during the prom and after-party. “Remind them to make sure that they’re only doing things that they’re okay being caught on camera if they’re in a public space,’” says Dr. Ice.

Parents can get excited about helping their kids plan prom — sometimes too excited. “Adolescence is a time where they’re exploring their identity and developing more of their own thoughts and feelings around what they wear, how they look, and who they’re friends with,” says Dr. Ice, so it’s important to make space for them to explore. “Parents can still help kids think through their promposal and practice what they’re going to say, without having to actually do the work, so the kid is still getting the experience doing it themselves.”

But let the developmental level of your kid and how independent they are guide you. If your child needs extra support in certain areas the rest of the year, then you should consider stepping in to assist. For example, “for kids with executive functioning challenges, knowing the deadline for when you have to get your ticket could be a real challenge,” says Dr. Ice. “You can give your kid a reminder like, ‘The deadline for getting tickets is on Friday. I just wanted to remind you that if you are planning to go, you’ll need to give the student council money by then.’”

What you absolutely should talk to your children about are your expectations for their behavior on prom night. “If you have rules around alcohol, sex, substances, curfew, say that up front and be clear about the consequences of breaking that expectation,” says Dr. Ice. (For advice on how to talk about these issues, see this article.) 

As prom approaches, discuss specific scenarios that might arise and talk about, or even role-play, what might happen in those situations. “It is helpful to talk through some of the things that could come up on prom night,” says Dr. Ice. “What are you going to do if there’s drinking or other substances there? What are you going to do about getting a ride home?” You can also tell them that they can and should call you if things go wrong, and you will help them. “If a kid knows they can reach out to you, and that you’re going to be there for them, it can create a safe place of trust,” says Dr. Shuldiner.

It won’t just give your child resources they can use; having these discussions ahead of prom can also allay your fears. “You might think, ‘I know that they’re probably unsupervised right now. I know there are probably some drunk people around them — and I know they have a plan, they’re going to be safe, they’ll call if they need anything,’” says Dr. Ice. “And then maybe you distract yourself that night, so you’re not just worrying.”

Your kid asks someone to the prom and gets turned down. Or they see plans about a pre-prom party online and realize they’re not invited. Prom offers lots of scenarios for Mama or Papa Bear to come out swinging, but your real job here is to give your child the tools to navigate social complexities on their own. “There’s such a pull to fix the situation, like let me call that mom or let me do this thing that will take your pain away,” says Dr. Ice. “But pain is a fact of life, and we have to help our kids learn how to experience it and cope with it and not let it take over their entire life.”

So, what’s a worried parent to do? She recommends that parents lend a supportive ear, but in most cases, let kids figure things out on their own. “You can say, ‘Wow that sounds really painful’ or ‘I’m so sorry that they didn’t include you. That must be really hurtful,’” says Dr. Ice. “Then you can ask, ‘What do you need right now to help you get through this moment?’”

Whether or not your child has a history of anxiety, a high-stakes social event can be stressful — especially if it’s the first one they’ve ever attended. “Prom can be a very anxiety-provoking event,” says Dr. Ice. “Parents should really validate that, be confident that their child can do it, and work with their child to find experiences and supports to help them through it.” 

If your child voices specific concerns, help them think through potential situations and how to handle them. Dr. Ice says that might mean saying something like, “Do you think that it would be helpful to go to a crowded place to practice what it might be like at prom?” She explains, “It’s really all about thinking through what will help your kid be able to face the anxiety rather than taking away the stressor.” 

Emotions can also be heightened in the days after prom. “It may be that they’re a little moody afterward because now this amazing thing that they’ve been looking forward to for months is over,” says Dr. Ice. Or perhaps prom didn’t live up to the hype. Staci recalls, “My daughter’s best friend, who went with her boyfriend, had so much pent-up expectation about the prom, that she was actually disappointed. She went home early crying.”

Scheduling other exciting things to look forward to might help offer your child a bit of balance and avoid a post-prom letdown. The goal is to enjoy this milestone and make the most of this time, but to keep it all in perspective. As Dr. Shuldiner says, “At the end of the day, prom is a dance where we can celebrate what we’ve achieved with people that we want to celebrate with.”

The post A Parent’s Guide to Prom appeared first on Child Mind Institute.

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By Caio Borba Casella, Clinical Data Analyst
Stavros Niarchos Foundation (SNF) Global Center for Child and Adolescent Mental Health

• New Lancet study maps widespread rise in high levels of emotional distress among young people post COVID-19 across six countries and territories from 2018-2020 across six countries and territories
• Girls consistently reported higher distress than boys
• Implications for health systems include strained workforce, more adolescents meeting thresholds for clinical concern and danger of chronic mental health problems
• Young people who are already vulnerable are now at greater risk.
• Investment in youth mental health, and disaster and pandemic planning must be a core priority

Most of the early answers came from convenience samples, such as online surveys, that, although valuable, are not designed to represent an entire country. That means we have had limited capacity to quantify how widespread the problem is and to plan services accordingly.

In a new study published in The Lancet Child & Adolescent Health, titled “Emotional distress in adolescents in 2018 and 2022: a comparison of cross-sectional national probabilistic samples from six countries, our team set out to address this gap. While leading the study, I worked with contributors including Giovanni Salum, senior vice president of Global Programs; Zeina Mneimneh, vice president of Global Epidemiology and Evidence-Based Interventions; and leading epidemiologists Guilherme Polanczyk, Kathleen Merikangas, and Ronald Kessler.

We used nationally representative data from the Programme for International Student Assessment (PISA) regarding six countries and territories (Hong Kong, Ireland, Mexico, Panama, Spain, and the United Arab Emirates) to compare emotional distress among 15-year-olds in 2018 (pre-pandemic) and 2022 (post-pandemic onset). Although the focus of PISA is on academic assessment, its questionnaire also includes items addressing other domains, such as socioeconomic and behavioral aspects (e.g., socialization and physical activity) and emotional distress (e.g., anxiety, depression, and somatic stress responses), that we used for this analysis.

What we found challenges the idea that “things got only a little worse.” On average, emotional distress increased modestly. However, behind that modest average lies a much more troubling story: evidence suggests the number of adolescents experiencing very high levels of emotional distress appears to have risen substantially.

Most studies on mental health trends focus on how the average symptom level changes over time. This is important, but it can also be misleading.

Imagine a classroom where most students feel roughly the same as before, but a smaller group at the back of the room is struggling much more than they used to. If you only look at the class average, you might conclude that “not much has changed,” when in reality, a growing subset of students is in serious distress.

To avoid this blind spot, we used quantile regression, a method that allows us to examine changes across the entire distribution of emotional distress, from those with mild symptoms to those with very severe symptoms.

Across the six countries and territories, we found:

• A modest increase in emotional distress between 2018 and 2022 at the median (the “middle” adolescent).
• Much larger increases of emotional distress at the upper end of the distribution, among adolescents with the highest symptom levels.

When we translated these shifts into population-level estimates, we found that:

• The proportion of adolescents scoring above the median pre-pandemic level increased by about 15%.
• The proportion scoring above the 95th percentile, that is those with very high levels of distress, increased by around 137%.

Put simply: the overall average increased a little, but the number of adolescents in severe distress seems to have more than doubled. When we apply these proportions to national population estimates, this corresponds to roughly an additional 200,000 adolescents aged 15 years in the severe distress range across the six countries and territories we studied. We explore the far-reaching consequences of this population-level shift and its implications for mental health systems later in this analysis.

Our study also examined how emotional distress is related to key social and demographic factors, and how those relationships changed between 2018 and 2022.

We found that:

• Girls consistently reported higher distress than boys, and the gap widened over time.
• Bullying was one of the strongest correlates of higher emotional distress, and its association with distress became even stronger in 2022.
• Lower sense of belonging at school, fewer days spent with friends, and lower perceived parental support were all linked to higher distress, again with stronger associations after the pandemic began.
• More frequent electronic contact with friends was also associated with higher distress, underscoring the complex relationship between digital communication, social connection, and mental health.

Taken together, these patterns suggest a “vulnerability amplification” effect: young people who were already exposed to risk factors, such as bullying, weak social ties, or limited family support, seem to have been hit hardest by the pandemic context and its aftermath.

Our findings add to a growing body of evidence that adolescent mental health has worsened over recent years, in ways that reflect both pre-existing trends and pandemic-related exacerbation. Crucially, this worsening is not evenly distributed: young people who are already vulnerable are now at even greater risk. This rise in mental health distress has important implications for health systems that were already operating under strain before the pandemic:

• More adolescents may now meet thresholds for clinical concern, increasing demand for assessment and treatment.
• Specialist services alone cannot absorb this surge, especially in countries with limited child and adolescent mental health infrastructure.
• Without timely support, severe distress in adolescence can evolve into chronic mental health problems, academic failure, social exclusion, and elevated suicide risk.

To respond effectively to the rise in severe adolescent distress, systems must adopt scalable, layered solutions that match support to need. Policies must also focus on environments where adolescents live, learn, and connect, including schools, families, digital spaces, and communities, rather than relying solely on clinic-based models of care. This includes:

• School-based prevention and early response, such as anti-bullying efforts, mental health literacy, and access to brief psychological interventions.
• Integration of mental health into primary care, ensuring earlier detection and intervention closer to families.
• Digital and telehealth pathways that expand reach and reduce barriers, particularly where specialist capacity is limited.
• Stepped-care models that provide the least intensive effective support first and allow young people to “step up” to more intensive care when needed.
• Task-sharing approaches, training non-specialists to deliver evidence-based interventions under supervision—especially crucial in low- and middle-income contexts.

Many of our current initiatives, within the Stavros Niarchos Foundation Global Center for Child and Adolescent Mental Health at the Child Mind Institute from school-based assessment tools to telehealth Cognitive Behavioral Therapy and single-session interventions, are designed precisely to address this growing gap between need and available care. We remain committed to partnering with governments, schools, communities, and young people themselves to translate evidence like this into meaningful, equitable change.

The post Beyond Averages: The Hidden Surge in Severe Emotional Distress Among Adolescents After COVID-19 appeared first on Child Mind Institute.

By Naomi Grewan
Senior Communicator Fellow, Stavros Niarchos Foundation (SNF) Global Center for Child and Adolescent Mental Health at the Child Mind Institute

That’s the situation I found myself in earlier this year alongside the 2025 cohort of Global Communicator Fellows with the Stavros Niarchos Foundation (SNF) Global Center for Child and Adolescent Mental Health at the Child Mind Institute. Mary-Ann Nobele, another senior fellow, and I had put together a three-day reporter training for the junior fellows we’d been mentoring. We’re currently working with our mentees Sikelela Rollom and Curtis Mkhize to produce two audio stories about child and adolescent mental health.

We all live in different parts of the country. So in June, we came together for a few days to connect and put into practice some of what we’d been discussing virtually. Each day, we started our sessions with listening to podcasts. Because, as Radio Workshop’s editor Lesedi Mogoatlhe always says, the best way to learn how to make good audio stories is to listen to good audio stories.

It’s been almost four months since that cold week in June, but we left feeling warmed by the experience. Since then, our virtual sessions have continued and Curtis and Sikelela’s stories are taking shape.

While that happens, there’s a question I’ve been trying to answer. What role does storytelling play in raising mental health awareness? This has led me to an even broader question. Why use storytelling at all?

Luckily, the answer came instinctively. Stories are something we’re all familiar with. Across continents and cultures, storytelling is a constant. It’s a way to explain our experiences and connect to others. It builds trust and empathy. And for children, it can be a way to learn about good and bad or right and wrong.

Storytelling has been around longer than any of us reading this blog have been alive. It’ll likely outlive all of us too. I can say that confidently, because there’s nothing that connects us, holds us, and guides us like stories do.

