Counseling Patients and Families on Using AI Chatbots

Question: Should I advise my patients and parents to avoid chatbots altogether, or is there more nuanced advice I should give? Especially thinking of younger adolescents (<15)? 

Answer: Thank you for this question. While we are still learning about the benefits and risks of Artificial Intelligence (AI) chatbots, the "avoid all chatbots" message is likely not realistic, nor the most helpful message for most families who are learning, alongside their child, how best to use this technology. Many youth directly seek out AI chatbots and because chatbots are built into everyday activities like search engines, social media platforms, and online games, avoiding chatbots altogether may not be practical.  

How common is the use of AI chatbots? 

67% of teens ages 13 to 17 report using chatbots, including about three-in-ten who do so daily. Teens report using chatbots for a variety of purposes, including: 

• Close to 60% of youth use chatbots to search for facts or information,  
• Over 50% for help with schoolwork or assignments, and  
• Around 40% to create or edit images and videos.  
• 8% of teens reported using AI companion chatbots for romantic or flirtatious interactions and  
• About 13.1% of U.S. youth aged 12-21 reported using Generative AI (GenAI) for mental health advice. 

Key terms 

Chatbots are conversational software using text or voice.  

• Rule-based (or scripted) chatbots use predefined scripts, making them predictable and limited.  
• GenAI chatbots use large language models to generate new responses each time, offering flexibility and natural human-like interaction. Their unpredictability presents more risks, as their output is harder to predict or control. There are two distinct types of GenAI chatbots:  
  • General-purpose chatbots (ChatGPT, Gemini, Claude) are built for a wide range of tasks and could be useful for homework and finding information. Despite sometimes being used to address unmet mental health needs, they are not designed to provide mental health care. 
  • AI companions (e.g. Character.ai, Replika.ai) are chatbots specifically designed to build an ongoing emotional or relational connection with the user.  

Potential benefits, opportunities, and concerns 

Benefits and concerns around AI chatbots vary by use and by age. This state-of-the-art review identified specific benefits by age groups. To answer your question, we’ve focused specifically on young adolescents.  

Benefits and opportunities 

For young adolescents, AI tools may: 

• Support digital literacy, career exploration and preparedness, creativity, and help with researching options like colleges.  
• Offer a rehearsal space for relationships and a nonjudgmental space for sharing emotions.  
• Some AI functions may also support adolescents who have specific communication needs, such as limited English proficiency or autism.   

Concerns 

Alongside these benefits come several concerns that you can discuss with families, particularly those with younger teens. Teens have shared their worries about the use of GenAI. They report being somewhat or very concerned about:   

• AI collecting their personal information without their knowledge (76%)  
• Their data being misused (72%)  
• AI impersonating kids and teens (72%)  
• AI giving them inaccurate or biased information (68%)  

The state-of-the-art review mentioned above identified a number of concerns, including: 

• Misinformation and deepfakes,  
• Overreliance on seeking comfort from technology for emotional support and decreased face-to-face social interactions (especially with companion chatbots),  
• Inappropriate responses to mental health crises like suicide questions, and  
• Privacy risks from data collection.   

The American Psychological Association issued a health advisory noting that general-purpose chatbots like ChatGPT, Gemini, or Claude were not designed to give clinical feedback, often lack expert oversight or safety protocols, and haven't gone through the same testing as medical tools.  

GenAI can hallucinate (generate made-up content) and may not handle mental health emergencies appropriately. An evaluation of GenAI psychotherapy chatbots used by youth were rated by expert reviewers as very accessible, but poor on actual therapeutic methods and safety risk assessments.  

Concerns specific to AI companions 

Companion chatbots are designed to maximize engagement. Because these tools keep users engaged through flattery and validation, youth may mistake them for true friends and pull away from the real-life relationships they need for healthy development. Common Sense Media evaluated popular social AI companion chatbots, including Character.AI, Nomi, Replika and concluded that they do not recommend the use of these tools by children and teens under the age of 18.   

