**This is a lengthy review, and it was written by a therapist with a degree in Psychology and postgrad training in Clinical Psychotherapy who also holds a Master’s degree in Special Needs Education and has had extensive training in Methodology and in Functional Analysis. Rather than bragging about my background, I point this out to make it clear that my criticism is coming from someone who knows what they’re talking about. Another important thing to note is that I am not from the United States of America, and while the authors currently live and work in Australia, this book is written from an USA-centric perspective that it fails to acknowledge time and time again. Please keep this in mind if you decide to read the rest of my review.**

The best way to summarise this book is to paint it as a compilation of missed opportunities, methodological obscurity, cherry-picked sources and convenient word choices. Believe me when I say that I wish I weren’t saying these things about a work that was by all means promising and really appealing. The authors are correct when they state that the so-called “youth mental health crisis” is a wicked problem, ie. one that doesn’t have a clear solution but rather feeds off of several different factors, and I agree with them that we must look at all these variables rather than blaming everything on any single one.

However, and despite how brilliantly written the first chapter (“Environmental Toxins”) was, the book quickly spiralled into pseudo-propagandistic discourse that failed to bring any clarity to the conversation. The scientific integrity was lacking, to say the least, and there were many instances of frighteningly disinformed assertions with a clear ideological agenda being pushed under the guise of evidence-based knowledge. While I do not think that there is anything wrong with being a conservative per se, I do think that a lot is wrong with trying to portray one’s personal opinions as scientifically backed facts, and this is exactly what the book does time and time again with numerous topics.

Some instances are more obvious than others, but as I made my way through the book (begrudgingly so after hitting the 70% mark), all I could see where failures to provide a definition for the concepts that were thrown around; methodological blind spots regarding source reliability and proper reporting of scientific evidence; cherry-picking of articles; and a blatant disregard for the copious amounts of decades-long research that debunks many of the book’s claims. For the sake of clarity, I will divide my review into sections that address said issues one by one, but if you don’t have the time or mental energy to deal with such a thorough explanation, here’s the summary.

TL;DR? “Kids These Days” fails to substantiate many of its claims, some of which are downright dangerous or false, and I would not recommend about 85% of its contents to anyone who doesn’t have enough methodological knowledge to find the remaining 15% that does bring interesting contributions to the table.

***

US-centric bias and the failure to address it

When one talks about youth in general, and their mental health in particular, there is a strong tendency to dissociate the topic from the sociocultural environment in which the studies and professional experience that the authors quote have happened. Omitting this information, which might not sound very relevant to the general public, is a severe disservice to the discussion presented throughout the book. When the authors discuss environmental toxins, wrongly using this term to refer to chemicals present in the environment that affect human health, they do acknowledge the different standards that the US, Canada and the European Union have imposed as “safe enough” levels of certain substances such as lead. This might not surprise you if you are a fellow European, but the United States is pretty loose compared to ours when it comes to regulating health hazards and looking out for public health.

What does not surprise non-US folks either, but is somehow ignored in this book, is the ways in which the United States has manufactured many of the issues that are discussed in this book, which the authors fail to acknowledge. Variables such as the lack of access to adequate healthcare, the very real environmental stressor that is the possibility of school shootings, the urban planning that leaves no room for urban spaces in which youth can hang out and play…, play a huge role in the issues that this book discusses, and yet there is not a single paragraph that acknowledges this. When you put mental health care behind a paywall guarded by healthcare insurance companies that demand diagnostic labels to even consider covering your child’s therapy or psychiatric bills, diagnoses rise in number. It’s that simple, and yet the authors disregard this entirely and much prefer blaming self-diagnoses, lousy parenting, and even female teachers that do not understand let alone allow rough play for little boys (this is stated in the book, yes).


Conceptual opacity

Something that the authors state early on in the book, which I happen to completely agree with, is that “defining words is key to any successful communication of ideas”. I stand by this. Meaningful dialogue cannot happen unless everyone involved understands what the key words and terms they’re discussing mean in the context of said discussion. Different people might use the same word to express different meanings, and when we disregard this and fail to establish a conceptual common ground, what ends up happening is that people end up arguing because they are often referring to different things. Take the word ‘sex’, for example. One person might be referring to genitals, whereas another might have chromosomes in mind and a third one could be thinking about male or female. All of these are meanings that someone might give the word “sex”, and when we fail to acknowledge this conceptual disparity and agree on the definition we will be using throughout the discussion, chaos is guaranteed to ensue.

