The short version

In 1998, Reykjavík had a real crisis. Forty-two percent of the city’s 15-year-olds said they’d been drunk in the past 30 days. The national government, the association of local authorities, and the City of Reykjavík responded by building what’s now called the Icelandic Prevention Model: evidence-based, run at the community level rather than the individual level, and kept honest by constant dialogue between researchers, policymakers, and the people actually working with kids.

The mechanism inside that model that’s easiest to copy is the Frístundakort, the Leisure Card.

Starting in 2007, Reykjavík began giving every child aged 6 to 18 an annual credit, now about 50,000 krónur, or 350 euros, redeemable only against registration fees at an approved club: sports, music, dance, youth organizations, more than 200 of them citywide. Not cash. It’s a voucher inside a municipal registry.

By 2018, the drunk-in-the-past-30-days number was down to 7 percent. Daily smoking was down to 2 percent.

Roughly 81 to 82 percent of Reykjavík’s teenagers now participate in some organized activity.

The beauty of the Recreation Card is 3 fold.

First, you create a mechanism to “call the question” with each kid: which activities will you pick, rather than will you pick any activities? If a teen declines, they’re both rejecting the behavior of all their friends (themselves using the Rec Card), and they’re wasting an obvious resource (the Rec Card is individually for them).

Second, you subsidize Demand, not Supply. (Well in Iceland they use the Consumption data to help improve the subsidies to Supply as well). We have so much building of extracurricular slots that nobody shows up to, because in USA, if we invest at all, it’s in the Rec Departments and nonprofits, irrespective of their skill or failure to pull kids off the couch.

Third, it’s like Social Security versus Welfare - a public good that goes to everyone instead of getting means tested. The benefit is everyone participates and you can build a Quality culture around it.

Inga Dóra Sigfúsdóttir is a sociologist who has been part of this effort from the beginning.

A fuller picture of the Iceland story is here.

Breakfast with Inga and her husband was delicious and interesting throughout.

Edited for length and clarity.

Mike: Take us back decades to the Iceland drinking problem. What did you try first that turned out not to work?

Inga: The obvious thing. Educating kids about the negative effects of substance use. Teaching them to say no. It sounds sensible, and it’s what Nancy Reagan told the whole world to do. When we actually tested it, it turned out that just teaching teenagers about the risks and mechanics of substance use could make them more curious about it, not less.

So we went a different direction. Instead of trying to change what’s in an individual kid’s head, we focus on changing the environment around them, and their behavior changes as a result.

Mike: So what does change the environment?

Inga: Three things inside the family: emotional support, positive monitoring, meaning you know where your kid is on a Saturday night and you know their friends, ideally their friends’ parents too, and then just the raw quantity of time spent with your teenager.

Not quality time. Quantity. You don’t have to be taking them to museums. Just be at their soccer game.

And then outside the family, participation in organized activity, sports or otherwise, it doesn’t much matter which, is a protective factor almost regardless of what the activity is.

Mike: Some American parents will agree with your description of what family should do, but despair. That is, they TRY to spend time, but the teen retreats to the bedroom. Imagine a 16-year-old boy, out of school, mostly on screens, whose parents have offered him everything, a new sport, a club, and he turns all of it down. What would you tell that family?

Inga: This is genuinely one of the hard ones, and we’re seeing more of it. What I’ve learned from research and from practice is: invest in the friend group, not the kid directly. Get to know his friends, and try to involve them in lifting up the teen. If the idea comes from a friend instead of a parent, it lands completely differently. Every teenager goes through a stage where anything a parent suggests sounds lame by definition. But if something fun is happening in the community and his friends are already there, he might think, maybe I should try this too.

Mike: How granular is your data? In the U.S. we track school outcomes town by town, and it creates real competition between states to improve. Do you have anything like that for teen wellbeing?

Inga: Very much so. It’s population-based. Each town is a cohort of roughly 4,000 teenagers, and we survey every community in Iceland every year. When we started in 1997, not every community wanted to take part. That gave us an accidental natural experiment: we could compare the towns that joined early to the ones that waited. The early joiners did better. And once the holdouts saw that, the competitive instinct kicked in on its own. Nobody wants to be the town whose kids are falling behind.

Mike: We’ve proposed precisely the same teen data gathering in the USA. That we need a NAEP like national assessment that tracks teen behavior 3pm to 3am, precisely to catalyze the competition you describe. Here NAEP gets governors to compete with education policy. But they don’t compete on Teen Flourishing.

In Iceland you have towns competing to get their teens more active. That’s awesome. Has the core data collection changed much since 1997?

Inga: The core stays the same: relationships with parents, the peer group, school engagement, substance use, emotional wellbeing, anxiety, aggression. We layer in whatever’s current. About ten years ago we added attention and hyperactivity screening. More recently, screen time.

Mike: Jonathan Haidt argues the 2012 smartphone inflection point is driving a lot of the bad mental health numbers we’re seeing in the U.S. Does your data support or push against that?