With that in mind, it only makes sense that mental health storytelling serves the same purpose. When you hear someone’s story, it humanizes the mental health struggle in a way some articles and research papers rarely can. In humanizing mental health challenges, we can destigmatize and normalize them. Doing so hopefully encourages those struggling to talk about it openly and seek support.

In the process of producing these audio stories, we’ve seen how having open conversations about mental health has helped us speak up about our own challenges. I shared with the group my experience with therapy, another fellow shared their struggle with grief, and one reached out to seek professional help after realizing there’s no shame in admitting they need it. If we want to drive connection, we need to lean into vulnerability.

But while this answers the storytelling question, there’s also the question of medium. If we wanted to, we could turn these stories into articles, or make videos to post on visual platforms like TikTok. So why audio?

My first argument for audio is that it’s accessible to a wide audience. In South Africa, radio is still the most popular way people get their information. And community radio is the most trusted source. If our goal is to combat stigma and normalize mental health conversations, we need to meet people where they are. In our case, we’re lucky that Radio Workshop has an existing network of community radio stations and young reporters who are well-versed in using podcasts to spark dialogue.

My second argument for audio is that it’s intimate. When visual distractions are removed, you leave room for a deeper emotional connection. Most podcast users listen alone, often with headphones on. You’re right there with the person telling the story, no matter where you are physically. There’s a closeness created by the voice that can’t be replicated by text.

My third and final argument is that audio encourages imagination. When you listen to someone describe their experience, your mind fills in the details, drawing from your own life and memories. This makes the story more personal than other media — you’re not just observing someone else’s reality. You’re experiencing it with them.

As Curtis and Sikelela’s stories continue to develop, I’m reminded daily why this work matters. Every interview, every edit, and every vulnerable conversation brings us closer to a world where talking about mental health is as natural as talking about how cold it was in June.

About Naomi Grewan

Naomi Grewan is a Senior Communicator Fellow with the Stavros Niarchos Foundation (SNF) Global Center for Child and Adolescent Mental Health at the Child Mind Institute. She is also a communications manager and associate producer with Radio Workshop in South Africa. With an interest in media and social justice, Grewan continues to explore this intersection through podcasting and youth radio.

The post Meeting People Where They Are: Audio Storytelling and Mental Health appeared first on Child Mind Institute.

New York, USA – The Stavros Niarchos Foundation (SNF) Global Center for Child and Adolescent Mental Health at the Child Mind Institute and the International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP), announce the third cohort of Clinical Fellows in Mozambique. Our strategic expansion into Beira, the capital of Sofala Province in Central Mozambique, is particularly significant. The coastal city recently welcomed a new era of healthcare with the opening of the Beira General Hospital in 2024 — one of the largest in the country.

Developed through a partnership with the MISAU – Ministerio de Saude (Mozambique Ministry of Health), the Clinical Fellowship reflects the government’s important commitment to expanding quality mental health services for children nationwide. The Clinical Fellowship began in 2024 as a multi-year joint commitment, with the below listed third cohort expected to complete the program in 2028.

The three new Clinical Fellows from Beira include:

• Domingas Ferrão, MD, psychiatrist, Beira Central Hospital
• Josefina Sambane, clinical psychologist, Beira Central Hospital
• Esmeralda Manjate, occupational therapist, Beira Central Hospital

They will spend one year in clinical training in Brazil at the Hospital de Clínicas de Porto Alegre (HCPA), under the supervision of leading clinicians, before returning to Mozambique to put the training into action. Fellows also receive funding to support their clinical training, career development, and ongoing work as both practitioners and educators.

By building specialized clinical capacity in this key regional area, the SNF Global Center Fellowships Program continues to work collaboratively toward strengthening existing mental health systems. The Fellows’ essential skills are vital in supporting the young people and communities who continue to navigate complex mental health challenges, including those resulting from climate effects, displacement, socioeconomic factors, and limited access to appropriate care.

“This fellowship represents hope for more care and dignity for children and adolescents in Mozambique,” says Dr. Ferrão. “Being part of this program means believing that change begins when you invest in people and in strengthening local capacities.”

With 16 years of medical experience, Dr. Ferrão works as a psychiatrist at Beira Central Hospital. Her primary research interests include the study of suicidal behavior and the development of strategies for suicide prevention among adolescents.

Prior to the first cohort of SNF Global Center Fellows in Mozambique, there was only one child and adolescent child psychiatrist in Mozambique — Helena Daniel, MD, PhD, who serves as the fellow mentor. This is in contrast to the approximately 16 million children in Mozambique. Alongside local partners, the SNF Global Center is helpingto train nine child and adolescent mental health specialists actively making an impact across the country’s most underserved communities.

“This fellowship symbolizes the possibility of transforming challenges into concrete solutions for child mental health in Mozambique,” Josefina Sambane says. “I hope to acquire tools that will allow me to train professionals and create support networks that ensure the emotional well-being of our children and adolescents in Sofala Province.”

With more than 15 years of experience in mental health care and education in Mozambique, Sambane leads the Center for Child and Adolescent Psychological Rehabilitation (CERPIJ) at Beira Central Hospital. Her research interests include child psychology, school and community-based mental health, and suicide prevention.

While also reflecting on the program’s impact, Esmeralda Manjate shares how the experience of stepping into a role as an agent of change for young people in her community can create lasting change.

“I am looking forward to strengthening my professional skills to act with greater purpose, reinforcing my response to the occupational needs of children and adolescents affected by various medical and mental health conditions in Mozambique,” says Manjate, who currently works at the Beira Central Hospital where she also provides therapeutic assessment and intervention for young people with mental health and neurodevelopmental conditions.

She aspires to continue contributing to clinical research and advancing therapeutic services for children and adolescents in her country.

As the Mozambique country manager for the SNF Global Center Clinical Fellowship Program, Lidia Gouveia, MD, PhD, emphasizes this historic achievement for Mozambique and the city of Beira, specifically. She notes how the program directly targets the region’s most pressing workforce challenges while creating sustainable clinical capacity intended to benefit generations of young people.

“The city of Beira is the capital of Sofala — a province that was the stage of the 16-year civil war and lies in the main cyclone corridor of our country. This means it is a city with a large number of people displaced by war or natural disasters, most of whom are children, adolescents, and young people,” Dr. Gouveia explains. “We strongly believe that these professionals will make a significant contribution to improving mental health care for this population.”

Through the SNF Global Center at the Child Mind Institute’s leadership position in transforming child and adolescent mental health, as well as collaborative partnerships with local governments and educational institutions, quality care is enhanced and existing systems are strengthened.

“We’ve established a transformative partnership with Mozambique’s government to continue to train clinicians with deep cultural competency — professionals equipped to implement evidence-based youth mental health care,” says Peter Raucci, director of Global Fellowships Strategy at the SNF Global Center at the Child Mind Institute. “By combining specialized training, funding, and structured mentorship, we can shift how mental health care is understood, delivered, and integrated into existing health systems.”

Dr. Helena Daniel, MD, PHD, who previously trained at HCPA, says introducing the third cohort of Clinical Fellows is a significant moment to celebrate. She plays a key role in supporting the essential infrastructure of a comprehensive child and adolescent mental health system.

“This fellowship represents a significant step forward in the training of mental health professionals, enhancing excellence in care and challenging contexts characterized by a shortage of human resources,” Dr. Daniel adds. “It creates a multiplier effect capable of positively impacting mental health across the country.”

Learn more about the impact of our fellowships and explore how strategic partnerships in low- and middle-income countries can create new pathways for specialized care through evidence-based approaches and authentic collaboration on the SNF Global Center’s Global Fellowship page.

About IACAPAP
The International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP) date its origin back to 1937 in Paris, France. Initially named the International Committee of Child Psychiatrists, it was renamed IACPAP in 1948 incorporating allied professions, and in 1978 adolescent psychiatry was added to form IACAPAP. IACAPAP’s mission is to advocate for the promotion of the mental health and development of children and adolescents through policy, practice and research.

About the SNF Global Center at the Child Mind Institute
The SNF Global Center brings together the Child Mind Institute’s expertise as a leading independent nonprofit in children’s mental health and the Stavros Niarchos Foundation (SNF)’s deep commitment to supporting collaborative projects to improve access to quality health care worldwide. The center is building partnerships to drive advances in under-researched areas of children and adolescents’ mental health, and expand access to culturally appropriate training, resources, and treatment in low- and middle-income countries. This work is conducted by the Child Mind Institute with support from SNF through its Global Health Initiative (GHI).

About the Child Mind Institute
The Child Mind Institute is dedicated to transforming the lives of children and families struggling with mental health and learning disorders by giving them the help they need. We’ve become the leading independent nonprofit in children’s mental health by providing gold-standard, evidence-based care, delivering educational resources to millions of families each year, training educators in underserved communities, and developing tomorrow’s breakthrough treatments.

The post Empowering a New Generation of Care: Strengthening Youth Mental Health in Mozambique appeared first on Child Mind Institute.

But for some kids, disliking themselves — a sense of being flawed, inadequate, or even toxic — becomes a core part of their identity. That’s what psychiatrist Blaise Aguirre, MD, calls self-hatred or self-loathing. He sees it in many of the children he treats at McLean Hospital near Boston, where they are often admitted after making a suicide attempt. And it’s the subject of a book by Dr. Aguirre called I Hate Myself.

Self-hatred, Dr. Aguirre explains, is a persistent, intense dislike of oneself that comes with feelings of self-blame and low self-worth. This goes beyond kids and teens lacking confidence or getting down on themselves. “It’s practically a rite of passage for teens to have self-doubt,” Dr. Aguirre notes. But for some, a high level of negative thinking becomes embedded, making it hard to distinguish it from themselves. They come to loathe who they are.

Self-hatred isn’t an official mental health diagnosis like depression or anxiety, but it does occur in teens or young adults who have diagnoses, most often borderline personality disorder.

Often, self-hatred isn’t recognized by mental health professionals, Dr. Aguirre says, because it isn’t included in any of the questionnaires used to gauge how patients are feeling. And patients, especially young ones, don’t bring it up, he says, because they are ashamed of it. They see not being worthy of love as a part of themselves they can’t change. And if you tell them it’s not true — that they are lovable and worthy — they often feel that you’re lying to them. This makes the condition particularly challenging to treat.

Self-hatred is such a painful feeling that it can lead to self-injury or dangerous behaviors — reckless driving or risky sex — that the person feeling it uses to numb the pain.

At worst, self-loathing can lead to suicidality. “People with self-hatred at times see themselves as a burden that needs to be removed from the world,” Dr. Aguirre says. “There is an enduring sense that ‘I will never be good enough.’”

“No one is born hating themselves,” Dr. Aguirre observes. Children learn to hate themselves when they receive messages from the adults around them that they are bad, lacking, or not worthy of love.

Those messages can come from harsh, abusive, or negligent parents and other adults. But self-hatred can also develop when a child who is highly sensitive reacts very emotionally to things that don’t seem that important to other people, and well-meaning parents dismiss or reject their feelings. Constantly being told “You are overreacting” or “Don’t be so sensitive” can make kids conclude that there is something wrong with them.

Self-hatred can also develop, Dr. Aguirre argues, when kids are told they are lazy, stupid, or bad. For highly sensitive children, the labels stick. Praise for other kids in the family can also be experienced as evidence that they don’t measure up.  

Self-loathing can then take root and become “a hurtful core self-belief,” Dr. Aguirre notes, further reinforced by an inner monologue that filters out or discounts all positive experiences. “Given this continuous negative dialogue, it is completely understandable that you come to the conclusion of self-hatred,” he says.

Children also get invalidating messages from the culture, including advertising and curated social media feeds, Dr. Aguirre argues. “I think that we market to self-hatred,” he explains. “You’re not tall enough, strong enough, pretty enough, thin enough, intelligent enough, a good-enough cook, friendly enough, put-together enough. You’re just not enough of a person. But if you buy this product…”

Highly sensitive children are more reactive emotionally than most children, explains Dr. Aguirre. “They have more intense reactions to seemingly smaller prompts. And then, once the reaction happens, it takes them longer to reach their emotional baseline.”

