Fresh Take: Dr. Stuart Slavin on The Pressures Causing Depression, Anxiety, and Burnout in Our Kids

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0:28hey everybody welcome to fresh take from what fresh hell this is amy today i am talking to dr stewart slavin he is a ucla trained pediatrician researcher and former associate dean for curriculum at thest louis university school of medicine today we'll be talking about his new book the success trap how the pressure to stand out is fueling anxiety depression and burnout in teens and the fundamental fix they deserve. Welcome, Stuart. Thank you so much, Amy. A pleasure to be here with you. So let's start our conversation with the moment you used to start your book, the moment you realized that what was being asked of your teenager was just objectively too much.

1:08Yeah, this is now a number of years ago. And my daughter, after picking her up from tennis practice at a really typically busy day in high school, she just kind of fell apart. And when I looked at her, I mean, she's tough, she's resilient, she still is. It just was very clear to me that the demands being placed on her, the pressure being placed on her by school, just to be clear, by school, not by either me or my wife, was just excessive. And I think it was particularly striking in context of the work I was doing at St. Louis University with our medical students and trying to kind of reduce stressors on them.

1:45So it was really kind of an aha moment that had been building for some time that really hit me. And her workload was an insane amount and also completely ordinary. Anybody listening who has a kid this age knows exactly what this moment was. Yeah, it's interesting because she was at, this was in St. Louis, and she was at what was viewed as the most progressive high school in the city. And I had the sense that if it was happening there, it was probably pretty widespread. spread. And I think it was more of a phenomenon that, you know, probably 15, 20 years ago was mostly on the coasts and really affluent communities and the really elite private schools.

2:25But research that I've done that I'm sure we'll get into, I think reveals that this has spread far and wide, not just geographically, but also kind of socioeconomically as well. You did your own research. You decided you were going to start talking to teenagers and see if you could quantify this. So tell us about what happened next. Yeah. So I laugh because it takes me back to a day where I was pretty unhappy with that aspect of the school. There's much I liked about what my daughter's schools were doing, but this load was really problematic. And I was a board member at this private school and tried to say, hey, this is just too much, folks.

3:03We need to reduce the demands, reduce the pressure. And unfortunately, no changes were made. And I kind of vowed at that point that like, no, I'm not going to let this drop. And I think it really was my pediatrician hat that said, like, this is kids' health that's at risk. And so that led me to ultimately do research in 18 high schools, one university, over 18 ,000 kids in three states across the country. And what did you find? Alarming numbers. We looked at depression and anxiety using very well-validated depression and anxiety screens. And some of these schools were, I mean, startling. One in California, More than 50 % had moderate to severe symptoms of depression, and 80 % had moderate to severe symptoms of anxiety.

3:5080%. So if you had a child in that school, and they had normal mental health or weren't suffering from a mental illness, they're an outlier. So just stunning kind of mental health. I think maybe on crossing any mental health outcomes that I would see. And the other thing that's really important, all of my research over the years related to well-being has been not to do the research. It's to try to understand kids' lives so that it can hopefully give us a sense of what do we need to target. You know, one of the things we looked at was their estimates of time of day, like how much time were they spending in different activities.

4:23And every single school I looked at, average of three hours per weeknight on homework and studying and an extra two hours on extracurricular. So after school, on average, five hours. But there were some kids seven, eight, nine, ten hours overall. all. And ultimately, the impact of that was they weren't getting enough sleep. And I don't know with your kids if this was an issue, but average, they reported every single school I looked at, six and a half hours of sleep per night. And if parents listening aren't sure of the guidelines, teenagers, high school students recommended is eight to 10 hours.

4:57So this is a huge sleep deficit. So those were some of the kind of core pieces of what I found. And the last that we can get into if you want, is I asked them to rate stressors, like how important various stressors were in their life. I have that list in front of me because I found it so interesting. So when kids rank their stressors, what they said they found stressful and what they didn't mention is just as illuminating. So tell us about some of the stressors. Yeah, I actually was pretty surprised. I mean, I knew school and academics were a big pressure point for them. And we asked about a whole range of stressors, you know, school, extracurricular, pressure from various people like coaches or teachers, parents, et cetera, but also kind of social stuff, bullying, cyberbullying, problems with boyfriend, girlfriend, loneliness, those kind of things.