Inga: I do think there’s something real there. Girls and boys use social media differently. Girls’ friendships tend to be built on a tighter, more exclusive friend group, and the rise of social media use seems to have made those relationships more superficial, which has hit girls’ anxiety harder.

Mike: Is there any evidence the card activates kids who weren’t participating before, versus just subsidizing the kids who were already going to join something?

Inga: That’s a good question, and honestly, it’s one we need to study more carefully rather than assume we know the answer. What I can tell you is that participation has kept climbing, past 80 percent now, and the menu of what qualifies is wide enough, sports, music, theater, all kinds of things, that there’s usually something for a kid who’s on the fence. But whether the card itself is the thing that tips a genuinely disengaged kid, rather than just removing a cost barrier for a kid who was already inclined, is exactly the kind of question I’d want better data on.

Mike: Where does traditional therapy fit into all this?

Inga: Psychologists do good work for many people, but they’re not necessarily the best fit for teenagers specifically. The standard model leans heavily on the cognitive side of things, and in my experience that’s not always what a struggling teenager needs. I’d rather integrate a kid into something they enjoy that’s cognitive, emotional, and physical all at once.

Mike: That’s essentially behavioral activation therapy: strip the “let’s talk about your feelings” out of CBT and just focus on getting someone active. There’s a strange history there. It worked well in clinical trials. But instead of letting it compete with CBT’s reputation, the psychology field folded it into page 57 of the CBT manual as a subsection, and it quietly stayed a minor share of what teens actually get. You seem to be describing behavioral activation at massive scale.

Inga: That’s the core of the Icelandic model, really. We’ve been doing population-level behavioral activation for thirty years without necessarily calling it that.

Mike: Where has this model taken hold outside Iceland?

Inga: Chile was the second country to adopt it nationwide. We have published studies on effects in Chile, in Lithuania, and in Spain, near Barcelona specifically, where the comparison group was neighboring towns rather than another country. A colleague of mine has also studied it in West Virginia. In Chile, interestingly, Santiago has ten different mayors across the metro area, and we simply presented them the full menu of what we’ve built in Iceland and let each one pick what fit their community. Many of them chose the leisure card specifically.

Mike: Has the cost of funding something like the leisure card been a barrier for other governments?

Inga: Less than you’d think. What’s changed is that evidence-based policy used to be a hard sell to politicians. Now they want the evidence. And this used to be seen as a soft issue, not something a serious politician invested in. Now, in most of the decent countries we work with, [JA14] a politician who won’t invest in the next generation is less electable, not more. That’s a bigger shift than the money.

Mike: Here’s an idea. Recruit a group of teenagers who have access to activities and aren’t doing those activities. Maybe a thousand kids. Randomize half to get an Iceland style leisure card plus a coach - a trusted adult who isn’t a parent, to help them find something and work through whatever’s stopping them (transportation, fear of starting, lack of initial skill, etc).

Compare their well-being to the control group over time. What do you think?

Inga: I think it’s a brilliant idea, and I’d want to be part of it in any way I could.

*
Final thoughts:

What a career she’s had.

Maybe some of us should journey to Iceland next year and see more of this story first hand?

Maybe some of that Facebook settlement money - which is meant to improve mental health - would be better used for Recreation Cards than more therapy appointments?

Four Caveats / Musings

Dear readers, you know me. Here are 4 unrelated stories on my mind.

First, we must consider the now diminished Finland Miracle. The short version: once upon a time, Finland led the world in PISA scores. The world policy community flocked there to learn lessons. Then the Finish results plummeted. It’s hard for even those on the ground to learn the right lessons.

Second, the Utah Complication. Megan McArdle has argued that Utah’s remarkable record on upward mobility runs substantially through the LDS Church’s private welfare system, and that Utah’s homogeneity and high trust may be doing more work than any specific policy choice, in a way that might not work in, say, Georgia or PA. Iceland is small, homogeneous, and high-trust too. So I don’t want to assume away that problem.

Third, the High Dosage Tutoring Scale Up issue. It worked really well in Boston, in Houston, in Chicago. All small. But when it got scaled up as policy, the gains diminished. The Recreation Card has been tried in Chile, Spain, and Lithuania, and as best I can tell, the results were less impressive - in one place the key politician expanded it too fast and then everyone lost interest.

None of that should diminish Iceland’s success but it should make us curious and cautious about this idea which I frigging love.

Finally, the Chintzy Individual Teacher Accounts. The good version of the idea: teachers are on the front lines, we should give them a lot of cash to spend as individuals. A 2nd grade teacher with 25 kids in Boston, spending well over 30k per kid, in theory has 750k per year. Easily that teacher should control 10k per year, 50k per year, take all the kids to Italy, hire an elite therapist for some really messed up kid, etc. There’s just so much cash in the system.

But when this idea gets tried in real life, it tends to be where the teacher controls just $250 per year and buys magic markers - what’s the point?