In this sense, the authors fail to do what they themselves asserted is key. Something that kept happening, and infuriating me, was the appalling disregard for nuance whenever the discussion went back to what they called “mental health care” and never actually defined. Did they mean classic one-on-one therapy? Psychiatric appointments? Referrals to assessment services? Group interventions? Talks at schools? All of the above? What’s worse, though, is that these men are therapists and yet conflated psychiatrists and therapists. A therapist neither diagnoses, nor medicates, because those are things that are reserved for medical professionals who have specialised in Psychiatry. Implying otherwise, or failing to point this out when you are continuously berating therapy and diagnoses and whatnot, is dishonest.


Evidence-based Therapeutic Approaches

Something that is sadly common nowadays is the demonisation of Behaviourism, which is an approach within Psychology that seeks to understand behaviour (which is defined as all ways in which an organism interacts with the environment and seeks to adapt to it, and thus includes emotions and feelings) in terms of learning. Far from being limited to stimuli associations, Behaviourism looks for factors that explain why we do the things we do, and why we keep doing them (or not doing them) even when they harm us. Despite the fact that functional analysis is by far the most useful tool we’ve got to understand human behaviour, because it helps us understand the purpose each behaviour serves as well as the reasons why it remains in a person’s repertoire even when it’s a dangerous or suffering-inducing behaviour, the authors do not even mention it. Instead, they dismiss behaviourism by claiming that “it excludes feelings”, which is false, and they go on to praise exactly what behaviourism looks at, which are environmental factors.

Lack of sleep, dietary choices, hormonal imbalances, economic resources and any of the things they pointed out are all variables that are taken into account by behaviourism. The dispositional variables are those that help us understand the person’s context, and when behaviourism analyses a person’s behaviour, said factors are vital. When the authors criticise the multiplicity of therapeutic approaches (CBT, ACT, DBT…), they fail to mention that they all stem from behaviourist functional analysis, which underlies every single effective therapeutic approach you can think of. Funnily enough, they do praise habituation as a process that can be considered when tailoring an intervention. Habituation is one of the most basic learning processes, and behaviourism is the one approach that acknowledges this and takes it into account.


Autism, ADHD, mental illness and the lack of clarity

Similarly, another thing that made me consider DNF’ing this book was the carelessness with which the authors conflated neurodevelopmental disorders and mental illnesses, which are two very different things. On the one hand, autism and ADHD have been researched for decades, and we’ve got very robust evidence explaining what these neuropsychological conditions entail. There are significant developmental differences between people with ADHD or autism and people without them, and we have known for decades that this means that the resulting brain is different and works in a different way. One is born with ADHD or autism, and the differences in one’s wiring translate into different interactions with the environment and a different way of functioning. This is not a disorder or illness because there is no cure for it.

Meanwhile, diagnostic labels such as “anxiety disorder” or “depression” are terms we use to refer to clusters of symptoms that appear together and co-vary, but they are far from being the same as neurodevelopmental conditions. One is not born with a depressed or anxious brain. One develops the symptoms that we then refer to as anxiety, or depression, as a direct consequence of the environment they are in and what happens to them. We consider them disorders, or illnesses, because they can be treated, and the symptoms can go away.

When we criticise the DSM system, which again is not something us therapists use because we do not have the authority to diagnose anything - at most, we can provide a referral report that points out strong similarities to a particular diagnostic label -, we criticise the tendency to apply biomedical logic to mental health, and try to classify every possible form of human suffering under its very own diagnostic label. However, we are not talking about neuropsychological conditions that are present from birth and entail a significantly different wiring, which needs to be properly assessed and worked with precisely to prevent additional suffering stemming from an inability to connect with others or one’s environment. Knowing that you are autistic doesn’t mean you are “internalising a diagnostic label”. It means that you’re aware of the ways in which your wiring and subsequent needs are different. Still, the authors prefer to dismiss ADHD and autism as labels that “stunt growth”, which is both a ludicrous idea and a deeply misinformed claim. Far from being something that isolates you, which is what the authors claim, a neurotype diagnosis helps people understand why they’re “odd ones out” and seek adequate support and strategies to overcome the difficulties and obstacles that they face due to the different wiring of their brains.

Even though the title and foreword claim to be addressing what's happening to kids and teens, the case they bring forward to criticise people identifying as autistic after receiving a diagnosis is that of a 20 year-old woman whose social media feed started showing her more and more products such as stim toys or weighted blankets after receiving her diagnosis. This is not good science or responsible divulgation. This is a misleading narrative that conveniently ignores thousands of papers, as well as first-hand testimonies from the autistic community, to focus on the authors' idea that social media influencers are making the kids (and 20 year-olds, apparently) self-diagnose. While there is an issue with the way social media keeps pushing nonsensical content that trivialises many diagnoses with stuff such as "5 things that you didn't know were ADHD!", I expect experts to be better than this. I expect them to know better than to assume that poor divulgation online is what’s driving rising rates of diagnoses, rather than a fundamentally broken system that demands diagnoses to provide basic healthcare.

