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May 16, 2024 Helping Children Thrive: A Conversation With Dr. Linda C. Mayes

“Children are just suffering more,” says Dr. Linda C. Mayes, director of the Yale Child Study Center. A pediatrician by training, Dr. Mayes specializes in child and adolescent psychiatry. Like other health care professionals, she is sounding the alarm about the rise in anxiety and depression in young people. In this episode, Dr. Mayes talks with host Suzanne McCabe about the reasons for this disturbing trend and explores how we, as a society, can address the challenges our children are facing.

Dr. Mayes is also the Arnold Gesell Professor of Child Psychiatry, Pediatrics, and Psychology at the Yale Child Study Center and Special Advisor to the Dean at the Yale School of Medicine. She heads the Child Study Center–Scholastic Collaborative, which arose from a shared commitment to exploring how literacy can be used to foster resilience among children and families.

→ Resources

New Mental Health Resource From Scholastic: Check out our new online hub of books and curated, free resources fostering emotional health with insights from leading child development experts.

Meet Dr. Linda C. Mayes: The director of the Yale Child Study Center, Dr. Mayes is an expert in developmental psychology, pediatrics, and child psychiatry literature.

Kids & Family Reading Report: There’s lots to explore in Scholastic’s biennial national survey of parents’ and children’s reading attitudes and behaviors.

Reach Out and Read: Learn how the nonprofit organization partners with pediatric care providers to help families make reading a part of their routines.

→ The Conversation

What trends are you seeing at the Yale Child Study Center in terms of children’s mental health? What types of emotional and behavioral disorders are kids presenting?

At the Child Study Center here in New Haven, what we’re seeing is no different than what’s being seen across the country and around the world. The increase in mental health needs among children and adolescents often is framed as a post-COVID phenomenon. But over the past few years, there’s been a steady increase in children’s mental health needs—depression, suicidality, anxiety, increased feelings of stress—that speaks to an overall stress among children and families.

COVID and the pandemic added to the mental health crisis. The pandemic also highlighted some of the fragilities in our healthcare system. One might think in the same way, that the pandemic highlighted the mental health needs and vulnerabilities of our youngest citizens, and that we’re seeing an increased volume is important to know. We’re also seeing an increase in severity. Children are just suffering more, and we’re seeing children thinking about suicide at an earlier age. We’re seeing more eating disorders starting at an earlier age.

Our children’s distress is also an expression of the increasing distress and fragmentation of our society. Children, in a sense, are like the canaries in the coal mine. They’re experiencing the distress, the increased lack of civility, the increased fragmentation.

The lack of civility and lack of empathy among adults is striking. Where did that come from?

I think there are multiple causes. We’ve had an economically stressed society. We have the stresses of the pandemic. We have a politically divided society now. Whatever side of the aisle you’re on, to use that metaphor, it’s very hard to cross the aisle. We’ve lost the ability to have a conversation where you see the other person as an individual who may or may not agree with you, but who is still an individual worthy of respect. How to do that is a fundamental skill. It’s the glue that holds society together. When children see and feel and experience that kind of fracturing, it’s not good for their—or anyone’s—mental health.

What signs should parents and educators look for if they think a child needs clinical intervention?

When children are just not themselves, when they’ve changed, when they might have been the outgoing, playful, always-helping child who now is quiet, maybe even a little bit irritable, when there’s a real change in who they are in their presentation. Typically, people talk about when grades start to go down. That’s another indicator. When kids start to lose their enjoyment for the things they dearly loved. If they love to read, for example, but they stop reading. Or they love to play with friends, but now they just want to stay in the house. Those kinds of changes in behavior are important to notice. It’s not always the child who’s sad and withdrawn. It can be the child who suddenly is acting out or the child who is now afraid of a whole number of things. Those kinds of changes, and especially parents who know their children well, when they see that they’re just not themselves, that’s what to pay attention to.

If a child is withdrawn, they may not want to speak. Are there ways to spur conversation without asking repeated questions?

One of the most important ways is to be present. Sometimes, it may be taking a walk, or reading a book together, or just doing something together. Silence can be quite deafening. In our busy lives, families don’t often have those moments, those dinner-together moments, or those quiet walk-after-dinner together moments, or those times just sitting on the steps and talking. Those are the kinds of moments that bring people together. A child may not start talking right then. They may need to have a bit of quiet reassurance that, yes, somebody is going to be there, and they’re going to be listening.

Many areas in the U.S. have a shortage of mental health professionals. What is being done to make treatment more accessible and more effective?

There’s a shortage of healthcare professionals broadly, and there’s a shortage of healthcare professionals around children’s needs broadly. That includes physicians, pediatricians, psychologists, and social workers, because mental health for children is delivered not just by one profession.

Before addressing what is being done and what can be done, we need to ask the question of why. Why is there a shortage of healthcare providers, especially post-COVID, but why is there especially a shortage of mental health providers? There are a few reasons that we, as a society, need to look at very deeply. One of them is how we think about mental health. We often think about it as “the other,” that it’s not a part of overall health, that it’s not a part of physical health. The division between physical and mental health is an artificial one. They go together.

