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The problem with teens and smart phones, experts say, is "they're always on."

Both of them.

And that can take a toll on their . A new study links anxiety, severe depression, and suicide with the rise in use of smartphones, tablets and other devices.

As kids head home for winter break, parents are urged to help their children foster those real relationships, the ones that involve making eye contact and interpreting body language. Local mental health experts encourage teens and parents to establish a routine that fosters a balance between real and virtual communication, even as many adolescents will no doubt find gifts of technology under the tree this holiday.

For as smart as phones may be these days, they simply don't know when to quit. To protect their kids' mental health, parents must develop methods for outsmarting them, experts say, and often that involves simply turning them off.

Jean Twenge, psychology professor at San Diego State University and a graduate of the University of Chicago, has written extensively on youth and mental health. She recently released a study that shows a correlation between the rise of the smartphone and increasing rates of depression, suicide attempts and suicide itself among teens. According to news reports, the finding is based on CDC data and teen-issued surveys that revealed that feelings of hopelessness and suicidal contemplation had gone up by 12 percent during the time period and that nearly half of the teens who indicated they spend five or more hours a day on a smartphone, laptop or tablet said they had contemplated, planned or attempted suicide at least once—compared with 28 percent of those who said they spend less than an hour a day on a device.

Local school counselors and social workers as well as clinical mental health experts at local hospitals confirm they are seeing an uptick in signs of depression and/or anxiety among teens. But, they also say, there are things parents and professionals can do to help curb the risks.

Too much, too often

"I just came from a South Side guidance directors conference where we heard from a couple hospitals in the area that treat students for depression or suicidal tendencies or high anxiety. They're telling us they've seen quite an uptick, that they're hiring staff, they've got longer waiting times, they're running more programs just to keep up with the need they're seeing among high school kids and even younger kids," said Brian Nolan, guidance director at Andrew High School in Tinley Park.

Nolan said, "My belief is that today's technology never allows children to truly disengage from their social lives. When we were kids we could hang out with our friends during the day and then at night, we'd have down time with the family or we might go shoot hoops or play Legos away from friends, so we could gain some kind of balance."

But the smart phone's ability to connect us all immediately doesn't allow that social interaction to ever be turned off, he said. Some of the allure is the desire to be included, and some of it is defensive, he said.

"They feel like if they're not on it all the time, they're missing something important, or will miss out on a funny conversation, or someone might say something about them. There's a lot of worry and concern and stress about what's going on in at a time when it would be nice for a child to step away from it and not care," Nolan said.

"We know that rely on smartphones. A recent study shows we touch them about 2,500 times a day on average," he said. "I use food as a metaphor. If a student is overeating or eating a bunch of junk food, you probably as a parent would have a conversation about better eating habits, the importance of exercise, moderation, things like that.

"Cell phones are exactly the same. To tell a student you can't use it, is the same as saying you can't eat. That may sound extreme but that's the reality. (Technology) is how they maintain relationships. So, it's probably better to discuss healthy ways to use it," he said.

Questions to ask your teen, he said, might include: Do you feel addicted to it? Are you checking it constantly? Can you set it down for awhile?

When students only interact via technology, Nolan said, "they're much more likely to withdraw from healthier interactions and are more likely to be hypersensitive to what's being posted. If they aren't included they can feel lonely. If they are included, they can feel pressure to keep up.

"I think parents feel bad (about this). It's hard to attack a thing we don't fully understand ourselves, because we didn't grow up with it," he added.

But, Nolan added, "modeling is a big piece of this. We as adults sometimes stop conversations with our own children because we have a text message coming in. Or we'll text at the dinner table or while driving. So, we're teaching our children that what comes through the cell phone is immediate and important and that it should take precedence over what we are currently doing."

Equal access to good and bad

In her 17 years as a social worker at Argo High School in Summit, Allison Bean said she's had "a front row seat to the shift from a time where kids couldn't wait to leave the house to hang out with their peers to the present day digital age where our kids reluctant to leave the couch.

"Many of my students may not have adequate clothing, food or even running water in their homes; but they have phones," she said.