While it is true that the US has a problem with overdiagnosing conditions in children, it has a lot to do with what I mentioned above and the authors omitted, which is that the healthcare insurance companies demand a diagnostic label to cover any sort of help for the child. Most adults in the US have such insane workloads that they do not have the energy, or time, to sit down and have the meaningful interactions they’d like with their children, and rather than being an example of poor parenting this is an alarm sign that there is something very wrong with the sociocultural environment. Living paycheck to paycheck means not being able to afford any alternative to getting a diagnosis that will make the healthcare insurance company cover your child’s therapy bills, and failing to address the systemic injustices in access to adequate healthcare when talking about overmedicalisation and overdiagnoses only leads to empty conversations.

While criticising the DSM is almost a moral duty indeed for any evidence-based practitioner worth anything, and there are indeed tools that are awful such as the PHQ-9 questionnaire, I find it hard to believe the authors' lack of actual research regarding psychometric instruments and how far they've come in the last decade. Considering that they mention meta-analyses at one point and even the concept of statistical significance (again, without defining it or explaining what any of the methodological jargon means or why it matters, which is concerning considering that this text is aimed at non-specialised audiences)... Why do they demonstrate, time and time again, such flawed methodological knowledge? Why do they refer to this one questionnaire over and over again to criticise all diagnostic tools and the diagnostic process as a whole? Why do they keep blaming labels and those who seek them without discussing what makes people depressed or anxious, ie. the environment and sociocultural conditions? Why do they conduct flawed research, cherry-pick sources, and ignore the copious evidence that debunks their alarmist claims?

As a last thought, I found it odd that the authors went out of their way to claim that children are getting diagnosed with personality disorders that stunt their development and whatnot. While I understand the sensationalism it brings to the table, this is completely untrue. By definition, personality disorders cannot be diagnosed before the person is eighteen years old at least…, which begs the question of exactly how much these authors know about how diagnostic processes work.


Intervention and ideology are bad… Unless they are ours, of course!

Interference, intervention and ideology are what the authors refer to as threats to kids' well-being, but throughout the book they fail to acknowledge that their very own suggestions are interventions rooted in their ideology rather than unbiased evidence reviews.

When you suggest that parents avoid at all costs allowing their children to explore their own identity, you are pushing for intervention rooted in an anti-"identity politics" ideology. From what I could infer (the authors did not define this concept or clarify what they refer to when they use it, mind you), they referred to a nebulous cluster of topics, from gender identity to diagnostic labels to race. The reason why identity politics is brought up at all is that the authors then go on to claim that children need to be protected from the cancel culture that forbids (!!) “valid concerns about gender affirming care’s long-term impacts”. Nevermind the fact that we have decades’ worth of research that prove, time and time again, how safe GAC is; they claim that there is no such thing. Of course, this quickly turns into a rant berating gender-affirming care and even drag queens, which is ideological propaganda to its fullest, and all of a sudden a book that claims to be evidence-based is ranting about how “Drag Queen Storytime might simply complicate kids’ lives”.

There wasn’t a single source provided to justify this framing of DQS as a hazard. There also wasn’t a single source quoted about gender-affirming healthcare, which has been researched extensively for a while now. Every single thing they said was their own subjective opinion, which honestly bordered on bigotry poorly disguised as concerns.

Hypocrisy regarding intervention and ideology peaked with the section “Child Protection: A Moral Obligation”, which essentially repeated what the previous chapters had said and stated that we have a duty to “protect” children from the dangers of diagnoses and discussions around identity; as well as from drag queen storytime, teachers that affirm students’ gender and whatnot. They go as far as to compare “affirming one’s gender” with “affirming anorexia”, which is as deeply ignorant as it is harmful. Gender is a part of one’s identity, whereas anorexia refers to a set of behaviours that are actively damaging to one’s health. Identifying as a boy does not starve you to death, and while the authors clearly decided to not do their research, no pre-teens are being given irreversible surgery. Puberty blockers aren’t being handed out like candy, and from 2017 to 2022, only 926 teenagers in the US used them. Fewer than 0.1% of all US teenagers received ANY form of gender-affirming care, be it puberty blockers or HRT, and yet the authors talk about this as if it were the most pressing crisis depressing children these days.