5:44And this is, I think, again, striking. Top 12 in every single school I looked at were school or achievement related. Maybe one of the things that worried me the most, or which was really, I think, has important implications. First was pressure from parents was significant. That was in the top 12. But pressure to not disappoint parents was ranked even higher. So even when you're not putting on the direct pressure, they kind of know like what your values are and they want to please you. They want to make you happy. But the thing that was always in the top one or two was pressure from self. So, you know, on this long kind of K-12 educational pipeline that they're going through, This relentless pressure that they get from all sorts of sources is ultimately internalized.

6:29And then they become so tough on themselves, so many, and especially girls. I think this is important to unpack because so often, so many problems out there. It's like parents need to get those phones away from those kids. It's just put back on the parents. I think that this achievement culture, which anybody who has a kid this age sees and is dismayed by, the fix is parents are too much. Parents need to relax. Parents need to chill out. And I felt like, okay, but I'm doing that. And they're still coming home crying. And there's still that the pressure is everywhere. It's not just me with unreasonable expectations of A's.

7:09No question. And I think you're absolutely right that people have been quick to point the pressure. And we tend to say, oh, these helicopter parents or these snowplow parents, et cetera, et cetera. I think those are actually in a small minority these parents. Their impact is kind of exaggerated because they're kind of caricatures of these people. But no, I don't think most parents are like that. I think it is. It's like in the air they breathe, the culture. And I think one of the hardest parts for me as a parent, thinking back to my two daughters as we went through it, I really felt kind of unable to really protect them from it in the way that I wanted to.

7:43I guess last thing I'll say about this, and one of the things I hope, I mean, my book, I think, gives people, parents, some ideas about how not to add to the pressure, how to keep them safe, how to protect them, how to work with them with this kind of negative self-talk that so many kids are so hard on themselves these days. But the other piece is ultimately, I think we need to change schools and the demands and pressure. There's a superintendent who I got to know, and one of the things he said to me is schools are simply a reflection of what the community wants. Ideally, what I hope this book does is get enough parents to question, do we really want this for our kids or not?

8:25So I think for me, the most important thing I'll say also about the book is we need a conversation. Yes. It feels like we're so fixated on screens and social media and phones, and we should be. I'm deeply concerned. But we are never, ever going to solve this adolescent mental health crisis unless we look at, I think, in many, many communities across this country, this enormous pressure and demands that our kids are facing today. I thought that that was really insightful and differential about this book, because we've talked a lot on this show about the depression and anxiety among teens. I think smartphones are a big part of that.

9:02But this book really is like, yeah, but so is achievement culture. It can be a both end. And that's, I think, an interesting thing in this debate. I see too much of no, you're wrong. It's this. No, like life is complex. Inputs in terms of mental health, multifactorial. So I think we need a more expansive view of our kids' lives. And frankly, spend a little less time kind of blaming them. Right. Right. It's like if you just get off your phone, everything would be fine. And I don't know if there's another group in our population we do that to. You know, we know there's a mental health crisis in physicians and nurses.

9:37Nobody's looking at them and saying, oh, get off your phone and that'll solve it. Right. Stop being so lazy. This is an environmental problem and we need to get at the root causes. One of our guests that we had, I can't remember who it was, suggested that the phones that what the issue might be is what they're the delivery system for. And I think that dovetails very nicely with your suggestion that achievement culture is a big problem. The phones are such a delivery system for achievement culture. No question it is. Those two intersect in significant ways. And the obvious ones, you know, the kid on posting videos of them opening the email, whether they got into Harvard.

10:14And I even heard from some kids about where kids are posting on social media. I'm so disappointed. I only got a 94 on this exam. Well, how do you think the kid who got a 78 is feeling? So there's an intersection there that I think is really significant. And it's in the data. You have charts in the book where you overlay the increase in the hockey stick increase in depression and anxiety, and you overlay it with things like the number of common applications each student is applying with skyrocketing. Yeah. Which means also the number of rejections, as you point out. If you're applying to 15 schools, you're probably not getting into 13 of them.

10:51The number of AP tests taken per student and correlation is not causation, but this stuff is ramping up and so is the mental health distress. Absolutely. And I think that's one of the things when we look at what, you know, these cultural changes, these big changes, I think one of the arguments that it has to be screens and phones is the argument that, oh, that's the only shift in years that has caused this. And I think in the book, I provide really good evidence. No, there are other profound shifts related to a lot of it's ultimately pursuit of college. And I guess what I have to say, it's really important, Amy, is to say, like, I have compassion for parents.

