Are We Misunderstanding Youth Mental Health with Dr. Will Dobud

Welcome to the Where Parents Talk podcast. We help grow better parents through science, evidence and the lived experience of other parents.

Learn how to better navigate the mental and physical health of your tween teen or young adult through proven expert advice. Here's your host, Lianne Castelino.

Welcome to Where Parents Talk. My name is Lianne Castelino. Our guest today is an award winning researcher, social worker and lecturer.

Dr. Will Dobud is also an educator who has worked with adolescents and families on three continents. He is the co author of Kids these Understanding and Supporting Youth Mental Health.

Dr. Dobut is also the father of two and he joins us from Adelaide, New South Wales. Thank you so much for being here.

Thank you. It's great to be here.

Lots to talk about and I wanted to start with the subtitle of the book. It is Understanding and Supporting Youth Mental Health.

The inference there is that perhaps we're misunderstanding something as it relates to youth mental health currently. Is that the case?

Well, I think that if we look at the numbers, we tend to assume that we know more and more about youth mental health, whether it's neuroscience or more diagnoses or more medications.

And what, what I've seen and I, what I think everybody has seen is that the numbers continue at a, at a macro zoomed out level to continue heading in the wrong direction.

So really what we, with that subtitle, what we thought was not there's too much of telling people what to do, whether that's parents, teachers or therapists.

What, what decisions would we all make if we knew a little bit more about what the research says, what the exper think about things that don't necessarily always get mainstream headlines.

So take us through some of those top line pieces that you think people need to know about, especially parents.

Well, one of the big ones that really hit home for me in my work as a social worker is we've seen over the last two decades this rise in labeling, in self labeling. These are all things social media doesn't help with all that much.

The algorithms find you once it realizes you're attention deficit or anxious and then they start feeding you more information about these labels. And so I know from my time working you mentioned having been able to work on three continents.

There are also three of the westernized continents that around the world the western mental health system is centered on the diagnosis or the label. You know, we both know from the states that to get health insurance coverage you need the label for, for this to happen.

And one of the things is we found data that Labeling, there's almost no association with getting a diagnosis or even self labeling yourself with a mental disorder and improved outcomes. Actually quite the opposite when it comes to self labeling. So we actually found a study of hundreds of students in California in sixth grade.

They found the ones that had this self imposed mental health label and then two years later, if they dropped it, they had the largest increase in self esteem, which we know is a protective factor that will help kids. So I think there's a lot of labeling.

That's one of the issues that feels sort of counterintuitive because we've improved awareness, we've reduced stigma, all of these wonderful outcomes, but also we're still seeing the number of young people who are diagnosed, those rates going up. The other thing that we saw that really informed the way we approached this book was that many best selling books pick on one thing.

And so if we look at parenting books, Tiger mom was a bestseller and so was Free Range Kids. Two opposite ends of the parenting spectrum both landed in parents hands.

And so it has this idea of like, there's one way to look at this, but there's also another way to look at this.

So the big craze today is obviously social media and the phones and that there's this, you know, argument that this caused some sort of mental health crisis. And the data is not that neat. It doesn't warrant the kind of knee jerk government reactions that we're seeing around the world.

I mean, being in Australia at the moment, Australia had the fastest federal legislation to ban social media for kids under 16. So we're seeing knee jerk reactions to things that might be a bit more reactionary and also cause moral panics than what the data really indicate.

So something, there's something important going on with technology, but it also requires that we don't paint ourselves into a corner, that once we deal with the phone, all youth mental health will be solved and then it'll be another thing in no time.

So along those lines, then you describe the book as both a guide and as a kind of protest. What are you protesting against? And then, you know, what was the tipping point for you and your co author to decide to write this book?

The tipping point was we were at a conference in Norway where we've both been able to work, play and research. So we're very fortunate to get to go and have fun in such a wonderful place.

And we're sitting there at a conference, and we were just thinking, you know, there's more therapists than ever before. There's better access to telehealth than ever before. There's more medications are being used than ever before.

So much so we see antidepressant runoff in the fish that we eat. Like Australia has had a stimulant shortage this entire year. And so we're all of these things.

We have more parenting books, more how to do therapy books. I mean, we have more how to do therapy books than rocket science books.

So if that tells you of a field that inherently confuses itself a lot, you know. And so we sat there and we went, what are we really missing?

If outcomes just seem to continue to deteriorate, then what Nevin did was just start sitting down with experts. We leveraged our professional networks to talk to experts about a range of topics.