We don’t want chintzy Recreation Cards, they have to be meaty to matter, they have to be able to buy lots of joyful teen hours in the marketplace as it exists. I don’t think 350 Euros will do it. Many families - who find themselves fortunate in having flourishing teens who WANT to do stuff - are spending $5000 to $10000 per year (including several of my readers, thank you for your emailed stories).

THEN let the market respond, like LASIK eye surgery over time, to drive down prices.

Finally, our Rec Card, should it ever come to pass, will need not just enough to buy access, but ALSO the adult navigators to help the teen overcome social anxiety and try things, plus a little bit of helping them figure out what’s out there. Like helping Gary, a teen who resisted.

Pru and I dropped Kiddo 1 off at college yesterday.

In the group text with his HS buddies, the fear wasn’t grades. It was: will I actually make friends here, or will I be alone in a dorm, when everyone else seems to find a tribe?

Jenny sent me Rose Horowitch’s Atlantic piece along the same lines. Rose writes:

But college has historically been about socializing—or, let’s just say it, partying—as much as it has been about education. It’s where young people escape parental supervision, move in with roommates, and encounter thousands of potential new friends.

But the anti-social century has arrived on campus. Today’s students spend much less time socializing than past generations did.

My longtime basketball playing buddy, Rick W, is quoted. Rose writes:

I don’t think there’s any question that loneliness has increased among young people,” Richard Weissbourd, a senior lecturer at Harvard’s Graduate School of Education, told me. But he also thinks that the shift is partly a result of students viewing normal desires for more friends as unusual or even pathological. Previous generations might have felt similarly disconnected but chosen not to identify themselves as lonely. “This is the most psychologically literate and articulate generation in history,” he said. “People are much more proficient at and much more inclined to label their emotional states.”

Over the years, I’ve had the chance to chat with a few college presidents about this issue.

Do they see increased loneliness as an issue? Yes!

Is addressing it high on their priority list, compared to other things? Emotionally yes but realistically no.

Compare student loneliness to, say, retention rate.

Retention rate is in the US News and World Report ranking, IPEDs, etc. Provosts built entire offices around early alert systems, advising overhauls, first year seminars.

Loneliness is sort of tracked but nobody uses it for ratings. There are 2 decent national surveys, Healthy Minds and the National College Health Assessment. But they’re voluntary, with response rates in the 25 percent range. Compare that to retention, where the number is the number - every kiddo, every year.

The loneliness data is less reliable, particularly at the individual college level, and not part of the ratings. And what doesn’t get measured often doesn’t get done.

Horowitch looks around for solutions.

USC’s Cat Moore built a friend-making course called CLICK, now licensed out to MIT. Intriguing! As best I can find, it’s never been evaluated.

I did find a UK researcher that ran an actual RCT on a peer support intervention to reduce first year college loneliness. 52 kids were randomized. Outcome metric: UCLA Loneliness Scale after 6 months. Did the treatment work?

No, it was null.

(Though kids do get less lonely over time).

My beliefs is that colleges look to COURSES to solve their problems, because that’s their hammer, courses. It’s what colleges do. Loneliness, loneliness, what do we do, BAM, it’s a nail, we need hammers.

Courses tend to be better for intellectual gains versus behavior change. We’ve already written at the CTF WTF blog about the famous Yale Happiness Course and its effects.

Early research showed the course itself changed student behavior. Later research, though, showed behavior change didn’t stick.

I think it will be hard to solve loneliness through well-intended courses, though people should try!

What else besides courses?

Horowitch speaks to a college president describing new footpaths he had built across the lawn so students would run into each other more.

Footpaths?

I’m imaginging Colonel Nathan Jessup’s mocking voice, invoking foot lockers:

Now, are these really the questions I was called here to answer? Phone calls and foot lockers? Please tell me that you have something more.

College president: please tell me you have something more than architectural solutions to loneliness. I’d love open a Kalshi market on the effect size of your college footpaths on loneliness and bet the null. Any takers?

So what would actually work?

Let’s go back to the data, and to the accountability.

First you agree on an outcome variable everyone will be held to. Then you get a lot of smart, motivated people racing to move it, in public, with money on the line. X Prize to solve College Loneliness.

Say that X prize existed tomorrow, fifty teams competing to cut loneliness on a campus over a semester. That would be worthwhile! 15 million students, let’s say 3 million really lonely!

What would CTF’s entry look like to this competition?

Ours from CTF would be behavioral activation. Every campus already has a kajillion clubs sitting there half empty. The intervention isn’t inventing new clubs or spaces or new courses.

It’s a structured coaching intervention to get kids who are isolated into activities that already exist.

Direct effect: you’re now physically in a room or sports field with people on a Tuesday night instead of alone in your room. You feel less lonely already.

Second order effect: some classmates in those rooms and fields become friend targets - not friends yet, but people you’ve now seen twice, people you could plausibly text - coach em up on that too.