This reactivity makes them particularly sensitive to criticism. And as children, they don’t have the ability to put criticism in context, so a minor complaint can feel defining.

How do you know if your child is highly sensitive? A child’s emotional reactivity often shows up very early, Dr. Aguirre says. “Parents often tell me that their children were sensitive straight out of the womb.”

Parents may recognize that a child is more reactive than their siblings, or other children they are around — something that one child takes in stride can feel crushing to another.

Dr. Aguirre, who has four children, uses his own family as an example. When he took his two young sons to judo practice, he recalls, he would yell encouragement from the sidelines. “If they were on the mat, I would yell, ‘Get up! Turn the guy over,’” he says. One son found the yelling motivating, rose to the challenge, and felt proud of himself. The other experienced it as criticism and eventually left the practice crying. “I said exactly the same words to both boys,” he recalls, “but they heard completely different things.”

Dr. Aguirre highlights some of the behaviors in people that are symptomatic of self-hatred:

• All-or-nothing thinking: Forexample, they make a minor mistake and then feel that their life is ruined or that they are a failure.

• Seeking approval and constant reassurance: They need others to tell them that they are worthy — you don’t believe it on your own.

• Doing all they can to fit in: They worry excessively that if they don’t do certain things, people won’t like them and won’t want to spend time with them — which reinforces the idea that they are worthless.

• Taking any feedback as criticism or a personal attack: They take even friendly recommendations or suggestions as hostile.

• Bringing others down: They intentionally make others feel bad in order to feel better about themselves.

• Fearing healthy connections: They push away friends, lovers, or healthy people in their life because they fear that if they get too close to them, they will discover what an awful person they are and leave them.

• Being afraid of having, or refusing to have, big dreams and goals: They don’t believe that anything will ever work out, or that if they go for something big, they will inevitably fail.

• Being overly self-critical: If they make a mistake, they have a very hard time being kind to themselves and instead, tend to take full blame for what happened.

Therapy can help kids become recognize these patterns in their behavior. “Awareness is the first step toward breaking the cycle of self-hate and beginning to think and behave in ways that are more consistent with self-care and eventually self-compassion,” says Dr. Aguirre.

While there isn’t any form of therapy specifically devised to treat self-hatred, Dr. Aguirre notes that several forms of therapy have been used with some success. All of them work with kids to reframe their self-image. It’s a painful process, he says, as it’s very difficult to dissuade someone from a core belief that began developing in early childhood.

Dr. Aguirre tells patients: “While your younger self had limited agency in this process, you now have the power to erode, and eventually dismantle, the toxic building blocks that led to such a hurtful core self-belief.”

Therapies that involve this kind of rethinking include:

• Acceptance and commitment therapy (ACT)
• Cognitive behavioral therapy (CBT)
• Dialectical behavior therapy (DBT)
• Mentalization-based therapy (MBT)
• Schema therapy

If as a parent you are worried about your child, you should begin by listening, Dr. Aguirre advises.

“I think that if parents pay a lot of careful attention, they’re going to see the ways in which children talk about themselves, devalue themselves,” he says. “They say, ‘I’m a loser,’ ‘I’m not clever enough,’ ‘I’m not strong enough,’ ‘No one likes me,’ and those kinds of things. The child might not identify that as self-hatred and nor might the parent. But I think if you’re hearing that on a persistent basis, you have to wonder about what that’s doing to the child’s core sense of self.”

The goal is not to try to talk them out of it. “It doesn’t work for a parent to just reassure them — ‘Oh, you’re so wonderful, you’re so intelligent’ — because that’s not how the child is feeling,” he says. “You have to explore it, and you have to sit with the discomfort of the child’s experience.”

That means asking questions about how they have come to think that way about themselves. He suggests saying something like: “Wow, you say some pretty mean things about yourself and you know, it doesn’t sound like you like yourself very much. What makes you say that?”

He also recommends that parents avoid using judgmental labels (like you’re a “good student” or a “bad student”).  Instead, try to assess what is going on and how you can help. “Like, ‘OK, you didn’t do very well on the test. How can you do this differently next time?’”

Starting in May, Dr. Aguirre will be offering a Continuing Education course for mental health professionals called Targeting Self-Hatred in Psychotherapy through Praxis Continuing Education and Training.

The post What Is Self-Hatred? appeared first on Child Mind Institute.

But the two disorders are very different. Bipolar disorder is a mood disorder, meaning it involves shifts in mood, energy, and behavior that unfold in distinct episodes. BPD is a personality disorder, which refers to a longer-term pattern of emotional and interpersonal volatility. Understanding the difference is important because for kids with these disorders to thrive they need very different kinds of treatment.

“It’s easy to mistake one kind of emotional intensity for another,” says Blaise Aguirre, MD, a child and adolescent psychiatrist and founding medical director of 3East, the dialectical behavior therapy (DBT) unit at McLean Hospital in Boston. “But understanding what drives those emotions is the key to getting teens the right treatment.”

According to Dr. Aguirre, several factors contribute to the confusion between BPD and bipolar:

• The term “mood swings” can be misinterpreted: Asking whether a teen has “mood swings” doesn’t distinguish between the weeks- or months-long episodes of mania or depression in bipolar disorder and the rapid, reactive shifts of BPD. “People say, ‘Do you have mood swings?’” Dr. Aguirre notes, “and when a teen says yes, the leap is often to bipolar disorder.”
• The two disorders share the same acronym: “BPD” can refer to bipolar disorder or borderline personality disorder, which can cause confusion — especially online.
• Public awareness is uneven: Bipolar disorder is widely described in the media and in popular culture, as well as in advertising for medication. “Big Pharma promotes mood stabilizers,” Dr. Aguirre says, “but no one is promoting dialectical behavior therapy,” which is the most effective treatment for BPD.
• Both conditions involve emotional instability: Extreme emotions are characteristic of both disorders, but “in BPD, episodes of dysregulation last minutes or hours,” Dr. Aguirre says. “In bipolar disorder, episodes last weeks or longer.” Episodes in bipolar disorder often arise without an external trigger. In BPD, emotional storms are almost always triggered by something outside the teen — an argument, or an unexpected change in plans — or something inside the teen, like a self-critical thought or perceived rejection.
• Social media adds another layer of confusion: Teens are often exposed to descriptions of BPD and bipolar disorder on TikTok or Instagram before receiving reliable clinical information. “It can be empowering,” Dr. Aguirre says, “but it can also spread misinformation.”

Bipolar disorder is a biologically based mood disorder marked by alternating periods of depression and mania or hypomania. These shifts involve changes in sleep, energy, and behavior that are difficult for teens to control.

• Elevated or irritable mood
• Increased energy
• Decreased need for sleep
• Racing thoughts
• Rapid or pressured speech
• Risk-taking behavior

• Persistent sadness or hopelessness
• Low energy
• Sleep or appetite changes
• Loss of interest in activities
• Difficulty concentrating

What distinguishes bipolar disorder is its episodic nature. Teens often return to a more stable baseline between episodes. Dr. Aguirre says the condition typically emerges later in adolescence than borderline personality disorder. “I tend to see the first break episode in later adolescence or early adulthood,” he says. And while stress can play a role, “there tends to be more of a genetic load” in bipolar disorder compared to BPD.

Borderline personality disorder is a condition in which overwhelming emotions create instability in a person’s relationships and sense of self. Teens with BPD often feel emotions intensely and struggle to return to baseline once they’re upset. It can lead to profoundly negative feelings, including self-hatred and suicidality.

• Intense, rapidly shifting moods
• Fear of abandonment
• Unstable or chaotic relationships
• Impulsivity, including self-harm
• Chronic emptiness
• Difficulty with identity or self-image

It’s common for teenagers with BPD to have experienced trauma or neglect, although it can also develop when a very sensitive child finds ordinary parenting invalidating. “You’re more likely to find early childhood trauma or invalidation in people with BPD,” he says. “In bipolar disorder, you’re less likely to see that history.” Unlike bipolar disorder, BPD symptoms don’t appear in episodes. They are part of a long-standing emotional, interpersonal, and behavioral pattern.

Highly sensitive temperament is central to BPD. “I’ve never met a person with borderline personality disorder who isn’t a highly sensitive person,” Dr. Aguirre says. Sensitive people react strongly to emotional experiences and once they are upset they take longer to recover. Many grow up in environments where their sensitivity was misunderstood or dismissed, leading to a sense of invalidation.

Parents often notice that their child reacts to things with more intensity than siblings or peers do. It is also something many parents recall from early childhood. “Parents often tell me their children were sensitive straight out of the womb,” Dr. Aguirre says.

Borderline personality disorder often emerges soon after puberty, when emotional intensity and social pressures increase. “Something happens around puberty,” Dr. Aguirre says. “You start to see impulsive and dangerous behaviors — fast driving, spending money, sexual encounters — behaviors younger children wouldn’t exhibit.”

Bipolar disorder tends to develop later — in the late teens or young adulthood. Early signs such as irritability, inconsistent sleep, or unusual energy may eventually develop into longer, more clearly defined episodes.

A younger teen whose emotions shift quickly in response to conflict is more likely showing traits of BPD. An older teen with prolonged periods of elevated or depressed mood, especially with disrupted sleep or energy, may be developing bipolar disorder.

Both disorders can involve impulsive or risky behavior, which is why parents often struggle to tell them apart. But the motivations behind the behavior are different. “Often these symptoms in BPD are used to regulate how they feel,” Dr. Aguirre says. “A teen might think, ‘I don’t feel attractive or lovable, so I’ll sleep around to change how I feel.’” In mania, however, risk-taking stems from elevated mood and grandiosity. “It’s not to change anything,” he says. “It’s because they already feel great.” Understanding the purpose behind a behavior helps clinicians distinguish the two disorders.

Misdiagnosis is common, particularly when teens with BPD are labeled as having bipolar disorder. “They come to us on a lot of medications,” Dr. Aguirre says. “They’ll say, ‘These medications aren’t helping me.’ And they often feel worse because the side effects, like weight gain, add to their unstable sense of self.”

When teens learn about DBT, many of them look up what DBT is and see that it is a treatment for BPD. “Then they look up borderline personality disorder and say, ‘This actually makes more sense than bipolar to me,’” he says. The reverse misdiagnosis is rare. “Maybe once a year I see that.”

Sometimes, the disorders occur together. “You can certainly have comorbidity,” Dr. Aguirre says. And co-occurring conditions such as anxiety, ADHD, PTSD, depression, and trauma histories can complicate the picture and the diagnosis because they all shape how symptoms appear. Dr. Aguirre worries about teens being diagnosed too quickly. Many who say they are “depressed” may actually be overwhelmed by existential worry — about world events, climate change, or the future. Accurate diagnosis requires understanding how each symptom works in a teen’s life rather than treating them as interchangeable.

Both BPD and bipolar disorder carry elevated suicide risk, but the patterns are different. “In BPD, suicidality can feel like it’s always hovering in the background,” Dr. Aguirre says. “In bipolar disorder, it tends to surge during depressive episodes. The key is understanding the pattern so you can put the right supports in place.”

Bipolar disorder is usually treated with a combination of therapy and medication. Therapy, such as cognitive behavioral therapy (CBT) or family-focused therapies for bipolar, helps teens learn to recognize early warning signs and maintain routines that support stability. Medication (mood stabilizers or atypical antipsychotics) help manage episodes.

For BPD, the most effective treatment is dialectical behavior therapy (DBT), which teaches skills in:

• Emotion regulation
• Distress tolerance
• Mindfulness
• Interpersonal effectiveness

Medication may help with co-occurring conditions but is not the primary treatment for BPD. With the right support, teens with BPD often make significant progress and go on to build healthy, stable lives.

