This chilling cry to a friend in need is directed at a female pal of frontman James Alex. He told The Independent: "A dear friend of mine thought that she wasn't worth being around anymore, so she tried to change that. She pulled through because she's a fighter and she deserves to be here but that was my very intimate rallying cry for her and a reminder that when that stuff starts to creep in again, shake it off and let's make sure you're still here, we've got a lot of good trouble to get into together."
Because of the personal nature of the track, Alex recorded it in a certain way. He explained: "It's just that one lonesome guitar with a very intimate vocal. I said to the guy that I produce these records with that I wanted it to feel like I'm sitting on her bed with her and playing this song."
Fall Out Boy's "The Kids Aren't Alright" song title is not a reference to The Offspring's 1998 single of the same name. It actually alludes to The Who's 1979 rockumentary film called The Kids Are Alright.