I believe he started with Dr. Gordon Neufeld, who is a co author with Dr. Gabor Watay of the book hold on to your kids.

When I watched the recording of that interview, I realized that because of our work and our, you know, our work and previous experience, we had connections to a lot of interesting people. And so talking to experts from a range of. From talking to my mentor, this is kind of a cheat code.

But talking to my mentor, Dr. Scott Miller, about psychotherapy outcomes, how does therapy really work? Where are we missing the point? How can parents help get the most out of therapy if they're going to send their kid to a therapist?

To talking to, you know, chief psychiatrist in Canada who talked about, you know, some of the discrimination that happens when mental health labels get put on a child's medical chart. To Dr. Martin broken leg, talking about indigenous child rearing practices. Outdoor play with Ellen Beat Hansen Sand Cedar.

She's the rough and tumble play expert in Scandinavia.

We talked to a range of people and more, and they're kind of the characters of the book, many of them quite towards the end, the tail end of their career. And so I think they were all in a place of going. I don't really have anything to lose to say what I really think.

And so I think where the protest came from is things like when surveyed, like 90% of therapists around the world say we've got ethical concerns about the dsm, you know, our book of disorders, and we've got concerns about the pharmaceutical Industry's undisclosed money going to disorders. But then we were like, so what are we all going to do about it? Are we just going to wait around for the experts to get us out of this mess?

Are we going to wait around for the tech companies to. To make this right for kids?

So the protest came find and that we're thinking about supporting and protecting youth, mental health, preserving the spirit of youth. That there are some times that many, a lot of us can come together and say, this is actually kind of ridiculous what's happening.

I mean, the state of Maryland, where I'm from, my county, had a, in the last two years, a ban of tag on the playground. Like, no teacher started working in elementary school. Passionate about teaching kids to read, write critically, think about things.

And I'd like to police tag during recess, you know, so I know that no adult is sitting there going, this. This makes a lot of sense. But somehow these sort of things keep happening.

So in many ways, it's a book about, hey, there might be some ways we're missing the mark. And if we kind of knew more than the headlines are saying, I think we can start being a bit less reactionary and more preventative with young people.

So on that note, then, what do you want parents to know about more so beyond the headlines that we all of us tend to read more now than ever because we're all scrolling through this stuff because so much information.

What do you want parents to be mindful of if they fear that their child may be suffering with some kind of a mental health condition that may be misconstrued as just being the developing child?

Yeah, I think the biggest takeaway is this.

This thing happens when we have a baby and you see this baby learning to crawl, and then it starts doing that thing where it pulls itself up and it's this huge adventure in walk. And there's virtually nothing a parent can do in this situation. It's all on the child's developmental clock. So this baby is learning to walk.

So what do you do? You block off the stairs. You cover up sharp corners of things.

And when your child falls, we have to sit with our own anxiety because your baby's going to look up at you and you have to be the one that goes, you're okay. So learning to walk is this learning to fail. And then eventually, barring disability or something else, you never think about walking ever again.

You've succeeded, and then it's then that developmental journey is over. None of us usually improve our ability to walk. You know, if we all had Walking coaches, it would be really hard, like improving your posture.

It's exhausting.

And so then in the teenage years, there's a whole different developmental journey where the brain is doing this synaptic pr, losing inconsequential information, but also draining some important stuff like how to speak clearly. And so your teenager gets home, how was your day at school?

You know, and the thing is, are they rude, obnoxious, challenging, annoying, up against the boundaries? All of those things can be true. Also a lot of those things are normal.

And so one thing that happens is we tend to start going, we start to have this disconnection where the kids, they want to be with their friends and have this peer oriented attachment. This is what Gabor Mate and Dr. Gordon Neufeld were writing about. But they still need that adult attachment.

So we still want to be that secure base, even though they look like mini adults, that they still need adults around them, but not really for interference. So less interference and more for increasing social connection.

So that was a big part of the book that many of the interventions, when we do become concerned about our child's mental health, they're often quite passive, even in the terminology. You know, if I follow this therapy manual or if I read this book or if I get the right medication, my child will change.

But what we know from a century of psychotherapy research is the child still needs to be engaged in some sort of process that we need to bring them into the therapy room so we can't treat them like neglected factors. They are the wild card of this working or not. And so I think that that was, that would be part of it.

And then the other side is pay a lot of attention to what we choose to notice. So I saw a rise in calling young people fragile.

And if we are walking around in this self fulfilling prophecy that the kids are more fragile than the kids from before and the kids before that and the kids before that. That's the kids these days affect. That's why we have the title of the book.