Third order effect: you now have an identity, maybe it’s college radio DJ, maybe it’s environmental warrior, maybe it’s college newspaper - a story you can tell family and yourself.

It’d be fun to try inside an energetic X Prize type environment.

In that hour of trial it was his love of his master that helped most to hold him firm; but also deep down in him lived still unconquered his plain hobbit-sense: he knew in the core of his heart that he was not large enough to bear such a burden, even if such visions were not a mere cheat to betray him. The one small garden of a free gardener was all his need and due, not a garden swollen to a realm; his own hands to use, not the hands of others to command.

The one small garden of a free gardener, not a garden swollen to a realm.

I think a young adult has 4 choices, and 3 seem pretty good to me.

1. His own hands to use - teach! One small garden.

Work with 20 kids a year. Or 75 kids in a Dev World classroom. Or as a high school teacher, maybe 150 kids. Any type of school.

Here I include the word “guide” or “coach” - any version of direct work with kids. There are many Sams out there who truly love their work, tending a small garden, and making a difference.

2. Create or lead a school, or even a network of schools.

3. Work on promoting a policy or idea, but in a small way, built on relationships with the people in the trenches.

4. Work on that policy at scale. This is very appealing at an obvious level, but we have so few examples of actual success, where kids benefit. Often: yikes.

* * * *

B. Book Review

A new book called A Chance To Solve Their Own Problems is one of most interesting I’ve ever read that looks at #3 and #4 above.

I recommend it.

It’s an unusually balanced book, evoking Larry Cuban’s Tinkering Towards Utopia in how comfortably it does NOT offer ANY false hope or glib solutions.

The subtitle is: Inside The New Methods Seeking To Remake Public Schools.

My preferred subtitle would be: How Dunbar’s Number Trumps Otherwise Perfectly Reasonable Scalable Edu-Ideas.

Jal and Max and their co-authors look at many of my favorite instructional practices, and talk to the people who built them.

Dick Elmore and “Instructional Rounds” (like doctors).

Tony Bryk and Don Berwick and "Continuous improvement.”

Japanese Lesson Study.

And more.

A common theme is

The idea worked when it had….

A) An intellectual champion attending to the details

and

B) That champion used personal relationships to have productive partnerships (hence my reference of Dunbar’s number)

…And the idea mostly failed when it scaled.

Educators downstream often are “handed” an idea from education policy. They go through the motions. Your idea this year; her idea last year; some other dude’s idea next year. Rinse and repeat. Meanwhile they just try to preserve doing things their way.

Co-author Max calls half-assed accommodation “Technical ceremonies” - when educators go through the motions.

Or you, as the ed policy creator, might even “win” one level. Educators LIKE what you’re talking about. They say “Yes!” in surveys. But then their teaching behavior does not change. They might say it does, but observers (and the kids) say otherwise.

Each little oval of the “Egg Crate” (the classrooms in each school, divided) remains unchanged.

Jal and Max talk to the Key People who succeeded in #3 but ran into problems with #4. For example, Barry Fishman has a model called DBIR. Design-based implementation research. It competes with another idea, called Research-development-dissemination….which is more common but has a bad track record.

Welp, Fishman reflects:

I think the thing we got most right is the principles…..The problem is partnerships (with actual schools) are precious. They’re pretty hard to come by…..So actually a lot of the most successful examples we have grew out of personal relationships.

Jal and Max have lots of interviews like this. They talk to people who created or pushed some great ideas, big ideas, but now are reflecting on how those ideas scaled or faded over time.

A competitive advantage for these authors? They and their fellow co-authors were front and center for many of these efforts. So they know where all the bodies are buried. This means their interviewees are pretty open and introspective.

I think if you’re going to vie for #4 - to push an education policy at scale - you should carefully read these case studies (do people carefully read anymore?).

You should be able to cite off the top of your head: where these thought leaders hit some singles and doubles and where they grounded out and struck out.

You should understand the authors’ Table 2.1 - and its implications.

You should look for their Gardener versus Carpenter analogy, and what Jal learned from an assignment to his 2nd grader.

You should read for their focus on practical solutions for real life teachers, which compete with clean ideological solutions that - even if they generally have the right theory - tend to break against real life complexity.

Good book.

And yesterday we got this. “Therapy Needs To Get Help.”

Daniel Duane is a working therapist. He says:

The sector is broken.

There’s no agreement on good outcomes.

There are competing schools of therapy with required-but-faddish training.

Duane’s take partly aligns with the essay Sean and I wrote called The Therapist Widget Effect for Education Next. We both valorize the scholar Bruce Wampold.

Duane’s proposed solution is Go Big. A Grand Unified Theory for therapy.

We have 2 concerns at CTF.

1. First, a better theory does not mean better practice. Take Neil Jacobson, who we think belongs up there with Wampold on the list of Mental Health Sage Hall of Fame.