When a teen says something like “I’m terrible” or “Nobody likes me,” a parent’s instinct is to reassure them. But reassurance alone rarely helps. Dr. Aguirre encourages parents to stay curious. “Rather than saying, ‘That’s not true,’ ask where the thought came from,” he says. “Explore what happened. Try to understand the story behind the emotion.” Teens who feel heard — rather than corrected — are more willing to open up and accept support.

Parents can also pay attention to patterns. A teen whose emotions rise and fall quickly, usually in response to conflict, may be showing signs of BPD. A teen with prolonged periods of elevated or depressed mood, especially with changes in sleep or energy, may be struggling with bipolar disorder. Early, compassionate support can make a meaningful difference no matter the diagnosis.

The post BPD vs Bipolar: Why They Are Often Confused appeared first on Child Mind Institute.

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By Michelle Freund, PhD
Director, Strategic Data Initiatives, Child Mind Institute
&
Michael P. Milham, MD, PhD
Chief Science Officer, Child Mind Institute

We’re entering an era where everyday technology — from smartphones to fitness trackers — can provide unprecedented insights into youth mental health. But realizing this potential requires careful planning, ethical safeguards, and a commitment to ensuring these tools work for all young people, not just those in wealthy countries.

A new white paper from the Stavros Niarchos Foundation (SNF) Global Center for Child and Adolescent Mental Health at the Child Mind Institute charts a strategic course forward, outlining how wearable and physiological measures can bridge the gap between research and real-world clinical care.

Traditional mental health assessments rely heavily on what happens in a clinician’s office. While valuable, questionnaires, observations, and conversations provide limited snapshots. Mental health is complex and doesn’t happen in scheduled increments. It unfolds across days and weeks, shaped by sleep patterns, daily stressors, social interactions, and countless other factors that never make it into a clinical note.

Wearable devices offer something different: continuous, objective data about the rhythms of daily life. Heart rate variability during a stressful exam, sleep disruptions following an argument with a friend, activity levels that gradually decline — these digital breadcrumbs can reveal patterns invisible to traditional assessment methods. The potential is enormous. But so are the challenges — particularly when it comes to making these tools accessible and appropriate across diverse cultural and economic contexts. The goal is not to replace laboratory science but to connect it to real-world behavior.

Here’s an uncomfortable truth: Most wearable research happens in high-income countries, using devices designed for more affluent consumers. A $400 smartwatch may be commonplace in Manhattan, but it’s out of reach for most families in low- and middle-income areas such as Nairobi or New Delhi, for example. This matters because mental health challenges don’t respect borders or income levels. In fact, roughly 90 percent of young people live in low- and middle-income countries (LMICs), where mental health needs are often greatest and resources most scarce.

The paper’s road map addresses this head-on, calling for investment in affordable, research-grade devices tailored to LMIC contexts. This includes:

• Local language interfaces
• Discreet designs (clip-ons rather than conspicuous smartwatches)
• Designs with cultural sensitivity, recognizing that gender norms and social contexts shape what devices are acceptable and practical in different settings
• Strategies to reduce import costs

One of the most promising recommendations involves leveraging technology many young people already have: smartphones. Most phones contain sophisticated sensors capable of tracking movement, screen time, voice patterns, and location — all potentially relevant to mental health monitoring. The key is doing this responsibly. With an emphasis on safeguarding policies, the road map establishes transparent consent, strict data minimization, and robust oversight to prevent misuse. Standardized methods for extracting and analyzing smartphone data would also ensure findings from different studies can be compared — accelerating the pace of discovery. Of course, smartphone availability and connectivity is not universal and other alternatives must be considered for our work to be truly inclusive.

Physiological data becomes far more meaningful when paired with context. That’s where Ecological Momentary Assessments (EMA) come in — brief surveys delivered via smartphone that capture how someone is feeling and what they’re experiencing in real time. Imagine combining heart rate data showing elevated stress with an EMA response revealing the teen just had a conflict with a friend. Or correlating disrupted sleep patterns with reports of anxiety about an upcoming test. This multi-modal integration creates a richer, more nuanced picture of mental health dynamics while maintaining protection protocols.

The challenge is doing this without overwhelming participants. Nobody wants their phone constantly buzzing with survey questions. The road map calls for adaptive approaches where EMA prompts are triggered intelligently — perhaps by physiological signals suggesting elevated distress — rather than on arbitrary schedules.

It also suggests possible alternatives to monetary incentives, which may not be sustainable. Lessons learned from game design: achievement badges, progress indicators, social recognition might offer more scalable ways to encourage participation.

Laboratory research offers controlled conditions and mechanistic insights. Real-world research captures the messy complexity of actual experience. We need both.

Emerging technologies are making this integration possible. Mobile Brain/Body Imaging (MoBI) labs, for example, integrate cutting-edge sensors and analytic tools to study how the brain and body respond during cognitive and emotional tasks. Data collected from a MoBI lab includes the synchronization of EEG with motion capture, eye-tracking, and other measures, enabling the study of cognition and emotion during naturalistic activities. The Child Mind Institute has been a leader in developing open source MoBI tools and training programs, positioning this approach as a critical bridge between traditional lab methods and ecological measurement. Virtual reality offers another promising avenue — simulating real-world scenarios in controlled settings, then measuring responses that might predict behavior outside the lab. Even traditional tools like EEG are evolving. Wearable EEG devices, though still emerging, could eventually bring neurophysiological measurement out of the lab and into daily life — if issues of comfort, stigma, and data quality can be resolved.

Research findings truly matter when they improve care. That means integrating wearable data into clinical workflows in ways that are practical, sustainable, and actually helpful.

In high-resource settings, this might involve dashboards that present clinicians with objective data alongside traditional assessments — similar to how cardiologists now routinely review data from continuous heart monitors. In LMICs where electronic health record infrastructure may be limited, integration could happen through school-based programs, community clinics, or mobile health platforms.

The vision extends beyond assessment to intervention. Just-in-time adaptive interventions could deliver targeted support automatically when wearable data indicates heightened risk — a mindfulness prompt triggered by elevated physiological stress, for instance, or a check-in message following disrupted sleep.

These technologies should extend human judgment, not replace it. The goal is to give clinicians better information, not to reduce mental health care to algorithms.

With great data comes great responsibility. The road map emphasizes that any partnerships with commercial technology companies must guarantee access to raw research-grade data, fair intellectual property arrangements, and strict protections against youth data monetization or exploitation.

This is especially critical in LMIC contexts, where extractive research practices have a troubling history. Local researchers bring essential expertise and must be positioned as partners and leaders rather than solely as sources for data. Agreements should ensure that benefits — whether new diagnostic tools, intervention approaches, or fundamental knowledge — flow back to the communities that contributed.

Policymakers have a role too: establishing national guidelines for wearable data collection that balance innovation with privacy, promoting digital infrastructure investments that enable continuous data collection, and requiring transparency in how youth data is used.

Technology alone won’t solve the challenges without people trained to use it effectively. The road map, therefore, also calls for significant investment in training programs covering device setup, data integration, AI-assisted analysis, and governance frameworks — with particular emphasis on building capacity in LMICs.

This includes:

• Supporting regional manufacturing and validation of devices
• Creating networks that connect researchers across institutions and countries
• Developing open source tools and protocols that reduce barriers to entry

The goal is a truly global research ecosystem where every region can contribute to and benefit from advances in youth mental health measurement.

Perhaps most importantly, the road map calls for coordination. Too often, research teams work in isolation, using different devices, protocols, and analysis methods — making it nearly impossible to compare findings or build cumulative knowledge.

Establishing a core dataset, with minimum standards for what gets measured and how, would enable more robust comparison across studies while still allowing for regional adaptation. Open data repositories could accelerate discovery by allowing researchers to pool findings. Preregistration and transparent reporting of methods would strengthen reproducibility.

These may sound like technical details, but they’re essential infrastructure for translating scattered insights into systematic knowledge.

The road map is ambitious, and success is far from guaranteed. It will require sustained commitment from funders who recognize the vision, measurable impact, and strategic advantage of investing in locally led initiatives and open tools. From researchers willing to prioritize collaboration over competition and open science over proprietary advantage, policymakers willing to update regulations for a digital age, and technology companies willing to prioritize youth well-being over profit maximization.

Every young person — regardless of where they live or household income — deserves access to mental health care informed by the best available evidence and most appropriate tools.

Wearables and physiological measures aren’t a panacea. Mental health is complex, shaped by biology, psychology, relationships, trauma, inequality, and countless other factors. No device can capture that full complexity. What these tools can provide, however, is a window into daily experiences that traditional methods may miss. They can help identify young people who need support earlier. They can track whether interventions are working. They can generate insights that improve how we understand and address mental health challenges.

The Child Mind Institute is proud to help lead this work through the SNF Global Center for Child and Adolescent Mental Health, because measurement matters. And because every young person deserves care grounded in evidence that reflects their reality.

The post Measuring Mental Health in Motion: How Wearable Measures Can Transform Youth Care Worldwide appeared first on Child Mind Institute.

New York, NY – A new study by researchers at the Child Mind Institute reveals how the brain’s functional dynamics — the flow of activity across brain regions that support behavior and cognition — mature from childhood to adulthood. The findings, published in Nature Communications, provide novel insight into how the developing brain supports the emergence of complex cognitive abilities.

The research team, led by Ting Xu, PhD, director of the Center for Integrative Developmental Neuroscience (CIDN), employed an innovative analysis method known as Complex Principal Components Analysis (CPCA). It captures the dynamic flow of brain waves rather than simply capturing which areas of the brain are synchronized. As a result, the researchers were able to examine the directionality of brain activation.

The team found that children’s functional activation patterns reflect adult-like activation by age eight. Specifically, they identified three patterns of brain activity propagation — one capturing basic sensory processing, another the hierarchical processing between sensory and higher-order association cortex, and the final pattern reflecting activation between attention and default mode networks.

“As children mature into adolescence and early adulthood, they spend progressively more time in a pattern we call sensorimotor-to-association, or S-A, which coordinates sensory information with high-order cognitive functions,” Dr. Xu explains.

A particularly significant finding involves the directionality of brain activity. The researchers discovered that “top-down” propagation, where activity flows from higher-order association areas to lower-level sensory regions, increases with age and better predicts cognitive performance than “bottom-up” propagation.

“This shift to top-down processing reflects the brain’s adaptation to growing cognitive demands,” says Dr. Xu. “As the top-down hierarchical processing system becomes more refined and efficient with age, the brain transitions from reactive to reflective processing, supporting the development of abstract thinking, reasoning, and executive functions that emerge during adolescence.”

The findings were robust across multiple methodological approaches, stable at the individual level, and were replicated in an independent youth cohort with different scanning procedures. The study used datasets from open-source resources, including the Human Connectome Project and the Nathan Klein Institute Rockland Sample, highlighting the importance of open science in accelerating scientific progress.

“This research provides compelling evidence that the maturation of brain dynamics directly supports increased cognitive function during adolescence,” said Dr. Xu.

“Understanding these developmental changes could have important implications for future research on neurodevelopmental disorders and targeted interventions.”

About the Child Mind Institute

The Child Mind Institute is an independent nonprofit organization dedicated to transforming the lives of children and families struggling with mental health and learning disorders. Through cutting-edge research, evidence-based clinical care, and public education, the Child Mind Institute builds open science platforms and digital tools to accelerate discovery and improve youth mental health worldwide. Learn more at childmind.org

The post Children’s Brain Activity Shows Shift from Sensory to Cognitive Processing as They Mature appeared first on Child Mind Institute.

My parents’ divorce proceedings would go on for nearly a decade. Important milestones like graduations and birthdays were often overshadowed by vicious arguments, court hearings, and petty games of one-upmanship. All the while, my siblings and I were forced to take sides in an endless war we’d never asked for.