Socrates, you know, we're talking 400 BC complained about kids for being disrespectful and not well read and they don't know how to critically think. So that myth has gone on forever, but today we seem to be playing it out with the rising rates of medication, the rising rates of diagnosis.

And what I'm seeing is we're not really asking what's going right as often.

So if we could balance out that, yes, there's difficult stuff going on, if we could balance that out with what Do I not want to change about my child? We might be less reactionary about things.

And, and for instance I, I've talked about this where like in Australia during COVID like, like one of the most locked down countries and all the kids were told go home. You're digital natives, go to school online, be online, all your friends are online. You need digital literacy.

And it only took four years that the government says no online, do not be online. You. So this, this is inherently confusing and unpredictable to, to children growing up.

So that I think creates more anxiety than just the phone itself. So moving goalposts is confusing. So I think really the book is about how to be a secure adult for young people.

You talk about anxiety, anxiety, depression, self harm are all rising sharply among young people. We are living in a time where there's a global epidemic of youth mental health conditions.

From your research and clinical work, what do you attribute and what is driving these increases in your estimation?

Well, I think the biggest thing is it's simply social connection.

And there's some undertones of the book that it's kind of like there's some old ways and I don't mean old ways like uber conservative ideas, but there are some old ways that we used to live that we don't anymore. Like for instance, having other adults sleep over at our house and let your. This is all in Martin Seligman's the Optimistic Child.

Having other adults around so kids can really watch you play, watch you have fun with other people, watch how you communicate at the dinner table. So that's an important one. And social connection is I think the biggest one.

I mean for me one of the most alarming when we talk about an, an epidemic is how many young people will self report feeling lonely. And how can you be lonely when you spend 70% of the school year surrounded by other children and adults.

Like you're in an institution designed for you not to be lonely. And they're saying they're lonely.

So we're missing something really important here that a young person, you know, could be surrounded by a thousand people and feel invisible. So that part to me I think was the really deeply troubling part.

And then when it comes to, I mean I'm not a massive fan of the, of I think resilience promoting what that translates to is like just do hard stuff.

You know, we need kids chopping wood and I don't think that, but I think that sometimes we have over protected and it's become what we call in the book the safety trap that we've you know, kids aren't ranging as much. They don't leave, walk as far from home as they did before.

There's tons of different ways we've led to this, what we call an extinction of experience that they're, you know, we look at the data with teenagers, they're having sex less, they're drinking beer less.

And I'm not advocating everyone to just drink beer and have sex, but there's sort of some rites of passage things that are getting delayed and delayed and delayed which might make it more difficult to adapt to the adult world. And so there's some theorists who argue that all of us are stuck in a stage of adolescence. I think my entire family would agree with that about me.

But so I think that there, there are really important things that can contribute to this. I don't believe it's any one thing. One of the most alarming chapters in the book for some people is about the environmental health of children.

And so one of the we interviewed a environmental toxins researcher interested in lead poisoning, pesticides, herbicides. All of those link far more clearly to attention related issues to youth crime, to anxiety, to traits that look like symptoms of autism.

Yet they don't get the fanfare of social media. And we've known about this sort of these concerns in the environment for a really long time.

And it kind of feels like every time there's about to be a shift and a change, it's kind of like wiggling jello. It looks like it's about to change and then I too hard.

Let's just not worry about that Today, for instance, in the United States, the chemical atrazine used in agricultural practices linked to a range of issues as a endocrine disruptor, including higher rates of cancer, issues of sperm count, and these are all things we see on the headlines. It's been banned in the European Union for over 20 years and in North America still allowed.

And so there's aspects of that where sometimes it can feel like what's the latest? You know, social media is making all our kids anxious and it's like maybe.

But also there's a ton of things out there that can be there and that's too much for any one person to navigate.

So our book is not designed to scare the hell out of people, but it is about now how do we all make informed decisions about what's best for our child? And so we, Nevin and I are not people that like telling people what to do or shoulding on people.

So we are both people that said, you Know, here's, let's lay this out, and then you can make up your own mind. Because we as parents, I know this is my role as a therapist. Parents give up a lot of power to me when they drop their kid off and they're in my.

In my office. That's the same thing when we go to a psychiatrist, what medication and why, it's often all about who the worker is.

So it's a lot about equipping parents so they can make informed decisions about what's best for their family.

So not a telling you what to do, but the feedback we're getting so far is from parents and people like yourself is that they're saying, you know, I always kind of thought that, and then I didn't really think about it that way yet.

