Hearing the news of the shooting at Apalachee High School sucked the breath right out of my body. The suspect, a 14-year-old. Fourteen. A child. A child in crisis.
With this school shooting, our attention again shifts to gun reforms. We will continue to argue. A nation divided. Though I appreciate the importance of this key issue, I write today, as a pediatrician and a mother, to argue this horrific tragedy, with a child suspect, warrants a conversation beyond gun reform. What is happening to our nation’s children?
Credit: Handout
Credit: Handout
Depression, anxiety, suicide and violent crimes are all on the rise among our youth. The Centers for Disease Control and Prevention reports in a 2021 survey of high school students that more than 4 out of 10 (42%) felt persistently sad or hopeless. As a pediatrician, I am experiencing the weight of this reality daily. Alongside the typical fevers, coughs, sore throats and stomach bugs, I am encountering overdoses that are suicide attempts, weight loss because of eating disorders, cuts because of self-mutilation, insomnia because of anxiety, fatigue because of depression — and the list goes on. This has become the norm for most practicing pediatricians. Without enough child and adolescent psychiatrists to serve the increasing needs of our patients, we have become the front line mental health care providers for our communities.
The data from pediatric emergency rooms across the country is perhaps the most striking, with a sharp rise in the number of mental-health related visits starting during the coronavirus pandemic. Between 2019 and 2020, the number of these visits for adolescents ages 12 to 17 increased by more than 30%. Though there is no denying the pandemic played a role in exacerbating the mental health crisis of our youth, there is more to the story.
Research demonstrates that the basis for this crisis is multifactorial. Genetics, relationships and life experiences — to name a few — play a role. Each affected child has a unique combination of factors contributing to their mental health. But what I have witnessed firsthand in clinic is there is a common thread that connects each case: social media.
Typically, I enter the exam room to find the teenager perched on the exam table with phone in hand, eyes glued to screen, scrolling. You can imagine it, right? This behavior is everywhere. At this point, social media use among teens is nearly universal, with the U.S. Department of Health and Human Services reporting up to 95% of children ages 13 to 17 use social media. As more and more evidence links social media use to our youth’s declining mental health, we have to start paying attention.
Social media is an unregulated, artificial world where children can be exploited by algorithms feeding them posts that might be inappropriate for their developing, impressionable minds. Contagious, dangerous behaviors can spread through exposure. Through communicating on social media, children learn to respond to others impulsively and without empathy. Social media platforms also encourage children to seek attention in the form of likes, shares and reposts. Their self-worth is often determined by their online appeal.
With further investigation into the Apalachee High School tragedy, we will understand more about the teen suspect’s motives, mental state and relationship with social media. Current evidence suggests, not surprisingly, that social media is linked to the case. In 2023, the suspect was interviewed during an investigation of online posts threatening a school shooting. These online posts included photographs of guns.
It’s time for us to take responsibility for the impact social media is having on the health, wellness and safety of our children. We must work together to advocate for a culture change. The easiest place to start is at the level of the parent-child relationship with rules, expectations and modeling of desired behavior. Beyond that, we can advocate — to our elected officials and directly to technology corporations — for age restrictions, content moderation and algorithm modification. Talk. Write. Vote.
Technology is and always will be an important part of our society and its progress. I can’t imagine doctoring without my smartphone. I look at charts, read medical journals, check medication dosing, consult subspecialists — wherever, whenever — all from the palm of my hand. But, I’m not on social media. Are you?
Margaux B. Gray is a board-certified pediatrician. For more information on this topic and how to get involved with change, visit the American Academy of Pediatrics’ Center for Excellence on Social Media and Youth Mental Health.
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