Any divorce can be emotional and difficult to navigate. But it can be considered high-conflict when it involves a series of disagreements (such as financial support, property division, or custody), a breakdown in conflict resolution, and aggressive hostility. This might look like repeated litigation, unfounded allegations of abuse, sabotage of parent-child relationships, and a host of other destructive behaviors — often undermining the quality of parenting and setting a poor example of interpersonal communication for the children involved.

“For a child, being in the middle of a high-conflict divorce can be incredibly difficult,” says Jaime Weiss, an attorney who specializes in family and matrimonial law in New York. “We see a range of consequences and mental health issues. It could be chronic headaches, stomachaches, self-harm, drug use in adolescence, difficulty forming intimate relationships, and so on. We see kids who end up bouncing from school to school or enrolling in more intense mental health programs.”

Still, there are ways to protect kids from the brunt of a nasty divorce, and we’ve turned to experts in the field for guidance.

A child’s experience during a high-conflict divorce is shaped by the parents. And the first step to making everyone’s experience easier is to educate yourself on what you and your child can expect, advises Natalie Weder, MD, a child and adolescent psychiatrist at the Child Mind Institute.

After that, there are additional steps you can take to make sure your child feels supported while shielding them from the worst aspects of a high-conflict divorce.

“Providing age-appropriate explanations of what they can expect can help reduce anxiety for children,” says Tanvi Bahuguna, PsyD, a psychologist at the Child Mind Institute.

It’s important, she says, that dialogue about the divorce remains clear, consistent, and neutral. “Reassurance is super important at this point, and your job as a parent is to simply validate all the confusing feelings that may be coming up, acknowledge that this is confusing, and understand that this is something that they’ve never experienced in their life,” she advises.

If the child is too young to fully understand what’s going on, says Dr. Weder, there are other ways to communicate and help them share what they’re feeling. “I’ve used picture books like Dinosaurs Divorce. It’s about a family of dinosaurs experiencing a divorce, and they describe what they’re feeling. Sometimes for a child, it’s much easier to talk about what they expect a dinosaur to feel instead of their own feelings.”

“In these types of cases, we sometimes see parental rejection,” says Weiss. “There can be issues of parenting time refusal that may involve one parent either consciously or unconsciously signaling to the child that they should not want to spend time with the other parent. And so, the child feels the need to align with one parent and reject the other. That becomes very problematic over time because it’s a tough issue to address once it cements itself.”

For this reason, having firm boundaries with the other parent from the beginning is important, says Dr. Bahuguna. “Parents need to be having those discussions. ‘What kind of communication do we want to have in front of our child about the situation? How are we going to talk about our divorce in a neutral way that isn’t harming the other parent?’ You want to prevent putting the child in the middle and reduce conflict as much as possible.”

Of course, in a high-conflict divorce, this can be difficult to pull off. One parent may want to keep things civil while the other continues to bad-mouth them to the child.

While the urge to defend yourself is understandable, says Dr. Bahuguna, it’s important to remain brief, factual, and neutral in tone when discussing the other parent. “Just sticking to the facts and keeping that consistent over time is more beneficial than engaging in counterattacks or trying to explain your position to your child,” she explains. “But it’s upsetting for a child to hear one parent bad-mouth the other, so validate those emotions. And remind the child that they are loved, and these are adult decisions that are being made that have nothing to do with them. Children tend to internalize a lot of the blame and guilt.”

While communication breakdowns between parents are common in a high-conflict divorce, there are ways to try to mitigate the level of conflict to make things easier for all involved.

“Parent coordinators can be utilized to help parents with disagreements,” says Weiss. “And in extreme cases, they can also be a conduit for communication between parents.” She also notes that if parents have the resources, they can each acquire a parent coordinator — then the coordinators can talk to each other and act as a buffer.

And if there is a family therapist involved, says Weiss, set clear boundaries with that therapist early on. “The one thing that I see come up again and again is that there aren’t clear ground rules for the therapist,” she recalls. “One parent might call the therapist all the time and provide information without the other parent being aware. So, it’s important to have a clear road map where both parents feel like they’re in the loop.”

Weiss also advises that parents refrain from responding immediately to every text message or email, especially if tensions are high. “Unless it’s an emergency that must be addressed immediately, I encourage people to take a cooling period. Instead of responding to the message right away, acknowledge that it’s there, put it to the side, and then maybe pick it up and respond 24 or 48 hours later when you’re not feeling incensed.”

Additionally, there are apps such as Our Family Wizard that parents can use to talk to each other. “The apps themselves can pick up tone and can stop a message from going through if it’s highly toxic,” says Weiss. The app can also be a great tool for maintaining a catalogue of communication. “It keeps in dates, time stamps, and an inventory of the back-and-forth. So, if one parent says, ‘Oh, you didn’t respond to me,’ you can look back and see exactly when everyone responded and who was on the thread.”

All experts agree that with the changes that come along with divorce, maintaining as much consistency and stability as possible in the child’s life is essential.

“A difficult aspect of divorce is when the child’s life is significantly disrupted,” Weiss explains. While they may have to change their living arrangements or reside in two separate households, try to keep everything else as uninterrupted as possible. “Try to make logistical arrangements where you’re both living in proximity to one another or in proximity to a child’s school so that they’re comfortable going back and forth,” she recommends.

“Reassure the child that they’re going to keep going to the same school. They’re going to be able to see their friends. They can continue their regular activities.”

Children do well with routine, says Dr. Bahuguna. “It would be in the parents’ best interest to keep the routines within the separate homes as clear and consistent as possible. So, having the same morning routines, nighttime routines, and structured mealtimes,” she says. “That really provides stability and safety for children, and that can also help parents provide their own internal stability and safety for themselves.”

Weiss describes helping clients come up with a plan to navigate the logistics. “I help my clients plan out their calendars for the next two or three years to give them a chance to reset, calm down, and breathe a little easier. And typically, with the passage of time, some of that high conflict can be tamped down.”

Divorce, especially a high-conflict one, is a painful and stressful process for all involved. “It’s important for parents to also take care of their mental health as they’re navigating this journey,” says Dr. Bahuguna. This allows you to not only take care of yourself but continue to be a warm and safe space for your children, which is essential during a time of immense change and chaos.

While kids are bound to be affected in some way by a high-conflict divorce, there are telltale signs that it might be time to seek help from a mental health professional. And, according to Dr. Weder, these symptoms will look different depending on the age of the child.

“Toddlers in general have much less of an ability to express their feelings through their words. So typically, you see more behavioral symptoms like regression,” she says. “For example, let’s say that a baby was already toilet trained. You might see them go back to having accidents.”

With young children, says Dr. Bahuguna, the biggest sign to look out for is a huge shift in their behavior. “They tend to act out when there’s a lot of internal distress. So that could also look like regression behaviors.” This can show up as increased clinginess or temper tantrums you thought they’d grown out of.

Teenagers typically display more anger or defiance, Dr. Bahuguna explains, but they may also internalize their struggles. “This can look like a lot of withdrawal behavior. They may withdraw from parents, from peers, from school activities and hobbies they once enjoyed,” she describes. “And they may start engaging in risky behavior, like hanging out with unsafe peers who can lead them astray.”

‌Family therapy, along with individualized therapy for the child, is typically recommended for a high-conflict divorce. But according to Dr. Bahuguna, trauma-focused cognitive behavioral therapy (TF-CBT) may be necessary if the child is displaying a lot of trauma-related symptoms. While the sheer shock of the divorce can be traumatizing for a child, witnessing volatile behaviors between parents, courtroom proceedings, and a sudden change in the living situation can also take a toll on their mental health.

“So, some of the signs that we would be looking out for would be if a child has grown to become more fearful around people, maybe more hypervigilant,” she explains. “They might be having flashbacks or reporting increased nightmares. Those would be trauma-related symptoms, and TF-CBT would be the best line of treatment.”

However, Dr. Bahuguna points out, if domestic violence or abuse is involved, then TF-CBT would not be appropriate for the child, as it has a family-focused component. “In situations like that, play therapy can be really helpful, especially for younger children,” she says. “In high-conflict divorces, we may see play that can be a little more aggressive in nature. Maybe there are themes of rescuing, where the child is rescuing characters within play. These are great signs that maybe a child is better suited for play therapy over talk-based therapy.”

And for older children and teenagers, a modified form of CBT can be helpful, especially if the divorce proceedings are ongoing, says Dr. Bahuguna. She recommends a regular discussion with your child’s therapist to determine the best form of treatment, as the needs may change over time.

The post How to Protect Kids During a High-Conflict Divorce appeared first on Child Mind Institute.

“Parents often hesitate to bring up sexual behavior in their kid, even to a clinician, partly because they are ashamed, or it feels awkward to talk about, and partly because they hope the behavior will go away on its own,” says Megan Ice, PhD, a psychologist at the Child Mind Institute.

Parents also don’t know what’s developmentally appropriate and how to recognize when it’s a symptom of something more serious. “There’s a typical level of curiosity about the body, or tweens and teens joking around,” Dr. Ice says, “and it’s hard for families to know when something rises to a level of concern.”

Being interested in the body is part of normal development in kids, but sexual behavior can be linked to other concerns. Parents sometimes worry that their child’s behavior can impact them socially — that they’ll get teased by other kids or won’t get invited over to play by other kids’ parents. Or they worry that sexual behavior is a sign the child has been molested.

Before jumping to conclusions, it’s important to listen to kids, says Dr. Ice. “I’m always on the side of being curious with kids, asking them questions in a nonreactive way in order to understand what’s driving the behavior.” Their answer may show that the behavior is innocuous, and you don’t need to get them evaluated. Or it may indicate that the behavior is a sign of a different issue than you originally suspected: “Some kids say inappropriate stuff or draw penises on the walls just to get a reaction,” she says. But you also might uncover information that makes you think the behavior is concerning or problematic, and then you’ll want to consult a mental health professional.

Here are some examples of sexual behavior at different developmental ages, from healthy to concerning to problematic.

• Healthy: Touches their own genitals during diaper changes, when going to sleep, or feeling afraid. Likes to be nude. Curious about watching other people going to the bathroom.
• Concerning: Touches own genitals repeatedly in public after being asked not to many times. Wants to be nude in public even when parents try to stop it. Interest in others’ bathroom functions lasts weeks or months.
• Problematic: Touches or rubs genitals so often that they hurt. Refuses to put on clothes and repeatedly exposes private parts to others. Won’t leave people alone in the bathroom or forces their way in.

• Healthy: Plays doctor and inspects others’ genitals. Plays house, acting as mommy or daddy. Kisses family members and familiar adults.
• Concerning: Frequently plays doctor even after being redirected. Imitates sexual behavior with dolls or stuffed toys. French kisses or kisses unfamiliar adults and kids, or is afraid of hugging and kissing familiar people.
• Problematic: Forces other kids to play doctor, take off their clothes, or have sexual contact with them. Talks or acts in a sexualized manner with unfamiliar adults.

• Healthy: Talks with friends about sex. Posts online about having a boyfriend/girlfriend. Self-stimulates genitals in private.
• Concerning: Talks with adults about sex and continues when asked to stop. Uses sexual language online. Masturbates in public or at inappropriate times, such as at school.
• Problematic: Says they are older than they are and initiates sexual conversation in person or online. Posts sexually explicit or violent materials online. Masturbates in front of siblings or in public.

Sexual behaviors that are problematic often have these elements in common, says Caitlyn Downie, LCSW, the Director of Trauma and Resilience at the Child Mind Institute:

• Frequency: The behavior may be healthy if the child engages in it every once in a while, but it becomes an issue when it happens very often. For example, a 3-year-old who touches their private parts once in a while is okay, but it becomes concerning if they do it multiple times a day.
• Social norms: The behavior might be fine when it’s private but not when it’s performed in front of other people.
• Persistence: If the child keeps doing the behavior even after the parent has talked to them about stopping it. “When they get redirected, do they continue to do it? That’s a red flag” that they might need help, says Downie.
• Aggressive or coercive: The child engages in the behavior with other people without their consent — say, touching their teacher or other kids inappropriately.