Jacobson found that a therapy called Behavioral Action Therapy is very effective. But teens don’t get offered it much, because therapists don’t feel like doing it - too boring for them.

2. That sets up our second objection: there’s no Unified Belief among therapists, policymakers, or philanthropists about the NEED for Big Change. Their preferred problem to work on is Access. Not Quality/Results of the 75 million hours per year of therapy that already flows to teens.

This reminds us of our field, K-12 education. It has spent a century trying to reform teaching, both from the top down and the bottom up, without success. Read Larry Cuban Tinkering Towards Utopia.

When you don’t have buy-in about the need for Big Change, don’t try Big Change!

Don’t try to fix the professionals.

Instead, go to those willing to change. The patients. In our case, the teens. Widen the menu instead for teens. A teen in trouble doesn’t only need better therapy (though that would be wonderful). She might need more sleep. A friend. Finding a sport or club to actually join, perhaps out of school. Some traction on her GPA. Or yes, good therapy for anxiety or depression. Any of those five doors can lead somewhere good.

The CTF path to teen mental health would be to change the point of attack - the menu first offered. Not - which of these therapists might you want. Instead:

A) Which Problem Do You Feel Like Working On, if any

B) Therefore what Type Of Person to work with (a sleep coach, a teen friendship coach, a navigator, a tutor or exec function coach, OR a therapist).

C) Which of these 3 competent adults do you want to try first?

But it’s really comedians like Jim Gaffigan who best understand.

JIMMY FALLON: How is the family?

JIM GAFFIGAN: It is great. By the way, how old are your daughters?

JIMMY: They’re 13 and 11.

JIM: Oh, it’s going to get much worse. I have five children, ages 13 to 22. I feel like I’m living in a psych ward. There is so much drama and conflict in my home. If my house were a neighborhood, it would be a bad neighborhood.

Twenty-two years of parenting changes your perspective. Teenagers are tough.

JIMMY: Would you change anything about how you parent teenagers versus when they were younger?

JIM: You have to adjust your parenting style because physically they’re larger, they’re intelligent, and each teenager is different. You have to engage in almost a diplomatic peacekeeping mission.

Some teens are like Russia, hostile for no reason at all. Some teenagers are like China, an emerging superpower that speaks a language you do not understand. And some teens are like North Korea. You’re just trying to figure out how to stop them from blowing up your world.

If you’re lucky during this diplomatic peacekeeping mission, you’ll have an ally, a spouse or partner. Occasionally, you’ll look at that partner and think, “I chose the wrong ally. I think they’re a double agent.”

When they’re teenagers, you have to use the limited tools at your disposal. You have economic sanctions. You can limit their communications ability.

I love my kids. They’re just always challenging. I understand that it’s developmentally appropriate for teenagers, but they’re stealing my stuff. Every day I wake up thinking, “Why is my son wearing my coat? What is my 16-year-old daughter doing in my blue jeans? Where are my socks?”

Last summer, my hiking shoes went missing. I have two pairs of hiking shoes. I don’t hike. I just like the shoes.

My eldest brought my two youngest, 13- and 14-year-old boys, to sleepaway camp. Apparently they needed hiking shoes, so naturally they took mine. But they didn’t take a pair. They took one shoe from each pair. I was just relieved they took a left and a right.

They were at camp for three weeks. During that time, I missed them. But I also missed my sons.

When I picked them up, I hugged each of them and said, “Where are my shoes?” They both said, “I don’t know what you’re talking about.”

I didn’t pursue it because when you have teenagers, there are always three or four ongoing cold cases that you instinctively know will remain unsolved.

Parenting as Model United Nations. Love it. Don’t tell our 16 year old, but that happens in our home. “Cod Wars” parenting. Kiddo is Iceland, wants fishing rights far beyond its coast. I am Britain, “nah.” Pru is USA, tells me to give in, preserve the relationship with Iceland.

You can watch the whole Gaffigan clip here.

Nearly every risky teen behavior of the halcyon 1990s started collapsing almost at once, kept collapsing for 30 years, and is collapsing still….And yet it’s hard to find anyone who planned this victory, and nearly impossible to find anyone who celebrated it.

At CTF, we celebrate those improvements! With Lactaid infused ice cream.

With some caveats….hey, Sean and I are quibblers by nature!

So…

A. Tail risks are much improved for teens these days, and unequivocally that is good news.

Walsh writes:

In 1990, 88 of every 100,000 Americans ages 15 to 19 died each year; by 2013 it was 45. The single biggest reason was the car.

In 2025 it was 51 out of 100,000, so those gains are roughly holding steady.

I occasionally have a nightmare where a cop appears on our doorstep at midnight, to ring the bell. Our bell is broken, though. Will the cop know to knock, or leave without telling us about the car accident? That’s the dream.

Our real life 18 year old is always borrowing the car. Our 16 year old gets her learner’s permit…tomorrow.