Teens, she said, "are (physically) isolating themselves more and more from their real support systems during a period of their lives that, even under the best circumstances, is very turbulent and stressful."

Exacerbating the situation, Bean said, is that the very device that can cause depression is also giving fragile teens access to websites that can encourage them to engage in self-harming behaviors.

To complicate matters, she said, mental health experts are warning about the dangers of technology at a time when more schools are going paperless and issuing tablets to students.

"While there may be an upside to going paperless, one thing is certain: Our kids will be spending countless numbers of hours in front of some type of screen during the duration of their education. Headaches, tired eyes, and insomnia are bad for everyone. For students that are already prone to mental health issues, this too often results in truancy, low test scores, poor homework habits and depression," she said.

"They are depriving themselves of the opportunity to exercise their social skills; skills that are critical for life. This is obviously dangerous in numerous ways. Not only does it dissuade students from leaving the confines of their rooms to engage with peers in a developmentally appropriate way, there are many predators online who are able to find young people who are vulnerable, isolated and desperately seeking attention," she said.

"There's no question mental health crises are on the rise, and at the level, depression and anxiety are the primary diagnoses that I see in our community," she said.

Signs of trouble?

It's not just technology that is causing the trouble, said Rian Rowles, chairman of psychiatric services at Advocate Christ Medical Center. In his 12 years at the Oak Lawn hospital, the psychiatrist has seen the number of patients referred to the adolescent program rise by more than half.

"It's also social media. It's very clear to me that the advent of social media has exacerbated stressors. Not just depression, but anxiety as well," he said.

"There are stressors that go along with adolescence but you used to be able to leave the interpersonal stuff at school. Bullying used to be a school phenomenon."

Social media, he said, can make it a 24/7 thing.

"When you're writing and posting things, there's a phenomenon in which you don't have the same filter you might when talking on the phone or in person. I think that lends itself to more abrasive statements," he said. "So not only is it constantly there for these kids, it's more intense."

Rowles said adolescents can have the same symptoms as adults when it comes to depression and anxiety: abrupt changes in sleep ability, appetite changes (usually significantly less food), social isolation marked by less communicating with friends and less participation in social or school events, and drastic or significant personality change, say from calm to irritable or angry.

Parents can help by reducing the amount of time a teen spends on social media, he said. Professional help typically involves teaching kids ways to develop new coping mechanisms.

Something that might surprise adults, Rowles said, is that overusing technology can have a detrimental affect on them, as well.

"Not as drastic, because of what kids have to deal with at school. The phenomenon I see in adults is someone who is already in my care for anxiety or depression and then they get on Facebook," he said. "People will sort of put on Facebook things that make their life seem very wonderful and it may not be the reality but other people see that and it can contribute to their depression. (Facebook) makes it seem like everybody has a better life."

Widening the lens

Technology may not be the lone culprit, and it is not necessarily bad, said Nadjeh Awadallah, licensed clinical professional therapist at Little Company of Mary Hospital in Evergreen Park.

The current increase in depression and anxiety among teens might be attributed to a higher frequency of smartphone use and the fact there's less stigma about mental health issues, Awadallah said.

"Kids are more prone to speaking about than maybe they were before," he said.

A lot of adolescents, he said, would argue that the relationships they have with people online are real relationships. "If they're interacting at a high level of frequency, either talking with friends or playing video games, they're actually interacting with them," he said.

And a cell phone can be a kind of "digital security blanket" in that it enables a person who is dealing with anxiety to look at their phone instead of at other people.

"It's kind of protective if you want to be left alone," he said.

Nevertheless, Awadallah added, there is "a great deal of benefit to interacting with somebody face to face because so much of communication has to do with nonverbal communication and giving feedback. When you're just texting you have to imagine how the person's voice sounds. It's hard to deduce if someone is being genuine, or sarcastic. So whatever the person transplants onto the thing that they're reading can impact their mood.

"There's a high correlation between people withdrawing from person-to-person interaction and depression because that's what people tend to do when they're depressed," he said. "So it's kind of like a chicken and egg relationship where you don't know if they're depressed because they're on electronic media or if they're on electronic media because they're depressed."