Another why is the stigma about mental health. As much as we’ve tried to work on it, it’s still alive and well in this country. It still impacts policy and decisions that people make about going into the field. It affects how we reimburse and support mental health, especially children’s mental health. Generally, children’s health is reimbursed less. By reimbursement, I mean by commercial payers and the individuals or institutions that pay for care. Then you take children’s mental health care and it’s not on par with other kinds of care. It’s very hard [for a health care professional] to make a wage that would support themselves and their family after years of training. So, we have a reimbursement structure that also perpetuates the bias.

As a country, we need to put that front and center because the other things we can do to improve access or care will be great and are great. During the pandemic, we learned a lot about the delivery of telehealth. We learned how to deliver mental health care across virtual platforms, making it available to children and families across state lines, from rural to urban, extending the capacity of a clinician in an urban area. We still need to increase broadband access in rural areas, and states need to work together so that clinicians can deliver care across state lines.

We’ve also learned that some children need just a few sessions with a mental health care provider. Some even respond to one or two sessions. Thinking more creatively about how we deliver services across telehealth platforms will improve access dramatically. We’re in a revolutionary time for mental health care for kids.

Can you describe the mechanisms by which literacy can lead to improved physical and mental health outcomes?

How does literacy impact health? It opens the world. You learn what a variety of people do. You also learn about your body. You learn how it works, what’s good and not good. Reading—including storytelling—is stress-relieving. Reading has dropped blood pressure to a healthy level in some studies. It’s what we call emotionally organizing.

Reading also brings people together. If you’ve read a good book, you tell a friend about it, and soon the two of you are talking about that book. The same is true if a child brings you a book and wants you to read it. Reading builds interpersonal links between parent and child or teacher and child. It’s a very strong glue for building relationships. And we know from research that relationships and social connectedness have as strong an impact on health as good nutrition and not smoking, for example.

So, it’s through those areas, and then another, what we would call a meta or proxy variable: If you’re more literate, you’re more educated. If you’re more educated, you know how to access health resources better. You make better choices. Yet we have two systems—our healthcare system and our educational system. The two don’t always work together. What’s good for kids in this country is to bring health and education together.

There’s a significant finding in Scholastic’s latest Kids & Family Reading Report that reinforces this notion. Kids who read more reported better mental health overall, with fewer occurrences of anxiety, depression, and loneliness.

Yes, and that’s a very important finding. As a researcher, though, I need to warn that it’s associative and not necessarily causal. It may be that children who have better mental health read more and by reading more, they feel better.

The report also found that 41% of students get most of their books at school, which highlights the importance of teacher curation and accessibility. Are you and other experts seeing adverse effects on children due to book banning?

I deeply worry for our society because of book banning. In my world, the medical world, we talk about symptoms that are the danger signs of something more serious. A very high fever, for example, or very high blood pressure, or a very low white blood cell count, indicates that something serious is going on in that individual. I see book banning as one of those indicators of something serious going on in our society, what we talked about earlier, the fractionated society.

I can certainly talk about book banning and children, but I think we also need to think about what it says diagnostically about our social fabric. That said, there are no empirical studies about book banning that I know of, but it’s just common sense. You don’t limit a child’s curiosity. You don’t say to them, “You shouldn’t read this. This book has principles that aren’t good for you.” Let them read it and have an open discussion. Let them watch a television program, watch it with them, and have an open discussion. When you ban a book, you’re saying that certain forms of knowledge and experience are off-limits. That is just fundamentally against learning, building curiosity, building an ability to engage with the world in any way.

I do realize that my stance is from a particularly liberal point of view. I’m very aware of that. At the same time, I know what’s good for children and I know what’s good for children’s learning, and I know that inhibiting or prohibiting pathways to learning in any way is not good for children’s cognitive development.

What measures among key stakeholders are being taken to improve literacy outcomes for children, even starting with preschoolers?

I would say even starting with infancy and prenatally. I think one of the fundamental messages, if you want to go back even further, is that talking, storytelling, building relationships, using words, is a fundamental literacy skill. So, a mom or a couple who are pregnant: Talk to the baby inside the mom’s tummy. Build up a repertoire of stories, and when that baby comes, you’ll have the repertoire of stories. When you have your infant in your arms, talk to them about the world around them. Tell them stories about yourself. Tell them stories about what just happened during the day. Tell them about the sun and the rain outside. You’re building literacy when you do that. Literacy doesn’t have to just be by books, by just using words and creating a narrative.

That said, while we certainly need more pediatricians in this country, and more access to children’s special healthcare, we miss an opportunity in the healthcare world, and this gets back to bringing education and health together. We miss an opportunity to not use pediatricians even more than Reach Out and Read already does. We should use pediatricians as the conduit for literacy and the conduit for books because pediatricians are the individuals or healthcare professionals are the individuals that children see before they are of school age.