And so think like studies about, like, just having dinner as a family, like three times a week, I think reduces your chance of your child having some sort of substance use concern during their adolescence. And young adults, like, that's something, for the most part, is a really simple strategy. But, you know, every family has their own.

They know their family better than two knucklehead authors do. So we didn't want to tell people what to do, but we wanted them to be able to say, huh? I didn't think about it that way. That's interesting.

And that is exactly what we try to do with this podcast. So, yeah, everybody's got a different circumstance. Definitely.

You know, you're right that kids don't need constant guidance, but they do need presence. So what does healthy adult presence in the form of a parent look like, and what should parents be keeping in mind in that regard?

Well, one of the. I think there's a few mantras that we've. That we've put throughout the book that sprinkle throughout.

One of them is this comes from Outward Bound and Outdoor Stuff, because Nev and I are both outdoorsy people, is to treat. Treat young people like crew, not like passengers. So that means they inherently have something to contribute.

So when we ask them about their day, try to ask in an interesting way that you hear things also share about your day. You know, some young people have no idea what their parents day actually looks like.

And so I remember interviewing young people from my doctorate who had been to residential therapy all over the world, and the kids would say, you know, I really liked this intervention. You know, they treated me like a human. And I realized that that person wasn't human. So, you know, when.

When we were kids and you randomly bump into, like, your science Teacher at a grocery store. And you'd go, you're not supposed to leave this laboratory. Like, you. You have a life outside of this school.

Like, let's see if we can find a way to make that a bit less weird, that we go, oh, hi.

You know, and then they have other adults around as well, other people they can go to when maybe they're like, I need to ask a question about maybe something related to sex, and I don't want to talk to mom or dad. I need another adult I can ask a safe question to. So bringing in other adults as well. So treating youth as crew, not passengers.

And the other one is that young people really benefit from experiences of mastery. And I don't mean mastery in the sense of, like, just learning skills, but learning, starting to internalize how they did a good job at something.

Or I stood up for myself and talk with them about, how were you able to do that? What was that like? Let them create the meaning behind it, but they might need you to ask the questions that they can bounce off.

So we talk about, you know, I'm only a stone's throw from the Dulwich center where narrative therapy was born. It's like five minutes down the road. And narrative therapy talks a lot about externalizing the problem.

So sometimes when your child comes home and says, I am depressed. So they're using it almost like an identifier, right? I am attention deficit. I am this thing.

You know, when I had chickenpox as a kid, I never said, I am chickenpox. So there's an interesting use of language about. I mean, surveying.

There's a political survey that came out this year that 70% of young people think their mental health identifier is important to their identity. And I'm not saying what's important, what's not for any one person. But also, that can be limiting if it's not externalized.

So a simple technique we talk about is changing mental health language from an adjective to a noun. So how long has this depression been impacting you? And now it's something the young person is experiencing. It's not who they are.

So simple changes in language is there times that, you know, you can think of all the metaphors from Winnie the Pooh, hey, Eeyore, is there times this cloud that rains on you all the time is smaller? Is there times it's larger? And so they can start noticing maybe everything's not as global as I think it is.

So I think there's a lot of different things, but it inherently comes down to that young people aren't passive in this.

And I think in America, I know before we hit record, we said we wouldn't talk about this, but when we look at politics and both sides are saying, we're so divided, and I'm sitting there going, you all need to talk to each other.

We need to start hanging out, and we need to make this right, because then our kids are going to be divided, and then when they're divided, they're going to be painted into a corner where there might be something to learn from someone that sees the world a bit differently than you do. And that's okay, that it doesn't always have to be a fight.

And I think if we see young people that are scared to go out on the weekends, they're nervous about, you know, asking somebody on a date, nervous about what world there is to participate in. I see that as well. Maybe we've shown them that this world is really scary and there's people that won't agree with you or accept you.

And I think that's a little bit sensationalist that. I think most of us are in this messy middle of the road figuring it out for ourselves, and the polls are getting all the attention.

And so I think if we all came together, it would make a really big difference about the world that we're showing young people that they can participate in.

The book also talks about tolerance for discomfort as being something that's really critical for resilience.

That is a pain point for a lot of parents and a lot of households with respect to how can parents help their kids experience struggle without stepping in too quickly, which is certainly the default for most parents.

A good technique is when your child comes home upset, sad, just make your reaction like 10 to 20% less. And so if we react more, it'll make it a bigger. It will grow.