One thing to look for is sexual behavior that is not age-appropriate — say, a 4-year-old acting out oral sex with stuffed animals. “That type of thing is concerning regardless of persistence,” Dr. Ice says. “The child should not know what that is, so we would be concerned as to how they have learned that.”

But people need to take care not to pathologize behaviors that are just cultural differences. “Kids learn about appropriate boundaries from their parents, and a teacher might hear that a 5-year-old sleeps naked in bed with their mom and freak out,” Dr. Ice says. There might be differences in how physical affection is shown, for example, so it’s important to consider whether a child is touching others in a culturally normative way. The issue may not be problematic sexual behavior but learning to respect other people’s boundaries.

Problematic sexual behavior rarely occurs on its own. Kids usually show other signs of a mental health disorder that may be an underlying factor, explains Downie: “Often the child will have sleep or appetite problems, intense anxiety, or depressive symptoms — the persistent inappropriate sexual behavior isn’t usually isolated. It’s part of a larger inability to cope effectively.”

For example, some kids with ADHD, conduct disorder, or oppositional defiant disorder engage in problematic sexual behavior because they struggle with impulse control. “It’s not necessarily something the child is thinking about,” she says. “They’re feeling a certain way and then automatically, say, touching their genitals or touching a teacher or classmates inappropriately.” They might also engage in inappropriate behavior to get a reaction, like taking off their pants in the classroom so they get sent home.

Problematic sexual behavior can also be more extreme, such as a teenager abusing a younger sibling. In situations like this, it’s possible that the teenager themselves was molested or abused in the past. But that’s not always the case. Research finds that many children who engage in problematic sexual behavior have not been abused and that the converse is also true: Many children who have been sexually abused do not engage in problematic sexual behavior.

Ages 2–5: When parents explain to kids what makes a behavior appropriate or inappropriate, that’s often enough to help kids change. For preschoolers and kindergarten-age kids, you can explain what private parts are and the difference between “good touch vs. bad touch,” says Downie. “You want to use the correct anatomical language, even when kids are very young, so there’s no shame attached to those words.”

Ages 6–10: Elementary school-age kids will start to have more curiosity about their bodies and explore more. And with internet access comes the possibility that they will be exposed to inappropriate content such as porn — perhaps on a parent’s or older sibling’s computer. While you should take steps to avoid kids seeing porn (using parental controls, keeping devices in shared spaces), you can also use this as an opportunity to talk to them about online safety and risk, making clear that they can come to you with any questions.

If you think your child has seen porn, she says, you can look at their browser history to see what they’ve been exposed to: “It informs where their mind is at and what they think is appropriate or inappropriate.” Because kids mimic what they see, it’s important to expose kids to appropriate sexual intimacy, say, through a movie or show, Downie says. “Nothing crazy, just something so that their first exposure isn’t something inappropriate.” 

Ages 11–18: When kids reach the tween and teen years, parents should talk about consent and boundaries, says Downie. “Teens start to get involved in romantic relationships, or ambiguous relationships like being in the ‘friend zone,’” she says, and it’s important that they should never put pressure on someone to engage in sexual or romantic activity. They also need to understand that consent isn’t just about saying “yes” or “no” — there are nonverbal signs if someone is uncomfortable that they should look out for.

For all ages, you want to keep the lines of communication open, so kids know that they can come to you with questions and aren’t afraid that they will get into trouble if they do.

When kids are engaging in problematic sexual behavior because of impulse control issues, they can learn to recognize the feelings that lead to the problem behavior, says Downie. “‘If I’m feeling this way, I don’t need to do that,’ they realize. ‘I can do this instead.’” For example, they can swap out the problematic action for another one that’s more acceptable — say, putting hands into pockets instead of down their pants. Or a solution can be as simple as having the child wear a belt so that they can’t easily pull down their pants in the classroom.

If kids are using the problematic sexual behavior as a way to soothe themselves when they’re upset or angry, they can learn coping skills to help them tolerate distress and regulate their emotions, says Downie. That might involve cognitive behavioral therapy (CBT) or dialectical behavior therapy (DBT).

When the problematic sexual behavior involves other kids, the instinct is to isolate the child so it won’t happen again. But Dr. Ice says it isn’t always necessary to be so restrictive as long as there is close supervision to reduce access to online sexual content and control behavior in high-risk locations like bathrooms and changing rooms. “Similar to other behavioral issues like aggression, there often are warning signs that a child might engage in the behavior,” she says, so it’s possible to isolate them only at those times. Treatment involves helping the child learn to recognize the impulses, manage their emotions differently, and set and respect boundaries.  

Kids who engage in problematic sexual behavior often feel ashamed, so they can be secretive about it, says Downie. But it’s important to get them help to talk about it, to understand the root of what’s causing the behavior.

Similarly, parents who find their kids behaving inappropriately often feel ashamed, that it’s a reflection of something they did poorly, says Dr. Ice. They also might be afraid that this means their child will become a pedophile or be branded as a sexual predator. But research finds that most kids who have problematic sexual behavior do not go on to be adult sex offenders.

Nonetheless, families can have trouble finding clinicians for treatment because, unlike risk assessment and safety planning for suicide, problematic sexual behavior is not a standard part of training. “It’s similar to fire setting or cruelty to animals,” Dr. Ice says. “Many clinicians are afraid to treat these kids because they’re afraid someone will get hurt on their watch.” Also, engaging in sexual behaviors like touching their genitals in public can disqualify kids from taking part in group therapy and therapeutic camps, so families have to work on the sexual behavior separately or before they can access the other help they need.

When she talks to parents, Downie says to them, “This is a snapshot into your child’s life right now. And children have to be able to be curious while understanding limits and boundaries. When you put a label on a kid, that’s never going to be helpful to them. You want to acknowledge the behavior, so they’re not shamed. But you want to talk about it in a neutral way.”

The post Problematic Sexual Behavior in Children appeared first on Child Mind Institute.

Matt Missar, LCSW, a therapist and certified gambling counselor, says the number of young people he treats for gambling issues is steadily growing. And even as he treats teens for other mental health concerns, he’ll later learn that they’ve placed bets.

While the majority of people who gamble don’t develop an addiction, participating in online gambling has been associated with an increased risk of gambling issues, especially in boys and men, according to a systematic review of research involving young people between ages 10 and 25. And studies suggest the earlier kids get exposed, the higher the chance of these behaviors yielding a problem.

Young people are specifically at risk for gambling addiction because their brains are still developing. Teens are often impulsive and think they have more control over outcomes (in this case, betting outcomes) than they really do, says Megan Ice, PhD, a psychologist at the Child Mind Institute. And their sensation-seeking and risk-taking tendencies can set them up for excessive online gambling, adds Suzanne Allen, PsyD, a psychologist who primarily works with children, adolescents, and their families.

In some cases, parents allow access to their own accounts with or without realizing how frequently their kids use them, Missar says. But children and teens are also finding loopholes and dodging safeguards meant to keep them from gambling virtually.

Kids may use someone else’s ID (or fake IDs), VPNs, or older friends’ accounts to bypass age restrictions. And offshore crypto casinos or other gambling sites operating outside of the United States aren’t as stringent.

Underage people may have indirect access to online betting by watching streamers gamble or by placing bets with peers who have found a way in. High school students with access to accounts like FanDuel or offshore platforms will, essentially, act as bookies and take bets from other kids, Missar explains.

“Teenagers are already very resourceful in circumventing restrictions, and so they’re pretty easily available if a teenager is looking in the right place,” he notes.

Saul Malek, now a public speaker on gambling addiction, says he gambled virtually for the first time as a 19-year-old college sophomore. Bookies hooked him up with online sportsbooks (he imagines they were offshore accounts but can’t confirm), and he started down what he describes as a “rabbit hole” — losing money on one online sportsbook, blocking the bookie’s number once he owed them, and then finding another bookie to repeat the cycle.

It got to the point where he couldn’t sit through entire games anymore; he had to bet on individual rounds during a match, then move on. Over the span of two years, Malek amassed about $20,000 in debts. It’s been six years since his last bet, and the 28-year-old is still paying off what he owes.

When you’re winning, gambling can be exciting, especially now that you can wager on anything, anytime — even the color of Gatorade poured on a coach or the length of the national anthem. Malek says part of the fun was “living in the daydream of the next big win.” Young people may also see online gambling as a way to relieve stress and cope with hard things, says Dr. Allen.

There’s a social component as well, offering teens a way to fit in and make new friends. “Anything that’s going to help you get accepted by your friends is going to be very, very reinforcing,” says Dr. Ice.

Kids may naturally transition into virtual gambling after participating in certain activities that “prime” them for it. For one, they can download apps that mimic casino-style gambling and sports betting with virtual currency — some of which are advertised as “social casinos” and “social sportsbooks” (think: Fliff).

Additionally, features in video games can mimic gambling. Kids, for instance, can pay for loot boxes that hold mystery prizes; it’s the luck of the draw in exchange for cash. “I’ve seen families be out tons of money on a video game based on their kids’ purchases. And that’s kids as young as 6 or 7,” Dr. Ice notes. (Some countries are regulating these types of boxes due to their resemblance to gambling.)

Similarly, young people place bets on outcomes of their own or others’ video games using “skins” — physical features that customize how an avatar/character looks — as currency. It’s not the exact same thing as betting money, but skins have real-world value, says Missar. (Skins gambling sites are also largely unregulated.)           

Some argue that, just as social casinos and video game features may prime kids for online gambling, so can fantasy sports simply by exposing youth to sports betting content on those platforms. Missar notes that he thinks fantasy sports can be completely separate from online sports betting (and, legally, they are), but “there’s a potential gateway” for kids due to gambling ads.

Gambling in general can become addictive because of the “dopamine rush” of betting, says Missar. Eventually, you can develop a tolerance, where you need to bet more money and gamble more often to get the same effect. “Gambling is absolutely as addictive as substances,” Missar adds. Gambling disorder, when a persistent preoccupation with gambling majorly interferes with your day-to-day life, is included in the DSM-5 alongside substance use disorders.

Gambling — and the financial, academic, and social strain that may come with it — can also lead to stress, anxiety, depression, shame, low self-esteem, and even suicide, Missar notes. In fact, gambling disorder has the highest suicide risk of any other substance use or addictive disorder.

All this said, gambling doesn’t have to be a full-blown addiction to impact a teen’s mental health. “We see negative impacts on mood, damage to relationships, and financial consequences occur even when an individual doesn’t meet the criteria for a gambling disorder,” says Missar.

Red flags specific to kids include:

Kids might not openly talk about gambling, so one warning sign is that they’re frequently checking stats on sports they never used to care about, says Dr. Allen. If they’re overwhelmingly upset about a random volleyball match they usually wouldn’t be interested in, that might be an indication they had a stake in the results.

If large sums of money seem to be missing or showing up out of nowhere, it’s worth looking into, says Dr. Allen. And if your kid lies to conceal the extent of their gambling, it might be cause for concern, says Missar.

Kids might be staying up gambling, skipping meals or showers, or not taking care of their bodies because they’re so preoccupied, says Dr. Ice.

Grades can fluctuate for many reasons, but they can certainly tank due to gambling. “I’ve had clients skip school because they’re so depressed, so anxious, from losing however much money they had in their checking account,” says Missar.

When teens start to build an obsession with gambling, they can disengage from friends, hobbies, and extracurriculars, says Missar. This isolation can snowball into feelings of loneliness, he adds.

Talking to kids about online gambling will not encourage them to do it or continue doing it, health educator and prevention specialist Brittany Sue Hines, MEd, said during a National Council on Problem Gambling webinar on youth gambling. “It just gives them the information that they need in order to make informed decisions.”