But it’s not just putting books in children’s hands, it’s also having adults know how to use those books. It’s not just reading the words, but helping the child think about what else could have happened in a story. The blue bear did this with his friend, the goose, but what else could bear have done? Or what was goose thinking about? Why do you think goose did that? To really help children expand that narrative and to engage with them around building out the story, not just literally reading the story. In doing that, you’re encouraging their imagination. The most fundamental way to build literacy is to build narrative and storytelling.

Many teachers are encountering not just mental and emotional challenges among students, but also behavioral issues to an extent they haven’t seen before. What advice do you have for educators who are feeling overwhelmed and don’t have the resources to address this rise in students’ mental health needs?

There are three things I would say to teachers. One is that, besides parents, you have the hardest and most responsible job in our society. You’re taking care of and launching our next generation. I deeply appreciate not only the work that all teachers do, but also the stress that teachers are under and the burdens they feel.

I also would say is that if you can hold in mind, and it’s incredibly hard to do, when a child is melting down in front of you or angrily yelling or out of control, that all behavior is a communication, and then take just a little space inside yourself to wonder what is this child trying to tell me? What are they trying to say with this behavior? Maybe the child won’t know, but you’ll know that they’re communicating something through their behavior. Maybe they’re trying to say that they’re scared. Maybe they’re trying to say that they’re exhausted. Maybe they’re trying to say that they need you or they need someone more, but they’re trying to say something. It’s a really hard thing to do in the moment, but it’s extraordinarily important.

Behavioral disruptions are happening across the country at all ages. It’s not just kids in classrooms. We’re seeing adults lose it in various settings. When children cause behavioral disruptions, the preschool phrase is often, “Use your words.” Preschool teachers know that if you can get the behavior into words, you can help.

The third thing I would offer to teachers is, if you can, have a peer or someone else you can talk to. You have your own mental health needs that shouldn’t go unheard.

Guns are now the leading cause of death among children and teens. Do we know the psychological and social impact of community violence, mass shootings, and even active shooter drills in schools?

I have many colleagues who think a lot about this and who are much more expert in it than I. For example, here at the Child Study Center, we have our Child Development-Community Policing Program. My colleagues Steven Marans and Carrie Epstein and the rest of their team, Megan Goslin, are often called to consult and help teachers, and they do that in such a clinically skilled and sensitive way.

We have an enormous availability of guns in this country and a history of guns being used to express a range of distress and feelings. The corollary is that it has happened so often, we’re numbed by it. A staggering number of mass shootings have happened in this country, defined as four or more injured. Some of them don’t even make the news at this point.

What’s the effect on children? Broadly, school is no longer as safe a place as it once was. What do active shooter drills do? As a researcher, I would want to know more about that, but I’m guessing it makes children more scared. I’m guessing it raises the anxiety level of teachers, too. Whether they’re effective for that event, may it never happen, is another question. I’ve often heard people compare active shooter drills to back when the threat of nuclear war began. Schools had drills, and kids were asked to get under their desks. If you look back on it, it looks kind of crazy.

My worry about active shooter drills is, not just are they effective, not just do they raise teachers’ anxiety and children’s anxiety, but my worry is that we may be putting our attention in the wrong place. We’re putting our attention on the possibility that this terrible thing might happen. Really, our attention should be on why? Why is it happening more frequently? Why is it that we can’t look at the harsh truth of the availability of guns? Why can we not look at other societies experiencing the same broad global stress that don’t have these kinds of mass shootings? Ask those questions.

Researchers at the Yale Child Study Center-Scholastic Collaborative have identified altruism as a hallmark of resilience. How can altruism play a role in helping children and communities emerge stronger after a traumatic event?

It’s not just us. There’s a large body of work about altruism across several settings, altruism and prisoner of war situations, altruism during natural disasters. Altruism is a fundamentally human capacity. We also see it in some non-human primates, as well. It’s the ability to reach outside of yourself and think about the needs of others, to make some sacrifice of yourself in order to help someone else.

So, for example, in the darkest of situations, like in a prisoner of war situation, when you take your food ration and give it to the person next to you who you know is starving, although you yourself don’t have much. It’s the ability to reach out and make a connection to someone else, thinking outside yourself about someone else’s needs. You see it all the time in this country. When there’s a tragedy, you see people coming together in the most remarkably altruistic ways: firemen risking their own lives to bring a family to safety, families who have almost nothing bringing everything they have to the neighbor down the street whose house was wiped out by a tornado. It’s a basic human. We survive because we are a community.

So, what can we do more of? Talk about altruism. Highlight it. Altruism is good for your health. It’s a very ironic message, that by sacrificing yourself for someone else, you also are doing something good for yourself. You’re improving your own health and your own likelihood of a healthy outcome. But you don’t do it for that reason. You do it because of the basic human need to create community.

→ Special Thanks

Producer: Maxine Osa

Sound engineer: Daniel Jordan

Music composer: Lucas Elliot Eberl

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