But at the same time, I think even though we have to, if something bad happens at school, we obviously have to protect our kids from harm. At the same time, we can all learn to let live a little bit.

I know for me, if friends are having babies and they come over, I hate watching a baby eat. I just go, oh, my gosh, are they choking? What's happening here? And I know that that's just me.

So I have to work on this is just my anxiety about this, you know, and then so we can start noticing, is this me? Is this going on inside of me? Or. Or am I really just, you know, or is this a warranted reaction?

The other thing about, like, CO regulation, we We've talked a lot about self regulation that we need to teach these techniques to kids. And I think the younger we do this, the more, the more action well the research is, the more harmful this is. We need to let kids feel emotions.

If they feel them, then they can feel through them and the intensity of them can start to decrease. So the five year old does need to feel big feelings.

So if we're going to teach mindfulness in schools at younger and younger ages, we need to be really mindful that we're not teaching it to regulate your emotions because that young person needs to be around adults where they can feel, feel the emotion and go, oh, this is just an emotion. So we don't need to teach how to feel feelings. They're a human, they will feel the feelings.

And so sometimes there's a bit too much interference when it comes to big feelings when we really actually want them. And so it's really hard. That's the challenge. I think that's how this, a lot of this has snowballed.

So there's no blaming of parents because just like, why am I anxious about watching a baby eat? Who the heck knows? But I just have to own my own stuff. But then co regulation. So I'm also a nervous fly.

I'm sounding like a train wreck here, but I'm a nervous flyer. So whenever there's turbulence, if I just sit in my own head and go, that's it, we're going down. This is terrible. Look at this, this is ridiculous.

Why'd I even get on this plane? But I could also just look at the flight attendant and go, okay, this is okay.

So then I can still be nervous, but I know I'll work myself up to getting worse where I can co regulate just with the flight attendant, you know. So being that secure grounded place for kids is really important.

You also write in kids these days that the kids aren't broken, but the system is. So what part of the system, Dr. Doba, do you believe urgently needs to change?

We, we have to get to a place where we revisit what really works in when we start. I'm going to just be the therapist here about what really works when it comes to the therapeutic interventions. Like I said, there's more.

For Freud, everything was about something else.

For the cognitive, behavioral people, everything's about your cognitive distortions so we continue to create these sort of myths about what's wrong with people and outcomes aren't improving. So we're falling for this story that what's wrong with kids is in between their ears. So we need more experts to help medicate.

You know, we've seen books coming out for the past few years about how the chemical imbalance is a myth. So we've done this over and over before. And so what I really think needs to happen is a revisiting of what works.

So when you talk to young people, you talk to any person who's gone to therapy and it's been good. What do they say? The relationship, relationship, relationship, relationship.

And within that relationship, maybe the therapist was confrontational, maybe they were really non judgmental and just like a mirror and didn't say anything. There's a million ways we can all work, but this notion that we have the answer is not working or we know what's wrong with people, it's not working.

So I think the biggest, when I talk about like this, passive interventions with kids, you know, around the world, the most common number of therapy sessions, when a person, person of all ages says I need to go to therapy, the most common number of sessions is one.

So it doesn't matter if I have doctor in front of my name, it doesn't matter if I'm trauma informed or evidence based or any of these things that I think are important. They might not come back after one session. So we have an engagement problem.

And so with youth, if we turned it from what's wrong with kids to how can we engage kids?

I think we'll really turn, we'll start looking at them differently and going, how can I get you engaged in a process where we're doing something together that is also tied with improving your mental health. So I think the medicalizing, the pathologizing, I have nothing against medication.

I'm only about what works and what works for who and not wasting people's time and things that are not working. So if we became a lot more pragmatic about outcomes, about what's working, we would see a shift away from quick knee jerk reactions, ban the phones.

And we'd see a, you know, speaking of, like when we do these quick reactions, we often see what are called regrettable substitutions. So in, in a county in Florida, in Orange County, Florida, that's where, I think that's where Disney World is.

School suspensions increased the first year after cell phone bans. So we all know suspending kids is not a good idea. It usually leads to more school disengagement.

And so we saw this uptick of and so it might level itself out. And maybe it was just the kids behavior reacting to not having phones.

But we need to be cautious of these quick fix attempts because they usually lump all teenagers into one bucket. And we know that no one's kid is any less unique than anybody else's.

Certainly lots of really important food for thought. Dr. Will Dobud, educator, Author, co author of Kids these Researchers, Social Worker Lecturer really appreciate your time and your perspective today.

Thank you so much.

Thank you so much for having me.

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