11:28You know, as a pediatrician, I always felt like the vast majority of parents are doing what they think is in the best interest of their child. And they look at this kind of economic landscape in this country. And I think people feel understandably a great deal of pressure to try to launch their kids into the successful future. And one of the things I'm seeing is I wrote this book, actually, it was primarily initially for parents of teenagers. But what I am talking to more and more people, I realized, oh, no, these pressures start early. I mean, people are thinking about what preschool can I get my kid into that will launch them into the best kindergarten through six and on and on and on.

12:07And then this other aspect that we're seeing is what's called intensive parenting, where these kids, like so much is being poured into their enrichment and development that they don't have time just to be kids, just to play and have downtime. So, yeah, I think these issues are really profound. And it's one that parents, I think, need to start thinking about earlier and earlier, unfortunately. I'm talking to Dr. Stuart Slavin. His new book is called The Success Trap, and we'll be right back. Let me tell you, summertime is when you realize just how dehydrated your skin really is. That's why Osea's Hyaluronic Body Serum has been amazing for me to use this summer.

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16:09orders over$65. The styles sell out, so don't sit on it. That's Z-E-N-N-I dot com slash podcast promo code podcast 15. So, Stuart, you have in the book three domains that contribute to distress and struggle, as you were saying, of the high school junior taking seven AP classes and also to the eight-year-old who's playing double baseball three nights a week and the distress and struggle. So let's talk about the three domains and how each of them sort of contribute to the pressure. Yeah, I think the main driver is this issue of just the sheer demands. And again, I think people need to really understand sleep isn't just a luxury.

16:47It's food for the brain. And so, again, if you have a child who has a chronic sleep deficit of, you know, two, three hours a night, it's going to leave them cognitively impaired, emotionally impaired, and at greater risk for depression and anxiety. So, I mean, one of the things I think that my work at St. Louis U that maybe we'll have a chance to talk about, one of the most important things we did with medical students was simply reduce the demands. And that was huge in terms of their mental health. And we have this belief, I think, that more is always better. If one hour homework is good, then imagine how much they would learn if we gave three or four.

17:25Right. And it actually turns out that there's probably no human endeavor where that's the case. at a certain point, if you actually add more and more and more, performance actually levels off and then it declines. And so counterintuitively, I think this is an important point that I make in the book. If you back off, mental health may improve, but actually achievement can improve as well. It's crucial. I feel like it's the most important point of the book because we feel like, I know it's terrible. They're sleeping five hours a night, but what are you going to do? They need to get into a good school that you have to do it this way or else they won't be successful.

17:58No question. And the credibility, I'll just add a little more detail from the experience at St. Louis University. So we cut back on coursework, reduced the amount of time they spent in class by 10%, freed up time for them to engage in like research or mentorship or tutoring or whatever they wanted to do, give them some sense of meaning and work. And we saw dramatic decreases in depression and anxiety, really unprecedented. ended. But ultimately, they reported spending an hour and a half to two hours less in class or studying compared to the average medical student. And the performance on the national board exam, the big exam at the end of the second year, it didn't fall.

18:37It increased and the failure rate was cut in half. So depression and anxiety and sleep deprivation are not good for academic performance. So hopefully I can find a school that's willing to let's try it. Let's cut back and see what happens. It's a scary thing to do, but I think it's something that we really need to try. So that's pillar one. Pillar two or domain two, you know, it's not just the short-term impact on kids of those demands. As I alluded to before, they start internalizing this pressure and they develop these, I think what I would describe as self-critical mindsets. The one that I've been most interested in is maladaptive perfectionism, setting the bar so high for yourself, you're repeatedly disappointed in yourself.

19:21And there's profound evidence, not only that that has been on the rise for more than 35 years, but that pace is accelerating. And so this negative self-talk is extraordinary. One other I'll give you as well, or there are like five or six that I have in the book, but performance as identity. I don't know if your kid suffered from this. It's the experience of getting a disappointing grade. And rather than saying, I got this grade, it's I am this grade, especially SATs and ACTs. You know, it's a measure of my self-worth as a human being. Very different impact on mental health and well-being if you are not performing perfectly and you think it's who you are rather than what you're doing.

