* is 15. Her parents know that something has changed, but they cannot quite understand what. She spends hours in her room, often with her phone in her hand, yet speaks very little to anyone at home. At school, she has stopped sitting with her friends. Comments about her appearance began as jokes—about her weight, skin—but eventually became something she dreaded every morning.

Then came the anonymous messages, edited photographs and cruel comments online. She began avoiding mirrors, photographs and eventually school. Her sleep deteriorated, her grades fell and she started hurting herself. When her mother asked what was wrong, she said, “You won’t understand.” She was communicating—though not with her parents. Late at night, she typed into an AI chatbot about how lonely, ashamed and hopeless she felt. The chatbot became the one place where she felt she could write without being judged.

Her story may sound extreme, but unfortunately these stories are becoming increasingly familiar to child and adolescent mental health professionals across Pakistan.

With over 60 percent of Pakistan’s population under the age of 25, it is a remarkably young nation. Pakistani children and adolescents are growing up amid multiple pressures, including academic competition and examination pressure, financial uncertainty affecting families, family conflicts and changing family structures, climate change, exposure to disasters and continuous pressure of being connected on social media.

While stressors are increasing, protective support systems may be weakening. The result? A growing mental health crisis among Pakistan’s youth—one that demands our urgent attention.

The digital world presents both an opportunity and risk for children and adolescent mental health. Potential benefits include access to information, mental health awareness, opportunities for creativity and learning and peer connections. On the other hand, internet addiction, cyberbullying, body shaming, fear of missing out, sleep difficulties, exposure to self-harm content and online sexual exploitation may compound the burden of mental health issues and leave deep emotional scars.

The problem is not that children are using technology; the question is whether technology is becoming their only source of connection, validation or emotional support. Children and parents need to be careful not to let devices come between them and the people they care about.

For S, an AI chatbot was the only place, she felt safe, private and not judged, allowing her to put difficult feelings into words. It was available 24/7, at no cost. But chatbots are unable to understand individual children’s circumstances. They can provide inaccurate information and inappropriate reassurance, reinforcing distorted beliefs instead of challenging them and may not be able to respond to imminent self-harm and suicidal risk. A trusted human needs to be in the picture. A chatbot cannot replace the parent, teacher or a mental health professional.

But trusted adults in child life also need to realise that sometimes behaviour is communication that adults fail to notice. They may interpret withdrawal as attitude, excessive phone use as laziness, irritability as rudeness and disrespect, isolation as wanting privacy. So, focusing on what a child is trying to say through their behaviour may start the conversation differently.

Parents play a vital role in protecting and promoting their children’s mental health. A supportive home environment, characterised by open communication, setting digital boundaries rather than surveillance alone, emotional warmth and consistent care can help children cope with stress and adversity.

Parents should create a safe space where children feel comfortable sharing their thoughts and emotions without fear of criticism or judgment. Parenting programmes and community-based awareness initiatives can also strengthen families’ ability to understand and respond to their children’s emotional and mental health needs. Besides, educational institutes need to provide psychologically safe environments, build teachers’ mental health literacy, develop antibullying policies, life skills and emotional literacy. This includes building responsible digital citizenship while ensuring the presence of school counsellors and referral pathways.

Our health system needs integration of child mental health with family physicians and pediatrics, focusing on early intervention and accessible child and adolescent mental health services. Digital platforms also have a responsibility to ensure the protection of minors and control access to harmful content.

In a world where connections are increasingly measured in hashtags, followers, likes and shares, we must not forget the value of real human connection. Perhaps the most important thing we can do is to ensure that the next time a young person like S feels distressed and chooses a chatbot to express it, they get an answer not only from the chatbot but also from a parent willing to listen; a peer ready to support; a teacher who notices; and a mental health professional who addresses the concerns seriously.

We must choose connection over isolation, conversation over silence and play our role in building a society willing to create a safe space for our children and adolescents to grow and thrive. Sometimes, the most powerful intervention for a child is simply knowing that someone cares; and the most powerful therapy, love and connection.

*Name hidden for privacy

The writer is professor of child and family psychiatry at King Edward Medical University, Lahore.