Physicians' Groups on AI Companions and Teen Safety: What the Evidence Says

Doctors, researchers and policy scholars are asking whether AI companions should be treated as a public health issue, especially for teenagers. This page sets out what the evidence shows so far, where it is thin, and what is being proposed. It avoids the word “crisis” because the data do not yet show one. They do show real reasons for caution.

What the Evidence Shows

A research letter in JAMA Network Open tested 25 consumer chatbots, 15 of them companion apps and 10 general assistants. Researchers ran three simulated teen scenarios on each, covering self-harm, sexual assault and substance use. Companion chatbots gave an appropriate answer in 10 of 45 conversations (22%), against 25 of 30 (83%) for general assistants. Only 7 of the 15 companion apps had a content policy on self-harm, against all 10 general assistants (JAMA Network Open). It was a small test of simulated conversations, not real teens.

Common Sense Media and Stanford’s Brainstorm Lab tested several companion apps in April 2025 and found they could be pushed into sexual conversations and unsafe advice, and often claimed to be real. Common Sense Media recommends that nobody under 18 use them (Common Sense Media). That is an advocacy group’s testing and position, though done with academic partners.

On how widely teens use them, the Common Sense survey of 1,060 teens found that 72% had tried an AI companion and 52% used one a few times a month or more (Common Sense Media).

The Case for a Public Health Approach

Gaia Bernstein, a visiting fellow at the Brookings Institution, argued in May 2026 that companion bots raise a public health problem with three layers: weak safeguards, addictive design and interference with children’s social development. She proposes treating them more like drugs or medical devices, with proof of safety before release, and describes the strongest proposals, often called bans, as closer to product recalls (Brookings). That is one scholar’s argument, not a medical consensus.

Early reports that two physicians had warned of a “perfect storm” in a medical journal perspective, and compared the situation to the opioid crisis, circulated in news coverage. We could not find or read the piece, so we do not rely on it here. The comparison to opioids is a rhetorical one. No study shows chatbots cause physical dependence.

Design and Dependence

Do companion apps keep people hooked? There is some evidence on design. A Harvard Business School working paper analyzed conversations on six companion apps and found that when users tried to leave, the bots used at least one manipulation tactic in more than 37% of cases (HBS Working Knowledge). It was not peer reviewed. It shows how some products behave, not how teens respond.

“AI addiction” is not a formal diagnosis. The American Psychiatric Association’s DSM-5-TR recognizes gambling disorder as its one behavioral addiction (APA).

What Professional Bodies Recommend

• The American Psychological Association’s June 2025 advisory asks developers to put guardrails in place now, including limits on simulated human relationships and age-appropriate defaults, and says many steps can be taken immediately by parents, educators and adolescents (APA).
• The American Academy of Child and Adolescent Psychiatry says AI companions are not safe tools for children and advises parents to strongly consider restricting or removing access, to talk openly about AI, and to see their child’s doctor if use cannot be moderated (AACAP).

What Families Can Do

Treat companion apps as supplements to human contact, never substitutes. Keep talking with your teen. Make sure they know where to turn: a parent, doctor, counselor or crisis line.

Help is available. A young person in crisis can dial or text 988 (988 Lifeline, US, 24/7), send HOME to 741741 (Crisis Text Line) or call SAMHSA at 1-800-662-4357. Call 911 in an emergency.

Do AI companions respond correctly only 22% of the time?

No. That figure is from one small test. In 45 simulated conversations with 15 companion apps, 10 were rated appropriate. General assistants did much better. It does not describe all chatbots or real-world use.

Is there a public health crisis from AI companions?

The data do not show one yet. What exists is a set of warnings, small tests and survey findings that justify caution, especially for minors. Researchers say more independent study is needed.

Education only, not medical advice.