So: Thousands of police officer door knocks that don’t have to happen, because car safety is way up, and maybe reckless driving is down? That’s amazing. Three full cheers.

B. Teen pregnancy, booze - down.

That feels like a mixed blessing.

When I was head of a small high school, I saw first hand how hard it was for teen moms. They often dropped out.

My friend Beth started a charter school devoted to, among other things, creating a school precisely for teen moms.

So declines in teen pregnancy are really good.

But…socialization itself is way down.

That’s not good. Some of the cause is better birth control. But some is decline in dating and socialization, where fewer pregnancies is the silver lining but isolation is way, way up.

C. Walsh writes:

The problem with reducing risk-taking behavior across the board is that not all risks are bad. The same caution that might keep a 16-year-old from smoking or having sex might later keep her from founding a company, moving across the country, or writing a strange novel.

I agree. But I think those 3 examples don’t correctly convey the Big Picture. Let’s consider a representative sample of 500 American teen boys and 500 American teen girls, then and now.

There might be zero or one death per 1,000 now; rather than 1 or 2 teen deaths in the mid 1990s.

There might be 6 of 500 teen pregnancies now, rather than ~30 of 500 in the mid 1990s.

And per Walsh, maybe there’s one fewer Michael Dell or Chris Paolini in that batch of 1,000.

But there might be 400 teens these days who are languishing, not really participating in life! They’re not leaving home much to hang out, or play sports, or work a job, or volunteer, or play music, or go fishing, or whatever. That’s way up.

It’s hard to perfectly model but we estimate Languishers have grown from 200 out of 1000 teens, to 400 out of 1000. That’s a lot more teens! Languishers are defined by behavior - they go home from school and that’s kinda it for the day. They’re not acutely suffering. Screentime fills up their afternoon and evening and weekend.

By contrast, flourishing teens balance screentime (still lots of it, alas) with many hours per week of real life.

As a clinical psychologist with over 50 years of experience, I know that therapy can be essential. A person with persistent intrusive thoughts can learn ways to reduce their intensity. Someone in an acute crisis can hear a perspective that helps steady his or her thinking.

But…..therapy seems to have become the default prescription for all forms of unhappiness.

That’s the CTF case on mental health. Therapy can be effective! Particularly if you get to drink red wine during sessions, per the NYT illustration, I guess that’s how they roll in Midtown.

But should therapy be the default for teens, when parent or teacher or coach or selves notice issues?

Anyone who simply needs a listener may get something out of therapy. But when every struggle is routed toward a professional, we risk mistaking mental health issues that require treatment for problems of isolation or circumstance.

This is the Abigail Shrier message in Bad Therapy, but framed differently - not just for kids, more for a blue tribe, and from an experienced therapist rather than a pundit.

In 2023, the U.S. surgeon general identified loneliness and social isolation as urgent public health concerns…..yet much of the response has focused on expanding clinical access rather than rebuilding relational life.

This! CTF makes 2 observations here.

One is that it doesn’t require a clinician to rebuild relational life, but more of a sherpa who gets languishing teens actually off the couch, doing things.

Two is that if you WANT a clinical version of this, it exists! With great RCT evidence. It’s a therapy called Behavioral Activation.

This is just a buttoned-up version of the sherpa thing. Clinicians do NOT like doing it so much but teen patients benefit a lot. It’s just shorn from the menu 99% of the time.

I.e., nearly zero teens are asked “Hey, do you want CBT, where we try to change your feelings and thoughts so you behave better, or BAT, where we try to change what you do, so you feel better?” BAT is hidden away as like page 283 in the CBT manual and pretty much nobody does it.

Sean and I wrote Behavioral Activation Is The Phonics Of Therapy for Harvard’s Education Next. Phonics, for you non-K-12 readers, is a very effective technique that many elementary teachers simply didn’t feel like doing. So they didn’t. For decades.

So what does Lieberman observe is the result from the rush to therapy?

Patients with the most disabling conditions are left competing for the limited time, and those who are primarily seeking friendship and connection may leave feeling disappointed.

That disappointment is not just bad for patients! But therapists too, we’d argue.

If you’re feeling extra nerdy, read: Barriers and Facilitators in Adolescent Psychotherapy Initiated by Adults.

Back to Lieberman. When is therapy good? He writes:

Therapy can be especially useful when people’s habits deepen their suffering, or when painful experiences remain difficult to make sense of alone.

But when distress is shaped primarily by situational difficulties or the absence of community, therapy may not be the best fit.

Feeling anxious does not mean you have an anxiety disorder. It could point to circumstances that are worth changing.

So what to do instead?

…Volunteering, joining a community activity or reconnecting with a group that once mattered to you.

The thing is, typically a distressed teen has ALREADY been offered all of these things.

Moreover, if Mom or Dad reminds teen to join something, per David Yeager, the cortisol flows and kiddo rejects it out of hand.

