BACKGROUND The mental health of children and adolescents is a growing public health concern, with increasing rates of depression and anxiety impacting their emotional, social, and academic well-being. In Japan, access to timely psychiatric care is limited, leading to extended waiting periods that can range from three months to a year. AI-driven chatbots, such as emol, which integrate Acceptance and Commitment Therapy (ACT), show potential as digital solutions to support young patients during these waiting times. The AI chatbot emol was selected based on a comprehensive review of Japanese mental health technology applications, including in-person evaluations with company representatives. METHODS This exploratory, parallel-group randomized controlled trial examined the feasibility of using AI chatbot emol with pediatric and adolescent individuals on psychiatric waiting lists. Participants aged 12-18 years were recruited from four hospitals in Kanagawa Prefecture and randomly assigned to either an intervention group, receiving eight weekly chatbot sessions, or a control group, receiving standard mental health information. The primary outcome was change in Patient Health Questionnaire-9 (PHQ-9) scores from pre- to post-intervention. Secondary assessments, such as voice and writing pressure analysis, provided additional engagement metrics, with data collected at baseline, during the intervention, and at week 9. FINDINGS Of the 96 eligible individuals on psychiatric waiting lists, eight expressed interest, and three provided initial consent. However, all participants subsequently withdrew or were excluded, resulting in no evaluable data for analysis. Low engagement may have been influenced by the perceived irrelevance of digital tools, complex protocols, and privacy concerns. CONCLUSION Significant barriers to engagement suggest that digital interventions may need simpler protocols and trusted environments to improve feasibility. Future studies could test these interventions in supportive settings, like schools or community centers, to enhance accessibility and participation among youth. FUNDING This study was supported by the Japan Science and Technology Agency (JST) Grant Number JPMJPF1234. The funder had no role in study design, data collection, analysis, interpretation, or manuscript submission decisions.