Childhood Deficit Disorder and the Atrophy of American Childhood

Dr. O'Leary proposes Childhood Deficit Disorder as a way to conceptualize the rise in mental health issues among modern youth, exploring how systemic changes in culture and environment contribute. He contrasts the "free-range" parenting style prior to the 1980s, which fostered autonomy and resilience, with the modern trend of intensive, managerial parenting driven by economic anxiety and a "culture of fear" fueled by media. Dr. O'Leary explores how children's independent mobility has plummeted due to these shifts and in response to a built environment hostile to pedestrians, leading to a loss of key socialization spaces.  Digital media, including social media, both actively displaced healthy social spaces and filled the void created by anxious, fearful parenting, and poor urban design. Childhood Deficit Disorder (CDD) is a framework—not a clinical diagnosis—to describe the developmental consequences of chronic deprivation of autonomous play, independent movement, and connection to the physical world, often exacerbated by the "digital colonization of childhood."

For references and a more in depth discussion: https://sciencebasedpsych.blogspot.com/2025/12/childhood-deficit-disorder-and-atrophy.html

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References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com. All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else. We reserve the right to be wrong. Nothing in this podcast should be treated as individual medical advice.

Transcript

For references and a more in depth discussion see : https://sciencebasedpsych.blogspot.com/2025/12/childhood-deficit-disorder-and-atrophy.html

Welcome to PsyDactic. I am your host Dr. O'Leary, a second year fellow in child and adolescent psychiatry in the National Capital Region. This is a podcast about psychiatry, about neuroscience, about psychology, about sociology, just about anything that could affect the way we behave or the way we feel. Recently, people have tried to come to terms with what has really happened to us over the last 50 years. What has happened to our families, what has happened to society. We've seen massive changes, and it's all been happening while we've been living it. So, it's been hard really to wrap our heads around it. But one of the things that we have noticed is that kids are not doing well. Many, many children are struggling. The question is why? Some out there have attempted answers. There's Jonathan Height. He's a social psychologist who wrote the anxious generation and he points to lots of factors that have caused children to have higher rates of different psychopathologies than they had in the past. There have also been thinkers for hundreds of years who have pointed to things like urbanization and stress in society and how those result in worsening of our general mental health. What I want to do today to add to that conversation is to introduce something I am calling childhood deficit disorder. Now, I'm not proposing that this disorder be included in the ICD10 or the DSM, but I would like people to think about this disorder as I define it because I think it is a good way to understand some of the things that are contributing to the skyrocketing rates of anxiety and depression and loneliness and suicide among our youth. [Music] But before I go through what are the would be considered the diagnostic criteria of childhood deficit disorder, let me back up all the way to let's say the 1970s seems like a good place to start if you're going to start anywhere. Parenting norms back then were more than just a little bit different from today. I did a Google Ingram search and I searched for the term parenting style and I found out parenting style wasn't even a thing until the 1980s. There was like a couple references in the 1970s. Parents didn't think of themselves as having a style. Child raring was viewed as natural, instinctual, even if a chaotic process rather than a professionalized set of competencies. Every parent must learn in order to have the best child possible. You could say the prevailing ethos was free range. [Music] Let them play. They'll be fine. I mean, this is why we have all of those early8s movies by Steven Spielberg, like The Goonies, where a group of kids completely unsupervised goes off on some grand adventure. Children in this era typically left their homes sometime in the morning if they didn't have to go to school. Uh, they operated with some degree of autonomy. There were no cell phones. You could call up a neighbor and say, "Hey, is Timmy over there?" if you were wondering where they were. But this kind of parenting would potentially be