It’s hard for the distressed individual to just “join in” - even if intellectually they agree it would help them. Lieberman sees that challenge too, across ages. He writes:

Rebuilding relationships should not fall entirely on individuals, but also on schools, workplaces and governments. Britain has treated loneliness through a national strategy that includes a “social prescribing” program, a model designed to provide patients with personalized care plans that connect them to community groups and volunteer opportunities.

Government? Sean and I wrote about Social Prescription for Education Next here.

High Schools? Let’s stipulate: They have lots of their plate, struggle to execute their main mission (reading, math, etc). But they could do more, see our ideas here.

Workplaces? Yes! More part-time jobs. They have so many benefits for languishing teens, including reduced screentime. See Sean’s description of teenage Zach, who he coached. It’s a complex case, but a game changer was a busboy job.

Lieberman concludes:

The challenge is often not creating new opportunities for connection, but helping isolated people discover and participate in the ones that already exist.

A final thought to our Out Of School Time policy friends. Yes, build more capacity. But ALSO grasp that many teens are rejecting the capacity that is there!

You have to somehow decrease the friction of joining, and somehow unleash the market to provide new activities that they’d prefer more.

The rejection varies a bit by gender.

Jed Foundation convened 65 experts with Morgan Stanley Alliance for Children’s Mental Health, to examine mental health of young men. They write:

Effective interventions include a shift from traditional talking to activity-based connection….Consider music, physical activity (throwing a frisbee or shooting hoops), or collaborative tasks (building) when talking.

Yes!

I’ve observed all these moves done with success.

The Walk And Talk. Love this. Used it for 25 years. With family, with colleagues, with teens. Allows for much better “lulls.” Nice “Small talk” opportunities to fill gaps - “Hey look at that car/dog/etc.”

Just to be aware: If it’s a mental health situation, the teen is typically sensitive to surroundings - i.e., who will see them walking with Adult (counselor, teacher, therapist) and any “overhearing” that might happen. Not hard to solve for, you just have to be proactive.

The Shoot Hoops. This is tremendous for boys who like to shoot baskets, perhaps 30% of population I’ve been around. Find a solitary court, nobody around. Kid shoots, you rebound, you’re 20 feet apart. I don’t think the talking happens so much during the shooting, though. It’s more “let’s take a break.” Frisbee is good too but fewer boys can competently throw one. For each of these, teen has to feel competent or this is insanely bad idea. No boy likes to throw frisbee only to see it consistently smash weakly into the ground after 5 feet; no boy can handle more than a few airballs in a row.

Collaborative Tasks. Again, for the right teen guy who likes to help with chores, this is gold. Paint these walls. Assemble this furniture. Rake all these leaves. Always: Side by side. Bonus: if this is a high school student and you can pull him out of class to do the work, even better!

This therapist features Walk And Talk in her practice.

Nerdy Mike was curious if anyone has actually studied The Walk And Talk. Yes! Seinfeld has.

But also some scholars at University of Newcastle.

There’s a 2025 tiny RCT pilot. They write:

While psychotherapy is effective for treating depression, men are less likely than women to attend and more likely to drop out. The value of alternative therapeutic approaches for men needs to be investigated. In this randomised pilot trial, we investigated the feasibility and preliminary efficacy of outdoor ‘walk-and-talk’ therapy compared to conventional indoor therapy for 37 men with low mood.

First, before randomization, they asked the fellas if they’d prefer conventional or walk and talk? Guess the result.

….

87% prefer walk and talk. That’s a big win!

Enough that therapists and counselors should REALLY consider big changes to their normal approach. (I bet many adults would like it too).

Result? Again, just 37 guys, so I don’t particularly think there’s much statistical power here. Walk and Talk did better on overall psychological distress and had higher retention, but aggression actually improved more in the indoor group. Anyway: All with big grain of salt. They’re now running a full 160-person trial.

I wonder about a key claim, which is Screen Quality OVER Screen Quantity. From the interview:

The fact of the matter is that by focusing on screen time we miss the far more important concept that we should be teaching our kids; screen value.

We’ll circle back here. This is a common theme I hear from scholars about teen mental health.

Some digital activities are just not a good use of a kid’s time (eg. playing a repetitive, luck-based game) while others provide much greater value (eg. editing a movie, creative writing, FaceTiming with a grandparent, etc.)

I agree. More grandma! Make Casablanca 2.

And context is important to consider too. Digital activities that are appropriate on a long car-ride will likely be different than those on a beautiful spring day when friends are around, or the day before a large school project is due.

I agree. With the teens that Sean and I work with, the details and nuance DO matter.

Together with our kids, we created a list of low-, neutral-, and high-bar Sunday activities.

Great, let’s see your scorecard.

Low-bar activities were things like watching National Geographic videos, listening to music, or playing Minecraft.

Medium-bar activities included things like playing a chess app with a sibling, reading an ebook, or listening to a podcast.

