The mother of a 16-year-old boy called me recently. “I’m worried about my son. I know most kids are on social media a lot,” she said, “but where is the line? I mean, when does it go from being normal modern teen behavior into a serious problem?”
It was a very good question. A 2015 study by Common Sense Media found that 59 % of parents think their teens are, in fact, addicted to their mobile devices. More surprising, so do 50% of their kids! Nearly 80% of the teens surveyed said they checked their phones hourly and 72% said they felt the need to immediately respond to texts and social networking messages. Another study, this one by Pew Research, found that nearly 25% of 13 – 17 year olds are online “almost constantly.” But is it an “addiction”?
Although Internet Gaming Disorder is classified as a “Condition for Further Study” in the DSM-5 (Diagnostic and Statistical Manual), the APA has not taken a position as yet on over-use of social media. There is debate about whether using social media to the detriment of functioning should be classified as a behavioral addiction, an impulse-control disorder, a variant of obsessive compulsive disorder or a symptom of another disorder. But there is no credible research to establish any of these. Since each revision of the DSM takes years, we may not have definitive answer for some time. Meanwhile, parents call us with their concerns.
What makes over-use of social media difficult to classify is that our social lives are becoming more and more integrated with technology. FaceBook is used by 79 % of the U.S. population. Instagram is used daily by over 400 million people and Snapchat has more than 300 million daily active users. Ninety-one percent of teens use text messaging on their phones. In fact, a 2012 Pew Project Study showed that the median number of texts sent by teens is 60 a day, with older girls having a median of 100 text messages a day and boys a median of 50. By now, that number is likely much higher. The kids are right: Everyone is doing it. So what’s the problem?
Most of the time there isn’t one. Although many adults are astonished and concerned about the amount of time their kids spend on their devices, most teens manage to use them responsibly. They stay connected on social media but they also do well in school, have an active and supportive friendship circle, play sports and have jobs. They get enough sleep most nights and are generally in a positive mood.
Is it a Red Flag?
In my opinion, a teen’s apparent compulsion to check in on social media is in itself not the problem. However, it may be a red flag for something else:
Medical Conditions: A teen was sent to therapy because her mother thought she was constantly using her phone to find medical conditions she could then complain about on FaceBook for attention from her friends. Sending the teen back to her doctor for her recurrent headaches and general malaise resulted in the discovery of a brain tumor. The teen was right. Something was very wrong. My personal rule is to always check for medical conditions first.
A diagnosable mental disorder: Constantly surfing social media platforms and lying about the amount of time doing so to concerned adults are, to my thinking, not an indicator of an addiction to social media. Although it can appear that withdrawal from others and decreased self-care are a result of obsession with technology, such behaviors are more likely symptoms of another disorder such as Depression or Anxiety or Attention Deficit Disorder or an Impulse Control Disorder. Teens with such disorders use social media to escape from their troubles or to manage their other symptoms.
Bullying: Sometimes the constant checking is due to being part of a Bullying Triangle: Bully, Bullied or Bystander. The bullies are bullying. The bullied are anxious about what is being said about them. The bystanders are upset and unsure about how to handle what they are seeing or are trying to stay of the side of the bullies lest they be the next in line for bullying. Just as we’ve learned in the last decades to routinely check for whether our patients are being abused in other ways, it is now crucial to ask a teen whether bullying is part of their problem. We won’t know unless we ask.
Sleep disturbance: It’s one of those cause/effect questions: Use of a smartphone during the night may be a way a teen is managing insomnia. Or worries about being out of the teen loop may be the cause of the sleep disturbance. A recent study shows that the average American teen is getting only four to five hours of sleep per night, largely because of being on his/her phones and other devices very late at night. The result may be irritability, falling grades, and problems with concentration generally. Treating the sleep disturbance effectively means first sorting out whether it is cause or effect.
When treating teens, it is now important to assess their use of social media and how it functions for them. Although some teens are quite frank about how much they and their friends are connected, teens in difficulty (especially those referred by someone else) are often in denial about the amount and function of the time spent on the phone and other devices checking social media platforms.
From the teen’s point of view, everyone else is doing it and it therefore isn’t a problem. It is therefore important not to get into an argument about whether he or she uses a smartphone too much. Rather, troubled teens need to be reassured that a balanced life includes being connected. Restructuring, not eliminating, their use of social media is only part of the treatment plan.