Mind you, I’d say that kids aren’t alright because their parents are overworked and barely see them, their schools aren’t safe, they don’t have proper access to healthcare, food is loaded with additives that mess with their health, and they don’t have suitable spaces such as parks where they can play and run around with their peers.


God forbid that kids have friends!

Another thing that consistently gets shunned by this book is peer interaction. For some reason, the authors do acknowledge that loneliness and a lack of connection are a part of the issue but then claim that peers aren’t who the kids should be interacting with. Not only is this developmentally questionable, since social skills are acquired through interacting with peers. It’s also concerning because the authors claim that these peer interactions are what happens when the kid cannot have a meaningful enough relationship with the adults, which is both false and disturbing.

Adults and peers play different roles in children’s lives, which is something that anyone who has paid attention during Developmental Psychology 101 knows. Peer relationships are not plan B when adults don’t pay enough attention to the kid, and they cannot be replaced by one’s bonds with teachers or parents. These are all important people in a child’s life, but they aren’t interchangeable because the roles and needs they fulfill aren’t, either. Kids need friends, which shouldn’t be a controversial thing to say.

Claiming that we should treat young people as crew, not passengers (ie. active agents in their own well-being), then turning around to say that teenagers shouldn’t rely on their peers because they are immature, is definitely an interesting thing to claim. "Peer orientation" isn't intrinsically immature; unless you are, of course, of the opinion that adults are the epitome of maturity and superior to all other age groups. Another thing that comes to mind in this regard is the expression “neurotic teen years”, which was used more than once. What does it even mean!? Other than being a stereotype about teenagers, that is. Either the authors are talking about neuroticism as in the personality trait that encapsulates emotional instability, or they are using Freud’s notion of neurosis as a psychiatric disorder. In both cases, they are once again doing the opposite of what they claim should be done by labelling an entire age group as “neurotic” (ie. unstable, unreliable, emotional).


Final thoughts

Overall, this book is ripe with contradictions, methodological flaws and conceptual gaps. At times I contemplated DNF’ing, but I pushed on because I wanted to know first hand what the authors were claiming when I wrote this extensive review, slash reply. Overall, though, I came out of this book feeling unsettled and disappointed. You cannot tell me that you are advocating for the suppression of interference, ideology and interruption if you’re going to call for the removal of disability accommodations in academic environments because you think, with little to no actual evidence to back it up of course, that providing disability accommodations and supporting students with special needs stunts their development. You cannot claim to be concerned about ideology, censorship and cancel culture when you at the same time berate gender-diverse children, dismiss decades’ worth of evidence about the benefits of gender-affirming professors and talk about conditions such as ADHD or autism as if they were mere fads rather than conditions that have been researched for decades.

When the authors claim that we need nuanced discussions that make room for all points of view, it’s funny how they fail to add that this doesn’t mean taking all opinions as equally valid. Yes, you can have any opinions you like, but that doesn’t translate into your opinions being bulletproof. If your opinion isn’t based on actual evidence, but rather on stereotypes and hearsay, you are entitled to it but you aren’t entitled to others not refuting it with evidence. In this sense, the authors clearly dislike the idea that gender-affirming care concerns are being rebutted in academic environments, but here’s the thing! If said concern is honest, there is no censorship in providing the generous amounts of evidence that GAC is safe and doesn’t cause “irreversible harm”. Quite the opposite! We should be glad that discussions are being had with scientific evidence on the table, and that people are accessing information that helps them understand why these interventions are safe.

However, claiming that these conversations are being censored points at a lack of actual concern regarding whether evidence supports the notion that gender-affirming care is safe. So does disregarding environmental factors that affect young people’s choices and habits, such as the lack of urban spaces where they can hang out with each other instead of doing so online; or the nightmare that is accessing healthcare in the United States if you don’t get your insurance company to cover the costs by providing them with a diagnosis.

Overall I would not recommend this book to anyone, for it is misleading and ripe with disinformation.

I came to this book with high expectations based on the blurb and the authors' expertise.
The heart of Kids These Days is in the right place, but unfortunately, it fell short for me.
The book is divided into parts, and each part, into chapters and each chapter, into smaller sections. The final sections of most chapters were what piqued my interest with a focus on solutions.
The authors discuss many issues that are relevant and prominent these days, however, that is one of the shortcomings of this book, because each subchapter requires more balanced discussions, resources, evidences and approaches than a book of this scope can provide.
I did not fully enjoy the arguments, did not always find them persuasive and convincing and found the tone to be a bit didactic.
My personal experience aside, I am glad Dobud and Harper are making some of the points that they are making and opening up many important areas to discussion.
I will not be reviewing this book publicly. I appreciate the opportunity and I took some value out of this book. I hope other readers can find more value in it.