I am a family practice doc who sees teens and 20-somethings daily in my practice. And I have raised 3 teenagers in the past 9 years, as well as a beautiful group of their teenaged and 20-something friends, who also hang out at my house. I love young people in their teens and 20’s. I love their sass and their creativity and their general aliveness. And I am acutely aware that these young people represent the future of our world and will receive the burden of all the problems we have created for them. So, how are they doing?
Last Thursday in my office I saw a strapping, healthy-looking 22-year old male who couldn’t attend school, get a job, or even look me in the eye because his social anxiety was so intense. I listened to a straight-A 18-year old who is taking a leave from college, even though she loves it, because her anxiety is keeping her from being able to focus on her work or attend class. And I saw a 16-year old who had been out of school for a year due to a wicked combination of social anxiety, sensitivity to loud noise, and a variety of anxiety influenced medical issues: headaches, fibromyalgia, and irritable bowel syndrome.
I am seeing an epidemic of anxious, stressed out teens in my office and in my community. And I am not alone. There has been a significant increase in the number of teens and young adults with anxiety and depression in U.S. since the 1940s. As much as 25% of teens in the U.S. will fit the criteria for an anxiety disorder at some time, and anxiety is the most common mental disorder in adults, at 18% of the population (according to the NIH). The U.S. (and other Western countries) have a higher incidence of anxiety than the rest of the world, where the global prevalence of anxiety is only 7%. So U.S. teens and 20-somethings have become progressively more anxious over the last 60 years, are the most anxious age range in our society, and are more anxious than their peers in the rest of the world.
What is going on in our culture and environment that is making our 21st century young people anxious? I think of our young people as the “canaries in the coal mines” of modern culture, with social, environmental, chemical, and community changes all coming to bear on their ability to function. No one knows exactly why teens are more anxious than they used to be, but I have a few guesses.
Loss of community connection and support:
In my book BodyWise, I write about the challenging mismatch between our physiology— which was designed for humans living thousands of years ago—and our culture and environment. And this is a more pronounced problem in Western countries than in more traditional cultures. Specifically, Western countries, like the U.S., have lost much of our communal connection. We often don’t even know our neighbors. The lack of religious and social community, the loss of family farms, and the increasing isolation of our nuclear families create environments which are less friendly to the happiness and relaxation of teens and adults alike. In the U.S., more social connections (at home, at work, in your softball league) lead to less depression and anxiety. Teens need social connections even more than adults, and not just through Instagram or Snapchat. Face to face interaction with friends reduces stress and fuels healthy development. My sister Lisa, who is a 30-year veteran educator specializing in anxious teens, suggests that creating an environment in which young people can feel safe, form connections with other young people, and be successful, is the key to helping them recover their peace of mind. And if you’re the parent of the anxious teen, your love, support and connection is a critical factor in their success. No matter how your teen is behaving, he or she needs your attention, your presence and your affection, if they’re willing to receive it.
Suggestion 1: Find an educational and social environment in which your teen feels safe and can be successful. Remember that “high achievement” is far less important for your young person’s success long-term than feeling comfortable and confident in her or himself. As a parent, even when it’s tough, try to stay open to communication, attention and affection with your teen or 20-something.
Insomnia and Sleep Deprivation:
The impact of artificial lighting and technology on sleep is harsh for everyone in modern society, but it is particularly important for teens, who need more sleep than adults, but have shifted sleep clocks, meaning that they naturally go to sleep later and get up later. The issue is that most schools start by 8 a.m. and teens can’t sleep in late, leaving them chronically sleep deprived. All artificial light has the result of reducing melatonin production at night and making sleep more difficult, but the light on computer and phone screens is a bluer light, and it has twice the suppressive effect on melatonin—severely impairing sleep in teens. A study published in the British Medical Journal reported that the more screen time teens engage in, the longer it takes them to fall asleep. Teens with 4 or more hours of screen time per day were 350% more likely to sleep less than 5 hours at night and 49% more likely to need more than 60 minutes to fall asleep. The impact of less sleep? Anxiety, depression, inability to concentrate and poor grades.
Suggestion 2: Help yourself (or your teen) sleep by limiting screen time at night and/or adding an amber filter to their phone, pad, or laptop to limit blue light exposure (see getflux.com).
