Fun child psychiatry fact!

If we analyze a group of 40-year-old adults with the same diagnostic criteria & screening as we use currently on children, we get virtually identical rates of autism.

"Exploding rates of autism" likely a reflection of our exploding understanding. A 2025 Canadian study estimated 1.8% autism prevalence in adults, similar to child rates, showing diagnosis consistency across ages despite evolving awareness.

/2

New JAMA study (2025) claims social media use → increased depression in 9-13yo.

🧵But let’s dissect:

overall:
* Within-person effects: β=0.07-0.09 (small/medium)
* No between-person effects (β=-0.01)
* 4 waves, n=11,876, caregiver-reported depressive symptoms

1/🧵 The study is here:



However, I have a lot of critiques of this study and its conclusions.

Let's dig in:

2/jamanetwork.com/journals/jaman…

We currently have almost zero explanatory power for autism aside from some very obscure genetic and prenatal influences.

We already know what has caused the autism "epidemic"... Increased awareness, broader diagnoses, and more screening/requests for assessment.

https://twitter.com/Acyn/status/1910385785834250435

Bobby Kennedy frequently likes to say it was "1 in 10000 when [he] was a kid". It was not. Studies have shown that if we used modern diagnostics on we would arrive at similar rates, and syndromic presentations of youth for neurodiversity were IDENTICAL to those in the 80s.

/2

🚨Countering COVID Myths:🚨

❌Myth: "Lockdowns definitely caused massive learning loss"

✅Reality: Using a large set (n=2mil) of Ontario students, we see more improvements then losses, and trend of older students doing better than younger students.

/1 As an example of the statistical reason why I can say the above is a myth, zoom in on ALL the grade 3 scores (Grade 3 did the "worst")

Looking at the distribution, we see more deteriorations (52%) than improvements (45% of scores) achievement scores, but its very broad!

/2

Vaccines and "placebo control"

Placebo-controlled trials compare a vaccine to an inactive substance (placebo). This helps measure how effective the vaccine is. In the case of vaccines, often, the placebo is not "saline", but rather a previous vaccine or vaccine solution.

/1 When a safe, effective vaccine already exists, using an inactive placebo means some participants are deliberately left unprotected against disease. This creates unnecessary harm.

/2

🚨🇨🇦Correcting Disinfo🇨🇦🚨
"COVID vaccination didn't work"

In Canada during the Delta wave, vaccination prevented infection (unvaccinated 6x higher chance of being infected). As well, being unvaccinated led to a 22X chance of being hospitalized and an 18X chance of dying.

/1 For confirmed infections, the IFR for unvaccinated was a whopping 2.4%. The IFR for being vaccinated was much lower, both due to preventing infection and reducing the consequences of it.

Delta was a very deadly strain, and unvaccinated people died/suffered the most.

/2

Correcting revisionist history:
"COVID is not a problem for young people in the US"

Covid responsible (not "with", underlying cause) for 2% of all deaths <20. That's 1 out of every 50 deaths of all kids who die. #1 in infectious diseases, 5th in disease overall.

/1 COVID-19 deaths created 300,000 American orphans, 330,000 if we count "primary caregivers" and 380,000 if we count "secondary caregivers". That's a lot of childhood harm.

2x as common for Black kids
4x as common for Indigenous kids
1.6X as common for Hispanic kids

/2

🏳️‍⚧️FAQ for posterity:

Why do you use pronouns in your bio?
Because it's an easy way to promote inclusivity & to increase awareness of gender expression. It costs me nothing, &because I work with kids who are establishing their identity it shows that I don't make assumptions.

/1 Is being transgender a mental illness?
Being transgender is not a mental illness. It is a natural variation of human phenotype, though some transgender individuals may experience distress, called gender dysphoria, which is addressed through appropriate care.

/2

🧵RFK Jr. is an antivax, AIDS-denying, absolutely antiscientific conspiracist.🧵

ANTIVAX:
“They get [vaccinated], that night they have a fever of 103, they go to sleep, and three months later their brain is gone... This is a Holocaust, what this is doing to our country.”

/1 ANTIVAX:
"I do believe that autism does come from vaccines"

Metaanalyses involving MILLIONS of children have confirmed there is no link. The lie started with another antivaxxer, disgraced fraudster Andrew Wakefield, who fabricated data.

/2

Battling Election Misinformation
Part 2: "The Mandate"

Contrary to media/republican pronouncements, the election of Donald Trump was one of the narrowest (by popular vote, +1.73%) in history, with only 7 elections since 1800 being narrower.

/1 In fact, if we look at the margin of victory when we include all eligible voters, Trump wins with 31.3% of the voting population, compared to Harris' 30.2% and 1% going to other candidates. 37.4% did not vote.

If we only include voters, Trump wins 50.03% to 49.97%

/2

"[AIDS] is not being caused by a virus. It's not a virus... These people are dying because of 'poppers'... they were people who were part of a gay lifestyle... "

"This is not a viral disease, but it's a disease that is environmental."