Here are some tips for getting started:

An easy way to broach the topic is when you hear an ad for a gambling site or leading up to Sunday night football. You could ask them about loot boxes when they take a break from gaming. For older kids, you can flag gambling lawsuits in real time.

But if your kids have friends over during a game, it might not be a good time to dive in, says Missar. Hines even suggests bringing gambling up during other prevention talks about sex, drugs, and alcohol, because it’s just as important.

You don’t want your kids to get defensive and tune you out, which might happen if you start rattling off all the risks of online gambling. Whether you know they’re gambling or not, ask questions. Missar suggests saying something like, “Man, I see these DraftKings commercials all the time. What do you and your friends know about it? Have you guys ever bet on sports online?” Then, if they’re upfront with you, you can ask what they or their buds get out of it. Your kid may say their friends gamble online to gauge how you’ll respond to their own betting habits. So be careful how you react if you’re looking for honesty, says Dr. Allen.

Kids might have a hard time getting perspective when they’re basking in the highs of winning. You can remind them that just because they know a lot about sports doesn’t mean they’ll find actual success as a sports bettor, notes Malek. You can also underscore that even if someone wins one day, the odds are still against them, and it’s not a sustainable way to make money, says Missar.

Plus, things are not what they seem. Even if it looks like popular streamers are winning a ton, they’re often playing with an online casino’s money. And, when you’re seeing influencers and celebrities promoting gambling, “you’re not seeing the person who has gambled away their paycheck and has to tell their parents that they stole their credit card,” says Dr. Allen. “That’s not a glamorous commercial.”

Highlighting the financial, social, and emotional toll gambling can take is fair game, as is talking about why gambling can be addictive, says Missar. When addressing his teen clients, Missar will reinforce the fact that their brains are still developing and are naturally wired to be highly impulsive — so gambling can seem more appealing even though it can have serious consequences. (He’ll show young clients this short animated video that depicts what addiction can look like.) Ultimately, “youth who understand that gambling has risks are less likely to develop a gambling problem,” says Hines.

If you gamble virtually or in person, be mindful of what you’re modeling, says Dr. Ice. Talk about financial responsibility, then bring up times where you may have lost more than you’d hoped. (Dr. Ice cautions against being too honest, but gauge what’s best for you and your kids.) Touching on your relationship with gambling can lower their guards.

Underage gambling is illegal; there’s no denying that. But take a beat to assess, suggests Hines. If your kid is spending a small amount to join a fantasy league, that’s one thing. If they’re in major debt and can’t seem to stop betting despite the financial, social, and mental toll, that’s another. 

If you lead with anger and frustration, they will shut you out, notes Hines. Shame is dangerous because it teaches kids that they, rather than just their actions, are bad, says David Tzall, PsyD, a psychologist who treats adolescents and adults struggling with addiction. It’s ideal to give off the vibe that your kids’ gambling issues are separate from their identities. That way, they’ll feel like they can get help and fix things. 

Even if you’re on board with therapy, your kid may not be. Seeing a mental health professional can be scary, so you have to find the right selling point. Dr. Allen suggests being specific. Try, “‘You’re losing a lot of money,’ or, ‘I’ve noticed you’re not having as much fun watching games anymore,’ or, ‘You lost your friends’ money and now they’re all pissed at you,’” she says. It’s difficult for them to argue with the truth.

A therapist who has expertise in treating addiction (or gambling addiction) can help. They can formally assess your child’s gambling and mental health, provide resources, and reshape a young person’s relationship with betting.

Therapists may use cognitive behavioral therapy (CBT) to reframe distorted thoughts or beliefs that fuel kids’ gambling, says Missar. These distortions include the illusion of control and overestimating winning. Therapists might also help your teen find good reasons to change via motivational interviewing, says Dr. Tzall. 

Young people can also make independent changes — with or without the help of a therapist — that will decrease their gambling. For example, kids of legal gambling age can sign up for an exclusion program. This means “legitimate gambling apps” they can access from their state will block them, says Missar. Underage gamblers who can’t sign up for those programs can use blocking software instead, he notes.

Then they can work on filling free time with new or old hobbies and unfollowing social media accounts that promote betting, Missar says. As a parent, you can help facilitate this by providing closer financial supervision on shared bank accounts and adding transaction alerts. 

In addition to working with a mental health professional and modifying their lifestyles, adolescents might want to try peer support groups like Gamblers Anonymous (GA), which the American Psychiatric Association recognizes as a resource.

Malek found great success with GA. He saw a therapist briefly in 2019, then felt like he was getting enough support through GA to drop therapy. Healing with like-minded people has influenced him to stop gambling — and “stay stopped.” Malek is actively recovering from his gambling addiction, and he says he’s working with his sponsor on step 10 of a 12-step program.

A young person struggling with a gambling problem can call the National Council on Problem Gambling Helpline (1-800-522-4700) or SAMHSA’s National Helpline (1-800-662-4357) to connect with local resources. Or, you can call on their behalf.

The post Teens and Online Gambling appeared first on Child Mind Institute.

Produced by Maranha Filmes, the video series — with an average length of five minutes — combines cinematic aesthetics, dramaturgy, and technical explanation to address key youth mental health topics in a responsible and accessible way. In total, five episodes focus on anxiety, depression, eating disorders, attention-deficit/hyperactivity disorder (ADHD), and self-harm — with an emphasis on recognizing symptoms, accessing reliable information, and encouraging support.

The star of this film series is Brazilian actress Duda Pimenta. She’s known for her roles in As Aventuras de Poliana and Poliana Moça, as well as productions for platforms such as Netflix, Prime Video, and Disney+. The dramatized scenes are accompanied by commentary from psychologist Mari Luz, who helps describe what is being experienced and felt, translates warning signs in an accessible way for parents and caregivers, and reinforces the importance of care and help-seeking.

This partnership speaks directly to the principles of White January by expanding the public debate on mental health and offering content that contributes to prevention, support, and stigma reduction. In a context marked by the circulation of what can be deemed as superficial or inaccurate information about mental health on social media, “Have you ever felt this?” seeks to provide technical, contextualized, and credible content, using language that is also accessible to adolescents and young people.

“This series is rooted in our commitment to translating scientific knowledge into content that truly resonates with the lives of Brazilian adolescents and those who care for them,” says Carolina Costa, Brazil country manager for the SNF Global Center at the Child Mind Institute. “Talking about mental health in an accessible, responsible, and evidence-based way is essential to reducing stigma, promoting early recognition of warning signs, and strengthening pathways of care that are genuinely effective and sensitive to Brazil’s multiple realities.”

According to the Institute for Health Metrics and Evaluation, affiliated with the University of Washington, around one in seven adolescents aged 10-19 live with a mental health disorder. In addition, the World Health Organization notes that half of all mental health conditions begin before the age of 14, yet most cases are neither detected nor treated — making childhood and adolescence critical windows for preventive action.

Despite the relevance of these data, an important limitation remains; in many contexts, the information underpinning studies is either unavailable or outdated. This is highlighted by a systematic review involving researchers from the Child Mind Institute, published in The Lancet.

It is within this context that the campaign “Have you ever felt this?” stands out by expanding access to information and encouraging help-seeking through an innovative approach to language and format. The series places particular emphasis on the use of trends, dynamics, and viral formats on social media to capture the attention of adolescents aged 13-17, bringing the content closer to their everyday digital culture and facilitating identification with the situations portrayed.

In each video, viewers are provided with information about free and confidential support channels, such as Pode Falar and Centro de Valorização da Vida (CVV), reinforcing the campaign’s commitment to responsible, ongoing care that is connected to contemporary forms of youth communication.

Maria Fernanda Quartiero, founder and CEO of Instituto Cactus, emphasizes that partnerships like this one are strategic for expanding adolescents’ and young people’s access to reliable mental health information as well as developing a closer, more responsible dialogue with this audience. She says, “By bringing together different organizations, forms of knowledge, and languages, we are able to reach young people in the spaces they already occupy and contribute to awareness-raising, stigma reduction, and the building of a culture in which talking about mental health and seeking help is natural and safe.”

As the first international film series launched by the SNF Global Center for Child and Adolescent Mental Health at the Child Mind Institute, this project underscores the power of global partnership. Teaming with Instituto Cactus, the Center is putting its vision into practice, creating scalable educational tools that bridge global knowledge with local context. By creating and disseminating these public educational films, the partnership actively translates a shared global commitment into localized action, directly addressing the urgent need for accessible, stigma-free mental health resources for adolescents in Brazil and setting a precedent for future international initiatives.

All videos are available to watch on Instituto Cactus’s official YouTube channel and the Child Mind Institute’s YouTube Channel with English subtitles.

About Instituto Cactus
Instituto Cactus is a philanthropic, human rights-based nonprofit, and independent organization that works to expand and strengthen Brazil’s mental health ecosystem. Its work focuses on care, disease prevention, and the promotion of mental health, with a primary emphasis on two groups: women and adolescents. The organization operates through strategic grantmaking and advocacy, prioritizing projects, actions, and initiatives that consistently contribute to the development and delivery of mental health solutions and tools, as well as generating evidence and fostering innovation in psychosocial care across the country.

About the Stavros Niarchos Foundation (SNF) Global Center for Child and Adolescent Mental Health at the Child Mind Institute
The SNF Global Center brings together the Child Mind Institute’s expertise as a leading independent nonprofit in children’s mental health and the Stavros Niarchos Foundation (SNF)’s deep commitment to supporting collaborative projects to improve access to quality health care worldwide. The center is building partnerships to drive advances in under-researched areas of children and adolescents’ mental health, and expand access to culturally appropriate training, resources, and treatment in low- and middle-income countries. This work is conducted by the Child Mind Institute with support from SNF through its Global Health Initiative (GHI).

About the Child Mind Institute
The Child Mind Institute is dedicated to transforming the lives of children and families struggling with mental health and learning disorders by giving them the help they need. We’ve become the leading independent nonprofit in children’s mental health by providing gold-standard, evidence-based care, delivering educational resources to millions of families each year, training educators in underserved communities, and developing tomorrow’s breakthrough treatments.

The post New Campaign Offers Mental Health Support for Brazilian Teens appeared first on Child Mind Institute.

When we separate from a really close friend, we tend to use language typically reserved for romantic relationships — we call it a breakup.

While a normal part of growing up, friendship breakups can still be uniquely painful for adolescents and teens, affecting the way they think about themselves and their relationships. So, it’s important for parents to understand why they happen, what to say to help kids cope, and how to talk to them about ending a friendship that no longer feels right.

“I think it’s important to distinguish a friend breakup from just natural shifts in relationships,” says Jenna Klorfein, LCSW, a former high school counselor. Friends may drift apart, say, when they’re no longer in the same classes together, but a friend breakup is an intentional rupture, either between two people or an ouster of one person from a group.

Friend breakups are rarely attributed to one thing or event. “With female friendships in particular, I feel like there’s a narrative that it’s usually about a guy or a romantic relationship, and I have not found that to be true,” Klorfein says. “I think there’s usually much more nuance than that.”

In Klorfein’s experience, kids often drop friends when their interests diverge or when they feel smothered, like they can’t hang out with other people — though they don’t seem to say these things directly. More often she hears things like, “‘She’s so annoying. She’s been acting weird,’” Klorfein says. “There’s some disconnect. Usually, it’s a couple of instances and then one that kind of breaks the camel’s back. It’s a pattern of behavior.”

These behaviors vary by individual but also by age group. A 2021 study found that middle schoolers most often reported “conflict or betrayal” as the reason they broke up with a friend. But among college kids, “lack of companionship,” meaning a lack of pleasurable time spent together, was a more common reason.

A friend breakup can hurt no matter how old you are. But for a preteen or teen, grieving can be especially tough for a few reasons.