Early adolescents are still figuring out who they are and developing emotionally and socially, which makes them potentially more vulnerable to design features in chatbots.  

Practical guidance you can share with families  

When counseling families on GenAI chatbots, consider some of the following tips and frameworks to guide families into having healthy and open conversations around this emerging technology: 

• Make AI use a routine intake and check-in topic, the way you'd ask about social media or sleep. You may want to consider using the 5 Cs of Media Use: Tips for Pediatric Clinicians and the age-specific 5 Cs of Media Use for parents. 
• Educate caregivers to understand the benefits and risks of GenAI, including uses for companionship and mental health, especially for younger teens.  
• Recommend parents be open and curious about their teens' use of AI chatbots. Suggest parents use specific low-stakes, non-judgmental prompts such as: How are you using AI? Can you show me how it works? How are your friends using it? How does it make you feel? 
• Encourage families to build AI literacy and emotional-regulation skills together, including around misinformation & to be able to notice when a chatbot interaction is affecting their mood or pulling them away from real relationships. 
• Caution parents to watch for signs that use may be more concerning, such as a change in sleep or regular activities, social withdrawal or spending time with an AI application over other interests or responsibilities, mentions of an AI friend, or other concerning changes in behavior, thinking, or emotional state. 
• Encourage families to set privacy defaults to the most protective option (consult the Glossary of Digital Media Platforms) and to remind teens that they do not need to provide the truth or all information to AI.  
• Advise families to integrate the use of GenAI chatbots into their Family Media Plan, which helps establish clear, family-level expectations, boundaries, and rules.  

Recommended Resources 

• AI and Teens: Usage Trends and Mental Health Effects: This previous portal response discusses how teens are using AI and the impact of AI on mental health. It also includes tips and resources for parents and educators. 
• Clinical Approach to Adolescent Artificial Intelligence Chatbots (AICs) Use in Mental Health Support: This approach provides a framework for assessing, guiding and monitoring adolescent AI chatbot use in mental health support and encourages clinicians to approach the discussion with balanced neutrality. 
• Generative Artificial Intelligence: Implications for Families and Pediatricians: This state-of-the-art review is organized by developmental stage (early childhood, middle childhood, and adolescence) and covers potential benefits, including personalized learning, creative expression, and enhanced communication, while also discussing risks such as misinformation, privacy threats, and false perceptions of AI as a friend or caregiver.  
• APA Health Advisory AI and Adolescent Well Being: This health advisory addresses the use of AI and youth well-being and includes evidence-based recommendations to support the benefits and minimize the risks to youth.  
• APA Health Advisory: Use of generative AI chatbots and wellness applications for mental health: This evidence-based advisory provides a background on GenAI chatbots and also offers a series of recommendations, including guidance for clinicians about asking patients about their use of GenAI chatbots and to educate patients about the benefits and limitations of these tools.   