illegal in many jurisdictions today. In the past, the physical boundary of childhood was really the broader neighborhood, not just your own property line. Parents in the 70s could be accused of having a kind of benign neglect for their children. Just kind of trusting that the community and really the children themselves could manage the frictions of everyday life. The primary parenting guidance of that area was Dr. Benjamin Spock. Um, and he focused really on pragmatics of physical survival and having a healthy child rather than like optimizing their cognition and their emotional outcomes um, or cultivating a resume for your child so they can get into the best school. Now, I'm not saying that this was a perfect or altogether correct approach to raising kids, but it did foster a sense of self-efficacy and curiosity in children. The 1970s parent didn't really seem to view themselves as a child's entertainer or their conflict mediator. If children argued on the playground, they were expected to resolve the disputes without adult intervention. In fact, if adults intervened, they were often considered medalsome, both by the kids and by other adults. Now, this lack of intervention was not merely a lack of interest in the child, though I guess for some people it probably was. But on average, it was more of a tacid acknowledgement of children's anti-fragility. The term anti-fragility in general just means that a system is resistant to stress. It has resilience and in fact it can improve if moderate amounts of stress are applied to the system. Systems that need challenges and stress in order to develop are anti-fragile. The cultural assumption back in the day was that a child's time was really their own. Boredom was a stimulus for creativity rather than a problem to be solved by an adult. Now, part of the shift in the 1970s permissiveness was not really a random cultural drift, but a response to structural economic changes. The 1980s saw a rise in economic insecurities, whether real or imagined. Parents are now relying on higher education for economic viability for their children, thinking that they won't be able to make it in the world if they don't have a college degree. This really raises the stakes for childhood. In the past, the economy was perceived as maybe more egalitarian, and this allowed for a more lz fair parenting style. You could achieve a middle class standard with a job that did not require a bachelor or master's degree. However, as safe middle- class jobs were shipped off to places like Mexico, China, and the South Pacific, the gaps between the halves and have nots expanded. The middle class contracted. Particularly, the ability to be in the middle class and not have a college degree was more limited. So, a lot of parents began to view childhood not as a time of leisure, but as this critical window for human capital accumulation. This economic anxiety drove the adoption of what some have called intensive mothering. It's a term coined by sociologist Sharon Hayes. I think it's better to refer to it as intensive parenting in general. So the idea basically posits that proper child rearing must be child- centered, expert guided, emotionally absorbing, labor intensive, and expensive. A child is a project to be managed, social capital to be maximized. Now, to be fair to mothers and fathers, this kind of parenting is not necessarily a choice that they were making, but a response to the economy and other social pressures. Some have tried to blame modern parenting styles on parents being too busy, but that doesn't seem to be the case. This may be more parents trying to just absolve themselves of responsibility than any kind of objective truth. There are time use diaries analyzed by the Pew Research Center that um reveal in fact an increase in the volume of time parents dedicate to their children. So in 1965, fathers spent on an average of just about 2.5 hours a week with their children. By 2011, that figure had nearly tripled to 7.3 hours a week. This holds true even for mothers. Despite entering the workforce in record numbers, mothers increased their child care time from about 10 hours per week in 1965 to 13.5 hours in 2011. This increase was most pronounced among college educated parents. So this kind of supports the idea of this classbased strategy of cultivation among children. You're spending more time with your kids not in order to have free play but to prepare them for the future. So the problem might be not spending too much or too little time with the children but not spending the right kind of time with children. It was the nature of the time spent with children that shifted fundamentally. In the 1970s, parental presence was often passive. The parent is in the kitchen while the kids playing in the yard. In the more intensive parenting era, the time is active and managerial, driving them to soccer practice, assisting with homework, mediating playdates, curating their experiences down to the tiniest little detail. This shift likely came at a high psychological cost. Of course, the mothers of fathers who intensively parent are likely to have higher levels of stress themselves, anxiety, guilt compared to those who do not. Now the pressure to be constantly responsive to their child has created a dynamic of parental burnout where parents selfworth is inextricably tied to the child's performance. But it also reflects onto the child. The child has to be constantly responsible to the parent. So the child also might feel responsible for not being good enough, especially if the parent insists they're not doing good enough. There was another driver and this can be described as maybe the culture of fear. I think it's commonly talked about that one of the things that drove kids into the