- HHS Secretary Nominee RFK Jr

/1 Chemicals in water are causing trans kids: "A lot of the problems we see in kids... are coming from chemical exposures, including a lot of the sexual dysphoria that we’re seeing."

- HHS Secretary Nominee RFK Jr

/2

🧵Battling Antivax Disinfo🧵
Vaccination did NOT increase cancer deaths.

Here I took the 6 deadliest cancers (all 5 survival rates under 50%) in a highly vaccinated population (25-54), and we can see ZERO evidence of vaccine-related cancer deaths, all the way to May 2024.

/1 If i move ages to 55+, we see the same thing, and we are now looking at a lot of deaths from these extremely aggressive cancers, so this isn't some underpowered stuff here. There is NO evidence that deadly cancers have increased due to vaccination.

None.

/2

The Presidential Election
Data Geekery with my interpretations

1) The Country Shifted, but More Didn't.

The final share will be ~ +1.3 to +1.5% for Trump, which is a shift of ~+5.8%.

If America was a room with 65 people in it, only 2 out of the 65 people switched shirts.

/1 Note: this math might seem like it doesn't work, but we have to remember to include those that voted 3rd party (1.5%ish) and those that didn't vote (about 35%).

Excluding non-voters who were eligible,
2020: 22/43 D & 20/43 R
2024: 20/42 D & 21/42 R

/2

🧵Medical Consent in Minors🧵

Let's do a detailed look at this issue!

Bottom line: yes, in most Western jurisdictions, mature minors who are deemed capable can consent to medical procedures (Sometimes with limitations)

/1 For reference, consider 2 scenarios:

1) a 6-year-old child needs chemotherapy for rapidly progressing cancer

2) a 17-year-old requests hormonal birth control ("the pill") and advice on STI prevention

/2

🚨COVID-19 Vaccination saves lives and improves outcomes 🚨

In this UK study of >3 MILLION PEOPLE who vaccinated, the incidence of mental health problems was significantly reduced when a subsequent COVID-19 infection occurred.

/1 Looking at the totals who were infected with COVID-19, it is clear that COVID-19 diagnosis was associated with a ROBUST increase in mental health problems after the diagnosis.

/2

Yet another study finding differential impacts (mostly with decrease of symptoms) on the mental health of youth comparing prepandemic to pandemic times.

The media far far far less likely to report on these now common findings.

/1

jamanetwork.com/journals/jaman… My colleagues and I talked about this at length, that there were many reasons to be cautious about the early "expert predictions" and in fact when good evidence was considered, many so-called evidence based scientists were wrong: dire outcomes on mental health harder to find.

/2

❌Mythbusting❌
Youth suicide & COVID

❌Myth:
responses to COVID "caused" 🔼youth suicides

✅Reality:
We now have 4 years of pandemic data showing that school-aged youth did NOT have an increase in suicides; in fact, rates decreased 18.3% from recent trends AND averages.

/1 This is true for girls in the US (pretty much right on the 3-year average (-0.8%), and 16.3% less than expected from the 10-year trend).

/2

Talking to kids when they're struggling🧵
For parents (or anyone who cares for kids!)

It can be really scary to notice something in your kid & be worried suicidality/self-harm.

How do you approach kids?

I've had this conversation >10000 times so I have some tips!

Be CALM

/1 CALM is a memory-trick to remember the key concepts of communicating to a struggling kid but also to remind you to be in control of your own emotions. If you are prepared, you will defeat your initial instinct, which will be to FREAK THE BLEEP OUT!

/2

Suicidology
Predicting Suicide Death

A recent study looking at >2M Americans presenting to ERs with MH concern shows the difficulty of "predicting suicide" - we can't predict suicide to help guide important clinical decisions.

The problem: Sensitivity vs PPV

/1 They used machine learning EMR-coded variables (outpatient visits, medications, previous appointments, age, etc etc) - you can see the entire dictionary used to "predict" here (word doc):

They had 2,069,170 ER visits and 899 suicides within 90 days.

/2ars.els-cdn.com/content/image/…

Debunking Antivaxxer Tropes:
"Antivaxxer is a slur" 🧵

Many many many accuse me of using a "slur" when I say "antivaxxer". It is a twitter shorthand for sure, but it is not a "slur", and I use it without regret or remorse.

/1





I certainly believe that if one is an "anti-vaxxer", they are not using science, reason, or reality to understand vaccines.

& I note a distrubing trend in antivax and some concerning other beliefs.

That being said, when I say antivax, I only mean "antivaccine belief holder"

/2

Debunking Antivaxxer Myths
"🇪🇺 Vaxxed Countries have higher mortality"
No, they don't.

This is COMPLEX:

a) countries had different PRE-VACCINE infection (offers more dangerous protection than vax but indeed protection). Obv, vaccination NOT correlated with pre-vax death.

/1 b) The FIRST VACCINATION SERIES against OG COVID was phenomenally effective at preventing infection, transmission, illness, hospitalization, and death (VE >80-90% in all).

This is clearly evident by one of the most striking correlations you'll see!

COVID deaths vs Vax:

/2