TikTok: Biggest Concerns for Children and Adolescents

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Q&A

With more than a third of TikTok’s daily users being under the age of 14, it is time to take a closer look at how this app is psychologically affecting youth. Psychiatric Times^TM sat down with Alan D. Blotcky, PhD, to talk all about his concerns.

Psychiatric Times (PT): You recently wrote an op-ed, “What’s TikTok doing to our kids? Concerns from a clinical psychologist,” for New York Daily News. In that article, you stated, “I have seen firsthand how TikTok’s appeal can turn to significant and potentially deadly mental health problems in our youth.”¹ Can you elaborate on what aspects of this app you are most worried about in relation to kids, perhaps more than other forms of social media?

Blotcky: Thank you for the opportunity to discuss TikTok. It is an astronomically popular platform for children, teenagers, and adults. My biggest concern about TikTok is that it recommends videos for kids that can be extreme, provocative, and even toxic. Such content can exacerbate a mental health problem for a child or teenager.

If, for example, a child is struggling with suicidal ideation, it would be harmful to be presented with video clips that demonstrate suicide or glorify suicidal behavior. If, for example, a teenager is grappling with an eating disorder, it would be harmful to be presented with video clips of self-induced vomiting or unreasonably strict diets. In a similar vein, I worry about conversations kids have on TikTok about their mental health concerns or problems. Kids with depression, for example, may be confronted with dismissive or sarcastic comments from others. They may be bullied or even encouraged to engage in suicidal behavior.

PT: TikTok, with its personal algorithm, tailors content to users’ interests. How do you start a conversation with kids and their parents/guardians about privacy and setting boundaries?

Blotcky: The answer to your question is contained in the question! Having an honest and open conversation with your child is the key. Warning them of the possible dangers on TikTok is vital, ranging from harmful content to bullying to dangerous “challenges” to lurking sexual predators. Parents must take responsibility for having these conversations, perhaps multiple times. Monitoring your child’s activities on TikTok is a must. At the same time, it is also important to highlight TikTok’s positive features, like its entertainment content.

PT: Instagram is often thought to have more toxic effects on young women than men. Do you believe TikTok is more harmful to girls or boys?

Blotcky: I tend to think that TikTok can be harmful to both boys and girls, depending on the particular situation.

PT: Let’s talk about #PainTok, the side of TikTok where suicide and self-harm are the topic of conversation.² Do you think mental health clinicians and the other members of the child’s care team should include questions about TikTok when screening for suicide risk?

Blotcky: Yes, for sure. I have a column coming out soon in USA Today where I give an example of a young teenager who was depressed and who was spending many hours at home each day on TikTok. TikTok did not cause this teen’s depression, but his obsession with it certainly exacerbated his ongoing sadness and withdrawal from others. In cases of depression, it is always important to ask questions about suicidal ideation and any specific plans. When I heard that this teenage boy was spending hour after hour on TikTok, I became increasingly concerned that TikTok content and conversations with others might be exacerbating his depression.

PT: According to a recent study, TikTok users take approximately 1 hour and 7 minutes to fall asleep after using the app, and spend only 14% of their sleep cycle in REM—almost half of the recommended amount for a healthy adult.³ Can you talk about why this is particularly detrimental to kids?

Blotcky: Sleep is very important to one’s mental health. Sufficient sleep, especially REM sleep, facilitates the brain’s processing of emotional information. During sleep, the brain works to evaluate and remember thoughts and memories, and it appears that a lack of sleep is especially harmful to the consolidation of positive emotional content. Poor sleep is linked to mental health problems such as anxiety and depression.

PT: One of the trends on TikTok is self-diagnosis, where teens and young adults are declaring they have conditions like attention-deficit/hyperactivity disorder, autism, Tourette syndrome, and more.^4,5 How is this harmful? Or could it potentially be helpful in lessening stigma around these disorders?

Blotcky: Misdiagnosis is harmful, in my opinion. Reading about a disorder on a social media platform does not mean you have the disorder. Being told you have a disorder by a stranger on social media is not a compelling reason to believe it. When it comes to mental health problems, children, teens, and adults need to be evaluated and treated by mental health practitioners. Unfortunately, some kids think they can be “treated” by peers on TikTok rather than seeing a psychologist, psychiatrist, or other mental health professional. And not getting treatment for a mental health disorder can potentially be life-threatening.

PT: The problems we are seeing with TikTok are not all that new. What about Tumblr? While that site is not as popular now, it had a similar popularity amongst teenagers, and it had similar issues with sexual and suicidal content.⁶ What would you recommend to the clinicians, parents, and guardians who are looking to talk to their child about social media and inappropriate content?

Blotcky: My advice is that parents and other adults should always have conversations with their kids about the possible problems on social media platforms. But more than conversations, parents should monitor their children’s activities on these sites. There is a way to monitor your child without being intrusive, unreasonable, or controlling.

PT: What do you think needs to be done to make TikTok a safer environment for young people?

Blotcky: TikTok needs to continue to monitor and regulate their content. They also need to make sure that predators are kept out as much as possible. All social media platforms, in my opinion, have a responsibility to protect children and teenagers. After all, kids do not have the cognitive ability and emotional maturity to extricate themselves from inappropriate or harmful situations on these sites.

PT: Finally, what advice would you give to any mental health clinicians talking to children and adolescents and their parents about social media?

Blotcky: My advice is that it is important to discuss the impact of social media platforms on children and teenagers with them and their parents. I find myself doing it more and more. Since social media have such a strong presence in the lives of our youth, it is imperative that mental health clinicians keep that in mind when evaluating and treating a child or teenager. To not ask about social media is a blind spot, in my view. We need to understand more fully why kids spend so many hours on certain platforms and how that activity impacts their mental health.

Dr Blotcky is a clinical and forensic psychologist in private practice in Birmingham, Alabama. His specialty is false allegations of abuse and parental alienation. He can be reached at alanblotcky@att.net.

References

1. Blotcky A. What’s TikTok doing to our kids? Concerns from a clinical psychologist. New York Daily News. November 18, 2021. Accessed March 15, 2022. https://www.nydailynews.com/opinion/ny-oped-whats-tiktok-doing-to-our-kids-20211118-32kx365w2ja6rhnoe2aoorkbpi-story.html

2. Byrne J. #Paintok: the bleak universe of suicide and self-harm videos TikTok serves young teens. New York Daily News. October 27, 2021. Accessed March 15, 2022. https://www.rawstory.com/paintok-tiktok/

3. Hayes A. TikTok is the worst app for disrupting your sleep, study finds. Men’s Health. January 5, 2022. Accessed March 15, 2022. https://www.menshealth.com/uk/health/a38672471/tiktok-worst-app-for-sleep-study/

4. Olsson R. TikTok and the dangers of self-diagnosing mental health disorders. Banner Health. November 2, 2021. Accessed March 15, 2022. https://www.bannerhealth.com/healthcareblog/advise-me/tiktok-self-diagnoses-on-the-rise-why-its-harmful

5. Kuntz L. Tourette’s or mass sociogenic illness? You decide. Psychiatric Times. September 23, 2021. Accessed March 15, 2022. https://www.psychiatrictimes.com/view/tourettes-or-mass-sociogenic-illness-you-decide

6. Ochs J. Is Tumblr bad for teens? LinkedIn. June 6, 2019. Accessed March 15, 2022. https://www.linkedin.com/pulse/tumblr-bad-teens-parent-teacher-guidevideo-josh-ochs/