This issue of the Carlat Child Psychiatry Report takes on a topic that is on the minds of child mental health clinicians and (of course) pediatricians, parents, and teachers: Is 24/7 immersion in screen media negatively affecting our children? I have been helping patients of all ages, as well as the general public, address this in practical and socially acceptable ways since 1999.
At that time, I was the consult psychiatrist for a pediatric unit in a public hospital, where the department had recently eliminated its Child Life program, moving media consoles into children’s rooms. I found a disconcerting number of children who were zoning out in front of their screens, with their anxious parents telling me that their children had become depressed and were refusing to interact or even make eye contact. I was also deluged with requests to address what appeared to be emotional numbing. I concluded that the steady exposure to media was the most likely cause of the complaints I was hearing. These problems started to resolve when our team helped parents reconnect with their children using games, puzzles, books, and even audio books. When I left the hospital, Child Life had been reinstated, and I began my quest to understand the impact of screen media on children.
The intent of this article is not to assert that screen media are harmful when used appropriately. The majority of us use the internet and our devices regularly and find them essential for learning and communication. However, screen media are not biologically neutral. As I will discuss, they are, by design, addictive for susceptible individuals; further, they are deleterious for babies and must be used wisely with young children. As children mature, they need to learn how to use screen media ethically and in moderation. This is a developmental task for which evolution has not prepared us.
Screen media guidelines
I’ve developed a set of guidelines, based on age range, that I share with parents as well as with my teen and adult patients.
Children under 2
Think of screens as the equivalent of a caffeinated beverage. Both give that pleasurable dopamine hit to help us do things that need to be done. But some dopamine sources are more detrimental than others, and we try to avoid exposing babies at all costs. Screens also emit blue light, which suppresses melatonin and interferes with sleep (Holzman D, Environ Health Perspect 2010;118(1):A22–A27. doi: 10.1289/ ehp.118-a22). And, as we know, babies need a lot of sleep, so I strongly recommend no screens until babies are talking—even better, no screens until babies are talking and potty trained.
From ages 2–7, when imagination, language, and the beginnings of autonomy are developing, I recommend no solo viewing. If your child is watching television or using screens, watch with the child and reinforce verbally what you are seeing. Per the American Academy of Pediatrics 1999 guidelines, I recommend that parents stick with the screen time limits of 10 hours weekly and no more than 2 hours daily until high school. While screens are great for teaching screen-based motor skills and children can indeed learn using them, they also need to learn in the physical world: by building, making, and experimenting. Tasks such as writing and drawing, turning pages, and taking notes are all neurologically different from using screens. Memorizing requires hippocampal activation. The rapid attention shifts and constant alerting that are triggered by screen-based learning are—as every psychiatrist should know—antithetical to the laying down of long-term memories. No existing data suggest that U.S. children’s academic skills are improving as a result of increased access to screen media—in fact, there is some evidence those skills are stagnating or worsening. There are also data showing that requests for ADHD treatment are escalating in the U.S., especially since 2007 (CDC, MMWR 2013;62(24):509). While we don’t know that these findings are causally related, the trend suggests a need for future research. So, for this age group, old-fashioned rules apply:
•• No screen time until homework is done.
•• Make sure kids get outside and run around every day.
•• Have children deposit phones in a designated place upon arriving at home, where they remain off.
•• No smartphones until children are old enough to purchase them and pay for data.
Pre-adolescents and adolescents
By upper-middle school and high school, laptops and smartphones have become a necessity in most classes. We will need longer-term studies to know when they produce meaningful gains and when they interfere with learning. At present, the U.S. lags behind other developed countries in multiple areas of proficiency, but it is not possible, based on the research to date, to attribute this lag to a single cause. When my son’s school implemented a “bring your own device” policy, he told me that, at any given time, half of his classmates were playing video games or chatting on social media. I regularly poll my teen patients on this topic, and they confirm this is often the case. Teens still need to learn the skills to moderate their use, and may not be able to simply “turn off,” especially at night. Less confrontational remedies at home include switching off the home internet at night and linking the privilege of device ownership to appropriate use.
Research behind the recommendations
Rates of use
According to a massive 2015 survey, U.S. teenagers use an average of nine hours of entertainment media daily, while tweens use an average of six hours daily. These numbers don’t include time spent using media for school or homework. Mobile devices now account for 40%–46% of screen time (http://tinyurl.com/jb4v4ac). This study confirmed prior surveys that noted high rates of rapid, sequential attention shifts (euphemistically known as multitasking) with simultaneous use of multiple screen media and applications available through those media. Among 13- to 17-year-olds, 34% admit using their phones almost constantly (Lenhart A, Pew Research Center 2015). In 2013, a Common Sense Media survey found 0- to 12-month-olds were spending 44 minutes daily watching screens and were being read to daily for 19 minutes; at 24 months, the number changed to 60 minutes of screen time and 29 minutes of reading (https://www.commonsensemedia. org/research/zero-to-eight-childrens-mediause-in-america-2013).