References 

• American Psychological Association (2025a). Health advisory on AI and adolescent well-being. https://www.apa.org/topics/artificial-intelligence-machine-learning/health-advisory-ai-adolescent-well-being.pdf   
• American Psychological Association (2025b). Health advisory on the use of generative AI chatbots and wellness applications for mental health. https://www.apa.org/topics/artificial-intelligence-machine-learning/health-advisory-ai-chatbots-wellness-apps-mental-health.pdf   
• Chen, T. H., Chu, G., Pan, R. H., & Ma, W. F. (2025). Effectiveness of mental health chatbots in depression and anxiety for adolescents and young adults: a meta-analysis of randomized controlled trials. Expert Review of Medical Devices, 22(3), 233–241. https://doi.org/10.1080/17434440.2025.2466742  
• Common Sense Media (2025). Talk, Trust, and Trade-Offs: How and Why Teens Use AI Companions. https://www.commonsensemedia.org/sites/default/files/research/report/talk-trust-and-trade-offs_2025_web.pdf   
• Faverio, M., & Sidoti, O. (2025, December 9). Teens, social media and AI chatbots 2025. Pew Research Center. https://www.pewresearch.org/internet/2025/12/09/teens-social-media-and-ai-chatbots-2025/   
• Feng, X., Tian, L., Ho, G. W. K., Yorke, J., & Hui, V. (2025). The effectiveness of AI chatbots in alleviating mental distress and promoting health behaviors among adolescents and young adults: Systematic review and meta-analysis. Journal of Medical Internet Research, 27, Article e79850. https://doi.org/10.2196/79850    
• Grundmeier, R. W., Fiks, A. G., Jenssen, B. P., Proctor, S. N., Ferro, D. F., & Johnson, K. B. (2026). Generative Artificial Intelligence: Implications for Families and Pediatricians. Pediatrics, 157(4), e2025074912. https://doi.org/10.1542/peds.2025-074912   
• Hinduja, S., and J. W. Patchin. 2026. “Risks and Harms of Conversational Artificial Intelligence (CAI) Chatbot Use Among US Youth.” Journal of Adolescence: e70164. https://doi.org/10.1002/jad.70164. 
• Lake, C., Gormley, C., Snell, A., Vinyard, I., Tate, L., Gillett, M., Anderson, K. S., O'Neil, E., Mann, S., & Robb, M. B. (2026). Generation AI: What kids and families think about AI. Common Sense Media. https://www.commonsensemedia.org/sites/default/files/research/report/commonsensemedia_generationai.pdf
• Madera, F., Nicodemo, G., Guasco, S., Ciulli, T., & Cardinali, P. (2026). A scoping review of conversational agents in adolescence: Effects on well-being, social inclusion, and mental health. European Psychologist. https://doi.org/10.1027/1016-9040/a000580  
• Maheux, A. J., Akre-Bhide, S., Boeldt, D., Flannery, J. E., Richardson, Z., Burnell, K., Telzer, E. H., & Kollins, S. H. (2026). Generative artificial intelligence applications use among US youth. JAMA Network Open, 9(2), Article e2556631. https://doi.org/10.1001/jamanetworkopen.2025.56631    
• Mansoor, M., Hamide, A., & Tran, T. (2025). Conversational AI in Pediatric Mental Health: A Narrative Review. Children, 12(3), 359. https://doi.org/10.3390/children12030359  
• McBain, R. K., Bozick, R., Diliberti, M., Zhang, L. A., Zhang, F., Burnett, A., Kofner, A., Rader, B., Breslau, J., Stein, B. D., Mehrotra, A., Pines, L. U., Cantor, J., & Yu, H. (2025). Use of Generative AI for Mental Health Advice Among US Adolescents and Young Adults. JAMA Network Open, 8(11), e2542281. https://doi.org/10.1001/jamanetworkopen.2025.42281  
• McClain, C., Anderson, M., Sidoti, O., & Bishop, A. (2026, February 24). How teens use and view AI. Pew Research Center. https://www.pewresearch.org/internet/2026/02/24/how-teens-use-and-view-ai/   
• Schwartz, S., & Diliberti, M. K. (2026). More students use AI for homework, and more believe it harms critical thinking. RAND Corporation. https://www.rand.org/pubs/research_reports/RRA1121-1.html  
• Sobowale, K., Humphrey, D. K., & Zhao, S. Y. (2025). Evaluating generative AI psychotherapy chatbots used by youth: Cross-sectional study. JMIR Mental Health, 12, Article e79838. https://doi.org/10.2196/79838   
• Zhang, Q., Zhang, R., Xiong, Y., Sui, Y., Tong, C., & Lin, F.-H. (2025). Generative AI mental health chatbots as therapeutic tools: Systematic review and meta-analysis of their role in reducing mental health issues. Journal of Medical Internet Research, 27, Article e78238. https://doi.org/10.2196/78238  

Age: 10-17 

Topics: GenAI Chatbots, AI, artificial intelligence,  Healthy digital media use, digital citizenship 

Role: Pediatrician/Clinician