For Parents who are Concerned with Screen Use Addiction in Children & Adolescents (phone use addiction, etc.)

[Episode 109 of The Intentional Clinician Podcast]

What is screen addiction?

• Screen addiction, also known as problematic or compulsive screen use, is a behavioral addiction characterized by excessive or compulsive use of digital devices such as smartphones, computers, tablets, and video game consoles, leading to negative consequences in daily life.
• The diagnostic criteria for this condition are not yet well-established.
  • Some researchers have proposed diagnostic criteria for internet gaming disorder — a specific form of screen addiction that involves compulsive gaming behavior.
  • In DSM 5-TR, Internet Gaming Disorder (IGD) is in the section recommending conditions for further research.

• Kathryn Lorenz, MD, defines screen addiction as “a group of behaviors that are negative; some negative outcomes, that can happen when we use too much technology during our day; Prolonged use of watching TV, video games, scrolling through social media – all of that use acts like a digital drug for our brain”.

Why does it happen?

• When a person experiences pleasurable experiences or hyperarousal while watching a screen, the brain’s reward center releases dopamine in response – a chemical that creates feelings of pleasure and motivation.

Dopamine is associated with addictive behaviors (Wise & Jordan, 2021). If someone experiences hyperarousal while playing video games, the brain associates the activity with dopamine, leading to the development of a strong drive to seek out that same pleasure repeatedly.

Excessive screen use can also trigger the release of dopamine in the brain, leading to negative effects on impulse control.  When the brain is repeatedly exposed to the dopamine released by screen use, it can become desensitized to these stimuli, leading to a need for more screen time to achieve the same level of pleasure.

• Online activity abuse is linked to the deregulation of the serotonin and dopamine neurotransmitter pathways in the developing brain of children (Dresp-Langley, 2020). This leads to negative and potentially long-term metabolic changes.
• According to a 2022 meta-analysis of internet addiction in adolescence, screen addiction is caused as a result of the following factors:
  • Individual factors
  • Educational factors
  • Socio-family factors
  • Cultural factors (Lozano-Blasco et al., 2022).

Signs of screen addiction

• Here are some signs that someone may be addicted to screen use based on Fiona Swanson, L.I.C.S.W. from Mayo Clinic.
• Major symptoms of Screen Dependency Disorder are the following:
• Preoccupation with screens: The person is frequently thinking about using screens or is always looking for ways to use them.
• Loss of interest in other activities: The person may lose interest in other activities that they used to enjoy, such as hobbies or spending time with friends and family.
• Difficulty controlling screen use: The person may have difficulty limiting screen time, even when they know it’s causing negative consequences.
• Withdrawal symptoms: The person may experience negative symptoms when they are unable to use screens, such as irritability, restlessness, or anxiety.
• Negative impact on relationships: Screen use may interfere with the person’s relationships with friends and family, causing conflicts or social isolation.
• Negative impact on work or school: Screen use may interfere with the person’s ability to focus or perform well in work or school.
• Physical symptoms: The person may experience physical symptoms as a result of excessive screen use, such as headaches, eye strain, or neck and back pain.

Sources:

https://mcpress.mayoclinic.org/parenting/are-video-games-and-screens-another-addiction/

https://nhahealth.com/screen-dependency-disorder-the-effects-of-screen-time-addiction/

https://kashmirobserver.net/2022/07/08/screen-addiction-what-parents-need-to-know/

What does screen addiction do to the body and mind?

• Too much screen time can affect sleep habits.
  • In a 2019 review, 90% of analyzed studies found an association between screen media use and delayed bedtime and/or decreased total sleep time (Hale et al., 2019).
  • 2 or more hours of screen time in the evening can seriously disrupt the melatonin surge needed to fall asleep.

• Screen time induces stress reactions.
  • Significantly increased screen time contributed to poor sleep during the pandemic (Chen et al., 2022).
  • Individuals who depended on screens for entertainment and social networking had up to 19% more emotional stress and up to 14% more perceptual stress Khalili-Mahani et al., 2019).

• According to (Lissak, 2018), screen addiction leads to adverse physiological and psychological effects:
  • Addictive screen time uses decreased social coping and increased craving behavior, similar to substance-dependent behavior
  • Brain structural changes related to cognitive control and emotional regulation are associated with digital media addictive behavior.
  • Screen time-induced ADHD-related

• Screen time increases overweight and obesity risk
• There is a positive association between screen time and overweight/obesity among adolescents (Haghjoo et al., 2022)
  • Prolonged periods of sitting can increase the likelihood of developing health issues such as obesity, heart disease, type 2 diabetes, and certain types of cancer.
• Screen time reduces physical activity as well.
  • According to a randomized clinical trial published in JAMA Pediatrics, The children in the screen time reduction group exercised on average for 45 minutes longer than the children in the control group.
  • Reduced screen time can prevent obesity and lower BMI in young children (Epstein et al., 2008).

• Screen time may contribute to decreased attention and impulse control which lead to disinhibited eating and obesity (Efraim et al., 2021).
• Exposure to light-at-night
  • Light-at-night from electronics has been linked to depression and suicide risk in studies (e.g., Tancredi et al., 2022).

• Brain development
  • There might be an association between screen time and adolescent brain development (Marciano et al., 2021).

• Studies on screen time and the brain have shown gray matter atrophy, reduced cortical thickness, and other effects.