Smartphone addiction is a form of process addiction, he said. "It's a nonchemical addiction where people compulsively use the internet or phone in lieu of self-care actions likes eating or sleeping," he said.

Signs there might be a deep-seated issue: problems at school, such as concentration, lack of energy, poor attendance or a drop in grades; substance abuse or superficial self-harm (such as cutting as an emotional release); and a significant decline in self-esteem.

What can parents do? Awadallah said, "Institute a routine. Make sure kids aren't using phones or devices when supposed to be sleeping because exposing themselves to unnatural blue light that's going to be overly stimulating and not let them sleep well. If they're more invested with interacting online than with people in person, you need to talk.

"Nobody likes to feel a loss of control. So work with them to arrive at a mutually agreed upon reasonable amount of time to spend on the phone. Have it be a discussion, a collaboration. That will probably yield better results than just saying, 'No phones'."

A chasm between teens and adults

Over the past 14 years, Aida Maravillas, social worker at Eisenhower High School in Blue Island, said she has observed an increase in reported symptoms of depression, suicidal thoughts, anxiety and difficulty with being able to feel connected.

"There are many environmental factors to consider but I have recognized a common thread in many cases when it comes to technology," she added.

"The intimacy of connecting with close friendships is getting lost and the electronic social connection leaves many young people with feelings of loneliness. They observe the self-appointed spotlight of others while they are longing to be 'liked,' followed and tweeted about without any thought of life behind the screen. They see the parties that they weren't invited to and read into the indirect comments that are put out there when conflicts arise," she said.

"Another concern that I have is the digital divide that technology has created between parent and child," she said. "It seems to be more and more common to find parents disconnected from their children's ecosystem of friends and their levels of relationship with those friends."

But, she added, "I have met some parents who have figured out how to balance the influence of technology in their homes and are continually figuring out how to stay connected to their children along the way."

Maravillas said she believes the schools have a responsibility to help kids sort things through.

"As an educational institution that is providing students with devices as part of their educational experience, we should carry some of the burden in educating our students about how to balance their screen time. Especially when some parents have not invited technology into their homes via tablets or cell phones but the school is now requiring it so those parents have little choice in the matter," she said.

Parents know their kids best

Kathleen Bobber, at Sandburg High School, said there are apps that enable parents to limit their teen's access.

"I know kids might not be happy about that but some kids need that, they need help managing their exposure to those things. Maybe your child is very sensitive and maybe it's not good for him to be on social media," she said.

"Parents know their children best," she added.

Teachers are on the lookout, too, for kids who might be struggling with stress. When a student stops raising his hand or stops participating or suddenly doesn't seem to care anymore, she said, "those are things that get kids referred to the guidance office.

"There is lots of help and a lot of resources available," Bobber said. "We have guidance counselors, social workers, psychologists. We have a lot of support people here in the school as well as in the community."

Plight of the privileged

"We have seen kids who've made suicide attempts," said Sandra Novak, clinical psychologist at Palos Community Hospital in Palos Heights. "And I am seeing kids who are self-harming. A lot of it is they're feeling peer pressure which is more intense than it was for us. They can't get away from it. They're always on."

Being able to take a break from whatever stresses you, she said, is important to your mental health.

"I tell to set aside time to be a family. It's very important to have that connectedness. To have a family dinner. Get out of your room and be together. Turn phones, TVs and computers off. Do something together," Novak said.

She added, even older kids need limits. "It's a good idea to put all of the phones in one place to charge over night. Maybe Mom's bedroom. Give everybody a break. Restful sleep is important to your ability to cope," she said.

Keeping up with social media, she said, can be exhausting for a teen.

"There's a lot of bullying and comparing ourselves in front of a wide audience. A lot of kids are anxious or depressed because whatever gets posted can be sent to everybody. There's no privacy anymore," she said. "It can be pretty traumatic.

"The research is pretty clear about the relationship between and the use of in teens. We're seeing who are very sad," she said.

"We've forgotten that a lot of these things are really privilege items. Having a is a privilege, having a computer is a privilege. We've made it a necessity but there are plenty of people out who don't have all that. It's good to remind ourselves of that."

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