house was this kind of media fueled panic regard regarding child safety. And this happened uh started really in the 1980s with this 24-hour news cycle and these highprofile abduction cases like Adam Walsh, if you can remember that one. So America's consciousness was bombarded constantly with all these narratives that public spaces are scary and that there are predators everywhere. One of the explanations of this phenomenon is by a guy named George Gerber and he talked about something called cultivation theory. And cultivation theory posits that heavy consumers of media develop an exaggerated belief that the world is mean and kind of scary. And this is despite clear statistical evidence that violent crimes against children, including sexual abuses and abductions had been declining and declined significantly from the early 1990s onward. Parents are more fearful now than they have ever been, but the risk is lower than it has ever been. And this, we think, is the result of something called the availability heristic. It's the ease at which one can recall terrifying news instead of some bland number about how safe we really are. The news of bad things is far more available to us than is the truth about the world. So this has resulted in a sort of societal stranger danger. Now, stranger danger itself is a natural condition of late infancy and um toddlerhood where kids sort of understand that some adults are not familiar and so they retreat to familiar adults especially their caregivers. But instead of being an infantile defense, it has become one of the prerequisites for good parenting. So to be a responsible parent in the 21st century is to be a watchful parent. The free range behaviors of the 1970s are seen as negligent. Having this fear justifies removing children from streets and parks and relocating them to the perceived safety of the home or the backseat of the car. And this effectively strips them of any independent interaction with the world. They are suddenly always around their parents. While it is unclear exactly how overprotective parenting and parental anxiety has defined modern parenting, I think there are a few that argue that it hasn't. In addition to how parenting styles have changed, the physical environment in which kids grow up in has changed significantly as well and their actual mobility has plummeted. Probably the most quantifiable metric of the contraction of childhood, something we can actually measure, is the decline in independent mobility. And this can easily be seen in children's commute to school. So the daily commute to school was once seen as kind of a a place where kids could be unsupervised. They could have all this socialization. There were no teachers. There were no parents. uh they had time together without the strict rules of society being constantly enforced upon them. But it's now something that for example makes other parents gasp when I reveal to them that we let our son ride his bike to school. You mean he crosses University Avenue all by himself? Yeah, I taught him how to do that. So here's a few statistics and these are from uh US school travel and it's from 2009 from mcdonald.web.unc.edu. edu. In 1969, about 48% of all students were walking or biking to school. In 2009, about 13% of all students were walking or biking to school. So, this is a change of like 73%. It's huge. Now, among students living within one mile of school, these are ones who easily could walk or bike to school, 87% in 1969 would walk or bike to school. And that number is down to 35%. So, by about 2009, the parental taxi had obviously replaced the child pedestrian. If you think about it, you can see how this creates kind of a feedback loop. Parents drive children due to fear of traffic and of strangers which increases traffic volumes around the schools which proves their point. I mean it makes the environment more dangerous for pedestrians because it increases the amount of cars. So parents themselves are creating a dangerous environment that they have been protecting their children from. And this prompts more parents to drive. Another thing about the environment is is really how hostile uh new construction is to children. So the physical landscape of the United States has been engineered it seems like to be intentionally hostile to kids and to other living things in general. So the dominance of the automobile and or urban planning this is evident in these widening of roads even like removal of sidewalks, sprawling suburbs um has severed and disconnected what used to be integrated neighborhoods and wider ecological systems. And here's something else ironic about the built environment. A lot of people want to live on a culde-sac because the culde-sac is designed for safety. Cars can't use it as a thoroughare. But this can isolate children instead of connect them because the arteries connecting the culde-sacs themselves are dangerous and there are no other places. There are no alleyways or paths between culde-sacs. There is a huge loss of translational spaces. There's been a huge loss of transitional spaces. Things like the alleyways, vacant lots, quiet streets. So, there are no longer venues where unstructured historical play even can occur. When an environment is designed primarily for cars, children are rendered dependent upon their adults for pretty much all of their movement. And this delays the development of things like their spatial awareness, their navigational skills, and their self-efficacy. Among the destruction of spaces for children is the dir of what are called third places for teens. So, sociologist Ray Oldenberg defines third places as places that are essential for community vitality. They're social environments that are distinct from the home and from the school. Places