A number of surveys report that young people tend to use avoidance strategies to end their friendships. Avoidance can be, and often is, gradual. It can look like making excuses to hang out less or — a tactic cited among middle schoolers — saying something mean but covering up how mean it was by faking a nice tone of voice or a smile until a friend takes the hint. But avoidance can also be sudden.

“Ghosting” — when a person abruptly cuts off all communication — was coined in 2006. The term is often applied to romantic relationships, but its original definition referred to “disappearing” on friends. The concept isn’t entirely new — you could certainly make a point of avoiding your friends before the invention of the internet — but research suggests that it might be newly popular. A study conducted in 2019 found that about 45 percent of teens and young adults had both been ghosted and ghosted someone else.

Obviously, being ghosted feels bad. But it feels bad in a very specific way, lending itself to rumination — “What did I do wrong?” The most extreme form of avoidance, it is a method of breaking up that offers no explanation or resolution.

Unresolved breakups can be harder for teens to process because former friends don’t actually disappear. “They’re still at school. You’re still having to interact with them in the lunchroom,” Klorfein says. “In adulthood, if you have a friendship breakup, you can go years without seeing them.”

Of course, preteens and teens still end friendships directly. But even then, those on the receiving end of a friend breakup can be left without satisfying answers and start to blame themselves.

Take Margaret, for example. She asked her former best friend what she had done wrong, and the response was less than satisfactory. “She was just like, ‘I just don’t want to hang with you,’” Margaret recalls.

We don’t choose our family members, but we choose our friends, Klorfein points out. “So, if somebody’s saying they don’t want to be friends with you anymore, it feels like a really personal rejection or like it says something about you.”

She also explains that a lot of teens look to their friends for their identity. “So, if you lose a friend, it feels like you’ve lost a part of yourself.”

If your child is on the receiving end of a friendship breakup, actively recognize the emotions they are feeling and offer support in navigating them.

Dave Anderson, PhD, a psychologist at the Child Mind Institute and host of the parenting podcast Thriving Kids, says it’s important for parents to act as a sounding board. “A lot of this is just listening. It’s validating. It’s telling kids, ‘Hey, I hear you,’” he says on an episode.

Teens crave being listened to and heard, Dr. Anderson says. You can ask if they want your help solving a specific problem — “Do you need me to help you think through the ways that you might confront this situation tomorrow?” — but be prepared to stand down if your child says no, he warns. “Sometimes it can be really, really hard, but you just have to realize what they’re telling you.”

You can also share your own stories about a friend breakup to help them feel less alone. In Klorfein’s experience as a school counselor, this has been particularly helpful. “It’s important for them to see that adults have experienced that and survived,” she says. “It makes it less isolating.”

But Dr. Anderson advises parents and caregivers to use their own judgment as to whether their experience is useful in the moment. “Sometimes teens find that to be irrelevant,” he says. “You can gauge with whatever teen you’re talking to.”

Klorfein says the pain of a friend breakup can be an opportunity to help kids “deal with psychological pain in ways that are more adaptive.” You can tell them it’s okay to be upset or angry but ask them to consider less emotionally driven ways of thinking about the breakup, too.

She often tells students who are going through a breakup: “This relationship isn’t serving either of you. If they’re feeling this way, if they’re feeling annoyed with you or like they want space, then this is giving you an opportunity to make other relationships with people who don’t feel that way about you.”

Klorfein says this is a way to “de-personalize” the breakup and help a teen understand the parts about the relationship “that weren’t good for them without bashing the other person.”

It’s normal to feel upset after a friend breakup, but counsel kids to cool down before trying to rehash it with their friend. Teens are prone to acting on strong emotions, Klorfein says.

Revenge-seeking is common and can be insidious — like passive-aggressive social media posts or needling the other person in class. If your teen expresses that they want to reach out to their friend, ask them what they want to communicate and why. “If you’re going to communicate when you’re still upset it’s not going to get the point across,” Klorfein says.

While it’s important to validate the pain kids’ feel when a friend breaks up with them, “it’s also important to teach kids that they don’t need to stay in a friendship that doesn’t feel good,” Klorfein says. Granted, that’s easier said than done. Here are things parents can do to help:

Kids and teens are still learning how to communicate in their relationships — give them some language they can use to do it. Encourage them to focus on how they feel and what they need, not what the other person is doing wrong. Using “I” statements helps check the instinct to place blame.

Instead of, “You’re driving me crazy” or “You’re a bad friend,” have them try something like, “I need some space,” suggests Klorfein. Or “I really enjoy our friendship, but I want to have the opportunity to meet other people.” Neither phrase may entirely fit the bill, but having something concrete to say can help prevent avoidant behavior, which research suggests, can become an uncomfortable crutch — something one does out of habit, not because it feels good.

Let kids know this conversation will likely be awkward, but stress that it’s important to have it with their friend directly, not talk to their other friends about it instead.

Consider your own friendships and try to model healthy friendship maintenance, rather than ignoring it or passively hoping it will resolve itself. Talk about how you address and work out problems with your friends to show kids that not every conflict signals an ending. In general, encourage kids to see challenges as opportunities to grow or maintain the friendship before they consider dissolving it.

The post How to Help Kids Through a Friendship Breakup appeared first on Child Mind Institute.

The partnership is backed by a co-investment of approximately 22.8 million BRL (around 4.38 million USD) split equally between FAPESP and the SNF Global Center. This funding is a major expansion of CISM’s work establishing a new research module there dedicated to advancing science, data infrastructure, and care delivery for children and young people in Brazil.

“This is a historic opportunity to change the trajectory of youth mental health in Brazil,” says Eurípedes Constantino Miguel, MD, PhD, Principal Investigator of CISM, psychiatrist, and professor at the University of São Paulo. “We are moving beyond isolated studies to create an integrated, data-driven ecosystem—from population-level mapping to neuroscience to front-line care delivery within Brazil’s Sistema Único de Saúde (SUS). This module will provide the evidence and tools our policymakers and clinicians desperately need.”

The initiative confronts a dire national reality: over 80 percent of Brazilian youth with mental health needs lack adequate care. And the country lacks the nationally representative data required to guide effective public policy and service planning, particularly for historically underserved communities. Addressing this gap also requires approaches that meaningfully engage young people themselves in shaping solutions that reflect their lived experiences and local contexts.

The new research module is designed to tackle this crisis by building a comprehensive pipeline from discovery to real-world implementation within São Paulo’s public outpatient mental health network (SUS).

In Brazil, this work is closely connected to youth-centered engagement through Juntô, a locally rooted initiative of the SNF Global Center that elevates young people as active contributors to mental health solutions.

Through Juntô, youth perspectives help inform priorities, shape culturally responsive approaches, and strengthen the relevance of research, training, and implementation efforts, ensuring that advances in science translate into meaningful impact for Brazilian children and young people.

To address the absence of foundational national data, SNF Global Center in partnership with CISM will launch Brazil’s first large-scale, population-representative epidemiological survey of youth mental health.

Critically, the program is built to ensure that discoveries reach those who need them most, countering the severe lack of access to evidence-based care in the public system. It will actively implement and scale proven treatments within São Paulo’s network of public outpatient mental health clinics (Ambulatórios de Saúde Mental).

Finally, to build sustainable capacity, the initiative will establish a new Center of Excellence in Data Science and Implementation. This hub will train researchers and clinicians in Brazil and Mozambique, fostering vital South-South and North-South collaboration.

“This partnership represents a monumental step toward health equity,” says Zeina Mneimneh, Vice President of Global Epidemiology and Evidence-Based Interventions at the SNF Global Center. By combining CISM’s deep understanding of Brazil’s public health landscape with the SNF Global Center’s innovative tools and methodologies, we are building a scalable model rooted in local reality. Our goal is to generate the robust data and effective interventions needed to transform care for young people in Brazil and create a blueprint for other nations.”

The investment marks a landmark moment for Brazilian science and public health, directly aligning national research excellence with the urgent need to build a more effective and equitable mental health system for all young Brazilians. By generating actionable data, deploying cutting-edge science, and investing in local talent, this collaboration aims to create a lasting legacy of improved mental health care, better-informed policy, and hope for future generations.

About the Center for Research and Innovation in Mental Health (CISM)
CISM is a national research center led by the University of São Paulo (USP) in partnership with UNIFESP, UFRGS, and municipal governments, and co-funded by FAPESP. Its mission is to advance mental health science and ensure discoveries translate into real-world impact for underserved communities.

About FAPESP
The São Paulo Research Foundation (FAPESP) is a public foundation dedicated to supporting scientific and technological research in all fields of knowledge in the State of São Paulo, Brazil.

About the Stavros Niarchos Foundation (SNF) Global Center for Child and Adolescent Mental Health at the Child Mind Institute
The SNF Global Center brings together the Child Mind Institute’s expertise as a leading independent nonprofit in children’s mental health and the Stavros Niarchos Foundation (SNF)’s deep commitment to supporting collaborative projects to improve access to quality health care worldwide. The center is building partnerships to drive advances in under-researched areas of children and adolescents’ mental health, and expand access to culturally appropriate training, resources, and treatment in low- and middle-income countries. This work is conducted by the Child Mind Institute with support from SNF through its Global Health Initiative (GHI).

About the Child Mind Institute
The Child Mind Institute is dedicated to transforming the lives of children and families struggling with mental health and learning disorders by giving them the help they need. We’ve become the leading independent nonprofit in children’s mental health by providing gold-standard, evidence-based care, delivering educational resources to millions of families each year, training educators in underserved communities, and developing tomorrow’s breakthrough treatments.

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In the past three years, the Child Mind Institute has led several highly successful data science competitions, attracting participation from over 9,000 teams of researchers, data scientists, and those interested in mental health. Now, researchers from the Centers for Data Analytics, Innovation, and Rigor (DAIR) and the Strategic Data Initiatives (SDI) have published new recommendations for designing and promoting successful data science competitions.

The paper, published in peer-reviewed journal Nature Mental Health, offers guidance and highlights challenges for structuring competitions to promote scientific advancement focused on brain health data. Accompanying the publication, the team has released a Data Science Competition Organizer Checklist to help researchers organize more effective competitions in the brain and mental health fields.

“Data science competitions offer a powerful way to crowdsource innovative solutions and multidisciplinary expertise,” says Gregory Kiar, PhD, director of the DAIR Center. “However, simply making data publicly available doesn’t guarantee meaningful participation or scientifically useful outcomes. Our goal was to provide a roadmap for maximizing both the inclusivity and scientific impact of these competitions.”

The paper addresses a fundamental source of tension in data science competitions: participants are typically rewarded for achieving the highest scores on performance metrics rather than generating scientifically meaningful insights. The researchers recommend that organizers design datasets and evaluation criteria that minimize the risk of exploiting these structural biases whenever possible.

It is also critical to recognize participants who contribute valuable discussions and interpretations, through “medals” or other reward systems. This way, organizers can leverage participant contributions to directly advance the scientific question — and drive meaningful dialogue that advances our understanding of mental health and informs future research and clinical applications.

In addition, competition organizers should consider and seek to remove barriers that prevent equitable participation. This includes recognizing underrepresented groups in data science and offering educational materials that support skill development.

“The availability of big data doesn’t automatically lead to engagement,” explains Arianna Zuanazzi, PhD, author and Open Science and Research Collaboration specialist. “Organizers need to deliberately plan for inclusivity, from recruiting diverse participants to ensuring datasets themselves don’t reinforce existing healthcare and other systemic biases.”

The Child Mind Institute has been at the forefront of supporting open science practices that have made such competitions possible and impactful. Prior competitions have featured data from the Healthy Brain Network, with support from Kaggle, the California Department of Health Care Services, Dell Technologies, NVIDIA, and the Stavros Niarchos Foundation. The Data Science Competition Organizer Checklist is freely available on the Open Science Framework for researchers and organizations looking to design their next competition.

Read the full article.

Access the checklist here.

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