Couch Potato Kids:
All humans are physiologically designed to be active, and young people, at their physical peak, should be the most active of all. Exercise is my number one recommendation for preventing depression and is also effective in combating anxiety. In addition, exposure to nature is particularly therapeutic, reducing both anxiety and depression.
Suggestion 3: Find any way for a young person to be active, preferably outside. Skateboarding, biking, walking to school, all sports, even fooling around outside—all count.
Now seriously folks, I meet young people regularly who can’t cook, do dishes, drive, figure out a bus schedule, do their laundry, handle a bank account, or write a comprehensible letter or e-mail to an adult. This makes them incapable, vulnerable and dependent, and they know it. Which is why they’re stressed. Do they feel ready to be independent come the age of 18? No. Which is a cause for anxiety and an impending “failure to launch” that hurts everyone. Our job is to raise adults, and to give them independence in every area that they’ve earned it, whenever possible. Let them fail at things while still at home so that they know how to figure out life when they leave home. A life-competent teen is a less anxious teen. And if you think that “tiger-parenting” a young person is a better option, in my opinion, excessively high parental expectations around school performance or college admissions is a major source of anxiety for many teens. Let them set their own expectations and establish an acceptable minimum for school performance. They should be responsible for their future opportunities as much as possible.
Suggestion 4: While living at home, require that your teen or young person care for their physical, nutritional, financial and transportation needs in whatever ways they are capable. Give them independence to make decisions whenever it is safe to do so. And don’t pressure them to meet excessively high academic expectations—let them set their own goals for achievement, and then support them.
Impact of Technology:
Our brains were not built to withstand the amount of constant information that barrages us. A study in Pediatrics of babies exposed to a DVD, showed significantly increased levels of the stress hormone cortisol, when compared to babies who played with blocks. And another study in Pediatrics showed that early television exposure significantly correlated with later diagnoses of ADHD. Fast forward to the small children I see in cars and airports all over the world with headsets and pads playing games and watching shows. What is the impact of all this stimulation? Well, increased stress hormones. And increased growth of the areas of the brain that respond to stress. Ultimately, a human with a lower threshold for stress and anxiety. Reducing screen time, as best you can, at all ages of development, is key to reducing anxiety. Most importantly, do your best to limit access to violent games, which increase both aggression and anxiety. Realize that kids who are on Facebook and other social media sites more hours, are more depressed and anxious. Perhaps comparing themselves to the “perfect” lives of their peers, falsely portrayed online. Some social media is fine, but require real face-to-face interaction to reduce anxiety and learn social skills.
Suggestion 5: Limit your teen’s access to and use of phones, pads and laptops when at home and require human interaction free of devices—at family dinner for example.
The impact of toxins in our food supply and environment:
Twenty-five percent of U.S. residents eat at a fast food restaurant daily. And the food at those restaurants is processed, heavy with sugar and salt and highly inflammatory to the body and brain. A study in Tehran showed that the more processed food young adults consumed, the more likely they were to be anxious. Multiple studies have shown a reduction in the symptoms of ADHD, depression and anxiety when kids are fed a diet with lots of fruits and vegetables, essential fatty acids (in nuts and fish) and healthy protein. We are also exposed to over 50,000 chemicals in our environment, water and food supply that were not present merely 60 years ago (most of which have not been tested for human safety). A sampling of the umbilical cord blood of infants born in the U.S. revealed more than 200 industrial chemicals. Of the 297 chemicals detected, 180 cause cancer, 217 are toxic to the brain or nervous system, 208 cause birth defects. We have been conducting the biggest experiment on industrialized food and toxic exposure that has ever been seen in human history. And increased rates of learning disorders, depression and anxiety in our youth are likely consequences of this experiment.
Suggestion 6: As best you can, keep your children and teens away from fast food and processed food. Only keep food and snacks at home that support their health: preferably organic fresh fruit, whole grain breads and crackers, nut butters and cheese, carrots and hummus. You’ll be amazed at how many healthy “snack foods” are available when you look for them. And avoid putting toxic herbicides and pesticides on your lawn or garden, which get tracked into the house or using toxic cleaning products.
Rachel Carlton Abrams, MD is a family practice and integrative medicine physician, speaker and author, most recently of BodyWise: Discovering Your Body’s Intelligence for Lifelong Health and Healing. You can view her work at DoctorRachel.com, or on Facebook: @doctorrachelabrams.