By Ashvin Sood, MD, and GAP’s Committee on Psychiatry in the Media
“If you have inattention and rejection sensitivity, you may have ADHD,” says a vlogger to Clara one evening online. “When I get anxious, I zone out, and that’s how I know I have ADD,” says an influencer in the next video. Clip after clip, Clara is inundated with performers, experts, influencers, naturopaths, and everyone in between, highlighting an ADHD diagnosis or symptom on TikTok.
As one might imagine, Clara is confused. She is a 15-year-old with normal identity issues for her age but she has been socially isolated through her early adolescent years due to the pandemic. In trying to figure out and make sense of who she may be, her main source of information is the app known as TikTok. From it, she receives cues and hints about non-specific behaviors that offer her explanations as to how she interacts with the world.
Inevitably, Clara tells her mother one day, “Mom, I have ADHD.” Mom is confused and, having little training about mental health diagnoses, ignores her daughter’s declaration. This leaves Clara feeling more isolated and continuing to question who she is, hoping that perhaps having a diagnosis can finally give her identity some stability.
With over 1.5 billion active users, TikTok is quickly becoming a social media monolith, rivaling Meta and Snapchat. The demographics of TikTok users are equally striking, with over 57% being female, and 28% being under age 18.
What makes TikTok so appealing? For one thing, it is easy to use. Users can flip through videos instantaneously and are fed personalized algorithm-driven videos that fit their interests. Like cat videos? Here are 7 clips of feline friends engaging in humorous antics. Interested in exercise? There are thousands of influencers waiting to teach you the latest kettlebell routine. However, the young audience that consumes these short bursts of information, misinformation, and disinformation doesn’t just digest these clips; they may also incorporate them into their identities.
Welcome to mental health TikTok.
Adolescent Mental Health During the Pandemic
When the pandemic was at its peak, children and teenagers became socially isolated. With severely limited access to outpatient therapy or psychiatry, emergency room visits skyrocketed for suicidal ideation and self-harm, eating disorders became rampant, and teen depression and anxiety hit an all-time high.
No wonder teens went to their screens, as these resources provided connections to peers as well as education regarding the latest trends and events. From the spring of 2020 onward, rates of social media use, particularly TikTok, rose significantly in the US, with a 10% to 28% increase among 15-to-25-year-olds.
Why? TikTok provided a sense of connection to the outside world, enabling teens to belong to a group again. More specifically, teens wanted to find peers and adults who suffered from their shared collective mental health burdens. As the sounding board grew, so did the number and types of distributors and sellers of mental health information. All flocked to the bazaar.
In Clara’s case, she watched multiple content creators dance to catchy songs, point to non-specific symptoms, and suggest she may have a mental health condition. Each video she saw increased in popularity based on how long it was watched, how many views it received, how many comments it received, and how often it was shared. It did not matter how accurate the information was or who was providing the information; if the video was popular, Clara would see it.
As mental health became a trending topic in social media over the past two years, content creators found themselves catering to an audience that wanted a name for what they were experiencing. Understanding the currency of TikTok’s popularity, creators developed short videos that were generalizable, flashy, and relatable, even if they did not provide accurate information.
On the positive side, medical educators and licensed therapists also joined the fray, attempting to provide appropriate evidence-based information to help those who had little or no access to accurate mental health facts.
The Growth of Questionable Practices
As their number of views grew, creators were approached by companies to advertise on their behalf. They were selling teletherapy, telepsychiatry, supplements for ADHD and depression, and related products. For example, Cerebral, a telepsychiatry company that is under investigation for the overprescription of stimulants, spent roughly $14 million advertising on TikTok alone. Better Help, an online therapy service, has come under fire for hiring influencers to advertise their products without properly indicating their terms of service.
As information boomed, questions began to surface regarding the accuracy of mental health videos on TikTok. A recent study examined 500 videos that had accrued roughly 25 million views. Medical professionals went through each clip and found that 83.7% offered inaccurate or potentially damaging advice; featured a content creator who was unqualified and did not include a disclaimer; or encouraged self-diagnosis. More problematic videos claimed to describe diagnoses of ADHD, bipolar disorder, and depression.
What to Do
Identity formation is an integral part of a teen’s development. With access to a digital world that provides troves of information, teens will understandably search for meaning in what they watch.
How Parents Can Help
- Begin with a non-judgmental approach, fostering curiosity about what a teen may be watching.
- Ask questions like “Where did you learn about the diagnosis?”; “What parts of that diagnosis do you connect with?”; and “Do you know others who may have similar symptoms?”
- Be patient with their responses. They do not have to have an exact answer, but they do need an adult who will listen.
- Ask to view the saved videos in their TikTok profile. Watch those videos with them and ask them to point out parts they connect with.
- If there are concerns, ask how these symptoms are affecting them day to day. Do the symptoms interfere with schoolwork, peer interactions, and home time?
- Ask if there are parts of the video which don’t resonate with them. Offer your observations that may be different from what is in the video and allow them to reflect on your thoughts.
- If there are more serious concerns, offer to help them seek out help such as setting up a doctor’s appointment or having an outpatient therapy evaluation.
How Clinicians Can Help
- Offer curiosity and a non-judgmental approach when asking about a self-diagnosis.
- Screen for symptoms of the condition and speak with the parent regarding the history.
- Specify what helps reduce the symptoms and what seems to worsen the symptoms.
- Ask why this diagnosis is important and what it may mean to them if there is no diagnosis.
- Highlight that diagnoses are helpful but that they do not define an individual.
- Inquire about other traits or personality aspects they like about themselves.
- If treatment is applicable, discuss that treatment is meant to relieve a symptom and not meant to define a person by a diagnosis.