like malls, diners, parks. All these places are increasingly hostile to adolescence. While the public spaces like parks aren't designed for teens, they're designed for small kids or they're taken over for organized sports. And this leaves no real legitimate space for adolescent socialization. So, the loss of these third spaces drives teens into social media. This is where I can connect with my friends. There is a vacuum left by the decline of physical gathering spots and that vacuum is filled by digital spaces. These digital spaces offer the illusion of connection but all too often lack any kind of real physical information or those kind of low stakes social interactions of the real world where you say something to someone, they interact, there is a small conflict and then you get through it. In the digital space, that is far more difficult to achieve. So, the decline of these third spaces forces socialization into the private sphere, into children's bedrooms where they're on their digital devices. Perhaps the most chilling development in the containment of childhood is the legal and social criminalization of independence. Parents who attempt to raise freerange children often face scrutiny from the states. There have been high-profile cases, and this increases parents fear, right, of being investigated by child protective services for allowing children to do things like walk to the park by themselves or play outside unsupervised. So, surveillance parenting is enforced not just by the state, but by other citizens who view an unaccompanied child as a victim in waiting. In response to this, there have been movements out there. I don't want to say everything is just like going in one direction. Um, for example, the let grow movement has emerged and it advocates for like reasonable childhood independence laws actually putting on to the books that children have the right to be independent from their parents under certain circumstances. Some of these statutes have passed in states like Utah, Texas, Oklahoma, and Colorado and they help to clarify um that parents can allow their children to engage in independent activities and this does not constitute neglect. But we wouldn't need this legislative push back if states had not already encroached on the fundamental rights of children to exist in public without adult supervision. Before I finally get to really defining childhood deficit disorder, I want to talk about something called nature deficit disorder. Richard Louu um created this concept and this concept really shows how some thinkers have been attempting to bridge the physical environment with mental health or the lack of being exposed to the physical environment and the mental health consequences of that. Louv argues that behavioral problems observed in modern children, including like ADHD stuff, are often just a response to an unnatural environment. So, among other things, he argues that the human child evolved to move through complex natural landscapes, not just to sit sedentary in climate controlled rooms. And I think we could probably all agree on that. Now, some research actually supports the hypothesis that being out of nature, being out of green spaces has consequences. And it does this by suggesting that actually exposing children to green spaces and unstructured outdoor play can significantly reduce hyperactivity and distractability and improve cognitive functioning. But for me, I mean, given the extremely diverse uh set of definitions of what constitutes natural, I'm not usually a huge fan of appeals to nature. But what is obvious is that outdoor activities, for example, have far more benefits than time spent in front of screens. Finally, before I get to childhood deficit disorder, I want to talk about what has been called the great rewiring or the digital colonization of childhood. Social psychologist John Hyde um identified this period between 2010 and 2015 as kind of a critical inflection point. uh and this has helped to create what he calls the anxious generation um which is what he discusses in a book by the same name. So this era marked transition from play-based childhood to a phone-based childhood. Now the introduction of the smartphone uh and it was the iPhone in 2007 and then the subsequent ubiquity of social media apps like Instagram fundamentally altered the developmental landscape for children. and I'd say even for adults. So, height argues that this great rewiring correlates precisely with a meteoric rise in rates of adolescent anxiety, depression, and self harm across the English speaking world. So, some of the mechanisms of this include social deprivation. So, screen time displaces face-to-face interaction, which is essential for reading social cues and developing empathy, not only for other people, but even for yourself. There's also sleep deprivation. So, the presence of devices in the bedroom, eroded sleep quality, kept people up very late. I have lots of patients who would say they stay up all night on their devices if their parents don't take them away. And sleep we know is a critical factor in mental health and well-being in general. There's also the attention fragmentation from devices. So, constant notifications, um having all the ads popping up, this really prevents deep focus that's required for any sort of complex cognitive task. and for emotional regulation. Then finally, there's the addictive components of these things. So the variable reward schedules and the way that these social media apps are designed are meant to hijack that reward system in your brain and create a dependency on them. And I've seen this multiple times where young people when they've had to be deprived of their phone experience extreme dysphoric reactions and withdrawal.