20:01I think that that plays out in the early decision landscape. So distressingly that we try to give our kids a sense of abundance that they can go to many, many schools, which is definitely the case. Yeah. But then they pick just one and they commit to just that one. And then, as you say, on December 10th, there's videos of kids getting into the school and that school. And the idea that you have to film that for public consumption. Back in my day, you applied to a bunch of schools and you forgot about it till April 1st. Now it's like, here's your first choice. Do they like you back or not? It's very pressure filled.

20:35And of course, that would affect your identity if you get in and if you don't. No question. I hadn't thought about that kind of early decision as really contributing to it. I do get this sense of kids increasingly having a dream school, a dream school. There were a young woman who was interviewed by a San Francisco newspaper and asked her, you know, what would happen. She said Stanford was her first choice. What would happen if she didn't get into Stanford? And her answer was striking. She said, I'll never be happy. I'll never be happy. So there's this wildness when you think about these narrow goals.

21:11And I think a place like Stanford and Harvard, it's down to 3%, you know, get in. And then half of those are like legacies and athletes. So putting all of your eggs in one basket is another thing I think that parents can try to move their kids away from this idea that there's one best place and that if they don't get in there, their life will be forever compromised. And I think the book really gives them some tools how to have that conversation and also make sure they're not the ones who are kind of contributing to that hyper-focus on, I have to go here. Right. We have to acknowledge that sometimes our own mental models are, we're a Princeton family or whatever.

21:50Even when you aren't a Princeton family, you know how you talk about other people's success? Like, oh, wow, they got into such and such a place. And all of a sudden, the pressure to not disappoint parents, that comes in. Oh, parents care about that outcome. They light up when they hear somebody's going to med school or law school or things like that. So even that, I think we have to be a little careful about what we kind of value and what we applaud in our daily lives. Okay. And then the third pillar is this lack of control that teenagers feel that they have over their own lives. Yeah. Lack of control and lack of meaning.

22:24I'll start this answer by something that hit me as we were talking earlier, that the approach to the phones and screens is, I think, an interesting one, which is like, no, don't use them and we'll confiscate them. That kind of thing. It's understandable, but it's inadequate. I think what we also have to do is recognize that in a lot of ways, their virtual life is more attractive now than their real life. Real life is just a series of exams and demands and that they have often little to no choice in what they're learning, how they're learning and they're driven understandably by pursuit of these kind of extrinsic measures of worth, right?

23:08Grades and scores rather than finding kind of intrinsic motivation of finding something you love. So I would love to see us work not just on the side of like banning phones or limiting phones, but what can we do that actually makes kids' lives more appealing. And one that's absolutely critical is finding ways to give them more choice. I mean, they're so programmed earlier and earlier in life. I mean, you alluded to this earlier, club sports has ramped out of control. The idea of just a bunch of kids hanging out and just playing baseball, you know, throwing a baseball around in the park, it feels like it's disappeared.

23:48That's another really important one that I think parents can have a big impact on as well. That lack of time for in-person connection, I'm thinking about my kids having studied over FaceTime, you know, one o 'clock in the morning and three of us are studying for this history test over FaceTime together. That is their personal connection on their phone. It is. I mean, there's an enormous human drive to have connection with people. And with those, you know, average five hours or even more of demands after school, we've crowded out time for kids just to be together and hang. And I think ultimately that's a huge problem and kind of not just their mental health, but their social development in some ways, too.

24:30Just learning how to be together and work out conflict and be off your screens and really present with each other. My parents went to high school together and in their high school yearbook is a picture of them like hanging out of the soda shop after school. I mean, it's straight out of Hairspray. It's so great. And it wasn't that long ago. No. And you would just go to the soda shop and everybody was there and you'd do a little limbo at the dance where you go into the pool. Yeah, yeah. They limbo into the pool. You know, they'd order a soda. I don't know. They'd be there all night and that's what you did.

24:59And everybody was there and nobody was worried about their fourth round of SAT prep in the morning. So true. So true. We've lost something. I mean, we're stealing childhood, I think, in many ways. And I think parents have been looking at this. And I feel many of them realize life is out of balance. But I think they don't think there's another choice. Like if they back off or reduce those activities or aren't getting tutors and test prep people to help them, that they're compromising their kid and their success in the future. And I'm kind of, I hope, giving them permission to think about another path.