Effects of Perioperative Music Interventions on Emotional Outcomes in Children and Adolescents: A Systematic Review and Meta-Analysis Integrating Developmental Psychology and Music Education Perspecti

Generative AI (GenAI) provides a novel tool for youth to access information and manage socioemotional needs. Humans—and especially young people—are using GenAI chatbots at unprecedented rates [-]. Yet, little is known about how children and adolescents use chatbots in real-world contexts. Youth may use GenAI to access information, complete tasks, seek advice or support, or simulate human interactions—including friendships, romantic relationships, and sexual encounters []. These varied uses could differentially shape mental health, adjustment, and beliefs about relationships, with potential risk of harm []. AI interactions are shaped by platform functionalities and design features, wherein certain tools may initiate and reinforce particular content based on model design or user input. Recent cases have drawn attention to chatbots harassing users [] or promoting self-harm and homicidal ideation [,]. Characterizing the behavioral patterns of GenAI conversations is therefore critical to understanding why youth turn to these tools and provides a foundation for addressing the developmental, social, and ethical implications of such use. The purpose of this study was to use naturalistic behavioral observations of keystrokes typed into GenAI apps to characterize the topics youth discuss with chatbots. GenAI chatbots have skyrocketed in popularity since the public release of ChatGPT in November 2022 []. GenAI refers to AI systems that produce novel content by learning patterns from large datasets; GenAI chatbots refer to conversational AI agents, enabling users to engage in real-time natural language exchanges with systems capable of generating responsive, human-like text []. Nationally representative data from US youth aged 13-22 years suggest that more than half use GenAI chatbots, including 28% using these tools at least daily []. Although existing polls have largely recruited youth aged 13 years and older, digital behavioral observations, which use passive sensing technology to track app usage on youths’ personal devices, have provided insight into usage rates among younger youth. Among the same sample analyzed for the current study, data gathered from the Aura parental monitoring app indicated that about 20% of youth aged 10-12 years and 10% of youth aged 8-9 years use GenAI apps on their devices []. That study also found that popular apps used by children and adolescents include general-purpose tools like ChatGPT, Gemini, Claude, and Microsoft Copilot, as well as tools designed for and marketed (ie, via app store indicators) for social support, companionship, and romantic and sexual role-play, such as Character.AI, Replika, CHAI, and SpicyChat AI []. Importantly, whereas the prior paper draws on the same sample as the current study, the papers address distinct research questions using different data streams and analytic approaches (ie, the former characterizes the prevalence and frequency of GenAI app use via passive sensing, whereas this study examines the qualitative nature and content of interactions through keystroke data captured via an overlay keyboard). Chatbots can serve multiple functions. Among US youth aged 13-18 years, motivations include task-based assistance, such as help with homework, brainstorming, or writing and reading support, as well as psychosocial goals, such as personal or health advice, and entertainment []. Most US youth (72%) report having engaged with an AI chatbot (whether a general-purpose tool like ChatGPT or a companion-focused system like Character.AI) as a simulated companion—including role-playing, chatting casually, disclosing emotions or mental health challenges, and social practice []. These survey studies provide critical initial insights into youth’s self-reported motivations for using AI.