All of the things I've discussed before result in this great paradox. There's this it's the paradox of connection. We are isolated within a highlyworked world. The impact of digital media on social connection has been a subject of intense debate. Some ascribe to that displacement hypothesis I've talked about where the internet kind of replaces real world interactions, but other people say that it just stimulates them. It improves them, enhances them. Current evidence suggests a picture that is actually pretty nuanced. There is in fact a rich get-richer dynamic. So for socially competent youth, those are youth who already have good social skills, social media can augment friendships. But for lonely, anxious youth or for youth with poor social skills, it is most likely to just exacerbate isolation and worsen their social skills. So this means that kids getting online before they have otherwise become socially competent, that's like anyone under the age of about 16, right? May be harmed more by being connected online than it would help them. Now, teenagers almost universally report that social media helps them to feel more connected. But this connection is often really performative. It lacks the embodiment of physical touch. It lacks eye contact, synchronous verbal communications, back and forth sorts of uh real-time uh exchanges. And so these digital interactions don't actually trigger the same kind of biological release of stress regulatory hormones, things like oxytocin, that real world interactions do. In the end, we see a generation that's really hyperconnected, but still reporting historically high levels of loneliness. What I think is most ironic about this is we're often asking kids who do not know how to connect offline, whether online or offline connections are better. They often don't even have the experience to know the difference. Australia just banned social media for kids under 16. And many of them are making statements like, "I won't be able to chat with my friends anymore without social media." It's as if they have no concept of any other way to communicate. [Music] So, now I get to defining childhood deficit disorder. I mentioned earlier I'm not a huge fan of nature deficit disorder um because I'm not a huge fan of an appeal to nature. Although I think that nature deficit disorder definitely has ideologically a kinship with childhood deficit disorder. Unlike traditional deficit disorders you might encounter in the DSM, childhood deficit disorder is more a disorder of the environment and the cultural surroundings than it is of the child itself. Although it does consist of a child's reaction to this environment and culture, childhood deficit disorder frames the mental health crisis not as malfunction of the child, but as a physiological and psychological response to systemic deprivation. Now, I can hear Alan Francis grunting right now. Allan was in charge of the DSM4 task force and because of this experience among other things he was convinced that psychiatry as a whole over pathologizes new normal human behaviors. So there's no shortage of psychiatrists out there trying to get their own diagnoses into the DSM. But if you're listening Alan I want to reassure you that I do not want this diagnosis in the DSM. This is not a diagnosis to use in clinical practice but more as a mental exercise. It's meant to help people understand what is happening to our youth, not just to add to the deluge of proposed diagnostic criteria. Childhood deficit disorder is a developmental condition caused by the chronic and systematic deprivation of autonomous social play, independent mobility, risk-taking, and connection to the physical world. It's characterized by the atrophy of emotional resilience, social competence, and self-efficacy due to severe environmental restrictions, and increasing digital displacement. A diagnosis of CDD assesses the child's ecosystem and their reactions to it. The presence of three or more environmental criteria leading to two or more functional impairments constitutes CDD. So, here are the environmental criteria. You might call them the causes. One, play deprivation. The child engages in less than one hour of unsupervised, unstructured, non-digital play per day. Two, mobility restrictions. The child is unable or not permitted to travel independently to any location, school, park, friend's house, within walkable radius appropriate for their age. For example, 1 mile by age 10. Three. Surveillance saturation. The child is subject to constant monitoring via digital tracking or adult presence during waking hours, eliminating the experience of privacy and solitude. Four, digital displacement. Screen media use exceeds 4 hours per day during school days and 6 hours per day on average during weekends or school breaks. So, those were four of the potential causes.