High-bar activities included writing a letter to a friend, FaceTiming with a grandparent, learning new Spanish words in Duolingo, or composing a song in GarageBand. Medium- or high-bar activities could be done at any time. But high-bar activities could also offset low-bar activities.

Wait, what?

This does NOT describe typical teens consuming 4 to 8 hours a day of screentime, depending on your data source.

We’ll look at the data in a moment.

For now, let’s reclassify the 3 categories into 5.

Here’s my five-tier version, numbered 1 through 5, built to match what’s actually happening with typical teens rather than what a thoughtful family does on a Sunday afternoon:

1. Bad activities period: problem gambling, porn, scary rabbit holes where teen is reprogrammed, etc.

2. Very low value: typical TikTok and Instagram scrolling, the algorithmic feed in general, Call of Duty and similar shooters. The default mode for most teens, most of the time.

3. Low: texting and video chatting with human friends, Minecraft (which has way more teen users than people assume), chess, listening to music, and the kind of content creation that’s actually typical, like making a dance video for TikTok.

4. Medium: listening to a podcast during a chore or a walk, a genuinely good how-to video on something the kid cares about - changing the oil, working on a pass-rush technique.

5. High: real creative output like composing music, an online physics class from Stanford. And for a socially isolated kid, texting the only friends he has, which sounds low on paper but is doing more for that kid than almost anything else on this list.

Now, here’s my best guess at true teen screentime, for those using at least 4 hours a day.

How did I guess this?

I pulled three things, and they don’t agree perfectly, but they triangulate well enough to be useful. Readers should push me here, via email.

Self-report surveys. Common Sense Media’s census is the gold standard here, nationally representative and repeated over time. Their own framing of the 2019 results was blunt: “Consumption crushes creation.” That’s where the roughly 85% figure comes from, the share of teen screen time going to watching, scrolling, gaming, and browsing, with content creation stuck in the low single digits.

Qustodio’s 2024 report, drawn from actual usage data across 400,000 family homes and 10,000 schools, found that US kids averaged 132 minutes a day on TikTok, 89 minutes on Instagram, 86 minutes on YouTube, and more than 2.5 hours on Roblox. Add just those four apps and you’re at roughly 7.6 hours, before a single minute of texting, Snapchat, or anything else, which is nearly the entire 8.5-hour daily average Common Sense found. Every one of those four apps sits in our Tier 2 “Low quality” list.

Yes, in THEORY you could be looking at National Geographic videos on Tiktok but guess what? Prrrrrrobably not.

Qustodio’s sample is households that installed parental-control software, so these are the RESTRICTIVE parents, not the typical ones, where it’s gotta be worse.

What’s actually in tier 1?

On gambling, research on adolescent problem gambling consistently finds rates 2 to 4 times higher than adults, with somewhere around 4 to 8% of teens meeting criteria for a serious gambling problem. On porn, maybe 10% daily consumers. Maybe 15% of teen boys have positive view of, say, Andrew Tate. Obviously some overlap here!

And yes, if the teen you’re responsible for is consuming lots of Very Bad content, and you see that affecting their behavior, then in THAT case your problem is a Quality issue - i.e., the first job is seeing if you can restrict the Very Bad activity. Tier 1 is a small share of minutes but disproportionate in impact.

Otherwise, for typical high use but not acute teen….

Tier 2 is somewhere around 80 to 85% of total minutes. Tiers 3 through 5 combined land around 15%, with tier 5, genuinely creative production, well under 5%.

Here’s what that looks like next to Culatta’s anecdote, mapped onto the same five tiers:

This is where I think the “quality index” idea, however right it is in principle, can become its own trap.

It reminds me of decluttering.

Have you ever helped someone with clutter? Tried to move Grandma and Grandpa into a senior independent living place?

When you try to help someone who is cluttered, the BLOCKER is them caring about quality. They try to sort every object, sell some things, donate others, find the right home for everything. Nothing gets done!

Could you persuade these people to downsize by 50%? I think not!

That’s part of what CTF sees in the screentime debate. For a teen on the screen 4, 6, 8 hours a day, YES in a perfect world we could parse quality.

But often that just blocks progress on HOW TO REDUCE QUANTITY, how to cut from 6 hours a day to 3 hours a day. The great becomes the enemy of the good.

Again: Culatta is 100% right that when talking to a teen about excessive screen use, you have to listen to their actual consumption choices. Quality matters. In particular, if you threaten to cut off something that gives them social status or connection, cortisol will flow, they might shut you out. And of course you don’t want to stop the from playing a little chess or watching a few silly Jackass videos.

But: Screen Consumption is what crowds out the healthy In Real Life activities for most Languishing Teens (our estimate is 40% of teens). For these, let’s stipulate quality matters, but not lose focus on our Outcome Variable - halving their screentime from 40 hours a week to 20 hours a week or thereabouts.

Olive branch: What I bet Mr. Culatta would agree with is the need for much better data on actual teen screen consumption, over time! Hence this.