The next are the functional impairments that result. So you would need three or more of the environmental criteria, the causes leading to two or more of the functional impairments. These impairments include one, an external locus of control, a persistent belief that problems cannot be solved without adult intervention or an insistence that adults be included most or all of the time in order to adjudicate conflicts with peers. Two, risk aversion and fragility. Extreme anxiety regarding minor physical risks, climbing, running, crossing the road, or social risks, disagreements, minor criticisms, playing where adults cannot be seen, leading to avoidance behaviors.

Three, social atrophy. Inability to resolve peer conflicts without arbitration by an authority figure. Reliance on digital media for communication.

Four, sensory dysregulation. Difficulty managing physical arousal or attention in non-digital environments. For example, not being able to sit still without a device in your hand. But of course, then there are all the other exclusion criteria. The symptoms cannot otherwise be explained by any other disorder including but not limited to neurodedevelopmental disorders such as autism spectrum disorder or attention deficit hyperactivity disorder or to anxiety disorders like social anxiety disorder or separation anxiety. However, childhood deficit could be used as a modifier. So the modifier with significant childhood deficit could be given to any other diagnosible disorder if that disorder has superseded CDD, but the child meets at least two or more of the environmental criteria and is likely to have added additional burden or worsening of the severity of their symptoms for that other disorder. That just means that if you think play deprivation, mobility restriction, surveillance saturation, or digital displacement, if at least two of those has significantly contributed to their current presentation, you can add the with significant childhood deficit modifier.

Now, I'm proposing this, you know, more as a intellectual exercise than something anyone will ever really be diagnosed with. But thinking about it in this way I think is very powerful because it does help us to understand something is happening to our kids. Those things have anticedants and we have a pretty good understanding of what many of those anticedants could be. I don't want to end the podcast just with this whole oh the world is terrible our children are suffering and we're doing nothing about it. You know I've mentioned the let grow uh campaigns. So in in resistance to these trends, there are movements out there and one of the movements is an organization called LECO and they are lobbying for reasonable childhood independence laws that really narrow the definition of neglect. So they protect parents who allow their children to do things like walk to school, play outside, um have nonsupervised interactions with other children and adults. There's also been a push for phone free spaces, especially in a lot of schools. Um, many of the schools that some of my patients go to, uh, my patients have have noted to me that, oh, next year we're not going to be allowed to have our phones in school anymore. We're not allowed to have them out, but you know, a lot of kids do anyway. And then there's some evidence, and John talks about this in his book, The Anxious Generation, that the mere presence of the phone, even if it's not being used, can have detrimental effects on students in the learning environment. And then one of the more extreme cases of what is happening is that Australia just passed a law requiring no social media site allow anyone under the age of 16 to sign up for their site. Now, of course, the social media uh outlets all protested, said, "Oh, it's going to be impossible for us to verify this." But we know that's not true. I know that's not true because I have to have my age and identity verified frequently when I'm online in order to do a lot of the things I need to do. So, it's not going to be that difficult for them. What happens when we do allow kids to grow up and socialize outside of social media first, become socially competent before they get on social media? How are those kids going to be different from the ones who assumed that experiences that they got on social media were equivalent to the ones they would have had otherwise? I really hope that I get some feedback from this episode. Good, bad, or indifferent. Call me names. Tell me you think this is great. Whatever it is, you can go to sidactic.com. There's a form there you can fill out with some feedback. This also is posted on YouTube. So you could go to Psydactic YouTube channel and you could post comments on the show there. If you made it this far with me, I really appreciate it and I welcome you to come back. I'm Dr. O'Leary and this has been an episode of PsyDactic.