Research has found that screen time is linked to gray matter atrophy in the brain. Specifically, two areas are affected:

• Frontal lobe – governs executive functions (planning, prioritizing, organizing, and impulse control.
• Insula – involved in our capacity to develop empathy and compassion and the ability to integrate physical signals with emotion (e.g., Weng et al., 2013).

Research has also demonstrated a loss of integrity in the brain’s white matter (Hong et al., 2013).

• White matter is part of the brain that contains nerve fibers, which are responsible for transmitting signals throughout the brain.

Source: Psychology Today

• Attention
  • Exposure to excessive screen time in children can be associated with attention problems (Santos et al., 2022).
  • Increased screen time in preschool is associated with worse inattention problems (Sukhpreet et al., 2019).

• Intelligence
  • There is an association between smartphone use and lowered intelligence.

How are Teens and Children affected by screen use?

Statistics of screen usage among teens:

• Teens spend around 5 hours in front of a screen every day.
  • 6-10-year-old children spend about 6 hours in front of a screen every day.
  • 11-14-year-old children spend around 9 hours in front of a screen every day.
  • 15-18-year-old children spend around 5 hours in front of a screen every day.
• 51% of American kids are allowed to have a daily screen time higher than 3 hours.
  • Outside of homework, 15% of children were allowed to have less than 1 hour of screen time; 34% had 1-2 hours.

Source: https://headphonesaddict.com/teen-kids-screen-time-statistics/#What’s-the-average-screen-time-for-teenagers

According to the 2020 National Health Interview Survey of the CDC:

• 7% of boys and 64.6% of girls aged 2-17 spent more than 2 hours of screen time per weekday, in addition to schoolwork screen time.
• The percentage of children spending more than 2 hours of screen time increased with age.
• For those aged 2-5 years, 47.5% spent more than 2 hours of screen time.
• For those aged 12-17 years, 80.2% spent more than 2 hours of screen time.

According to the American Academy of Child & Adolescent Psychiatry

• Children aged 8-12 years in the US typically spend around 4-6 hours daily engaging with screens, while teenagers can spend up to 9 hours daily on screens.
• The World Health Organization recommends that
  • children aged 1-4 years old should have no more than 1 hour of sedentary screen time per day

How screen time affects kids:

During the preteen and teen years, the brain undergoes significant changes and developments, which makes tweens and teens especially susceptible to the effects of excessive screen time on their emotional well-being and brain function.

Here are some of the ways in which screen time can impact different aspects of their growth and development:

• Learning: Excessive screen time can have a negative impact on academic performance, as it can interfere with memory consolidation, attention, and information processing.
  • A meta-analysis of 58 cross-sectional studies found a negative correlation between screen-based activities and academic performance in children (Adelantado-Renau et al., 2019).

• Self-confidence: Overuse of social media and other forms of digital communication can lead to feelings of inadequacy and low self-esteem, especially if teens engage in social comparison and feel pressured to present a perfect image of themselves online. This can lead to a negative body image and a distorted sense of self-worth.
  • On the other hand, reducing social media use significantly improves body image in teens, and young adults (Thai et al., 2023).

• Social skills: Spending too much time on screens can hinder the development of social skills, such as communication, empathy, and conflict resolution. It may also increase feelings of loneliness, social isolation, and disconnection from the real world.
  • On the other hand, time away from screen media, with increased social interaction, may improve comprehension of nonverbal emotional cues (Uhls et al., 2014).
  • According to Carson et al., (2019), screen time was unfavorably associated with social skills across early childhood. As she says, “Unfortunately, these behavior patterns, once they’re established in early childhood, seem to persist as children get older.”

• Emotional development: Excessive screen time can disrupt the natural emotional regulation and processing systems of the brain (e.g., Skalická et al., 2019), which can lead to mood swings, irritability, and difficulty managing emotions.
  • It may also increase the risk of developing anxiety and depression (Maras et al., 2015).
  • Higher screen time exposure in early childhood is associated with later emotional and behavioral problems (Liu et al., 2021).

• Behavioral problems: Excessive screen time has been linked to behavioral problems, such as ADHD, aggression, and impulsivity (e.g., Keikha et al., 2020).
  • Children and teens who spend too much time on screens may struggle with self-control, have difficulty following rules, and exhibit disruptive behaviors at home, in school, and social settings.

What are ways parents can reduce, prevent or stop screen addiction?

OSF Healthcare guidelines on screen time for different age groups:

• Children under 2 years old should have zero screen time, except for video chatting with family or friends.
• Children aged 2 to 5 years old should have no more than one hour per day of screen time, which should be co-viewed with a parent or sibling.
• Children and teens aged 5 to 17 years old should generally have no more than two hours of screen time per day, except for homework.

Here are some additional guidelines from Premier Health.

Tips to prevent or stop screen addiction based on Premier Health’s advice:

• Set a good example: Parents should monitor and limit their own screen usage and avoid having the TV on in the background during family activities. This sets a good example for kids and encourages them to engage in other activities. How parents behave around technology will greatly affect how their children interact with it as they grow, so modeling healthy screen habits is important.
  • 2022 study findings show that parents’ screen-related behavior affected the child’s behavior. Specifically, parents’ weekday screen times indirectly affected children’s BMI (Ishii et al., 2022).

• Be involved in your kids’ screen time: Parents should set screen time limits with their kids and stay involved in their screen use. They can even play video games with their kids so they know what content their children are viewing.
  • About the importance of playing with your children.

• Encourage other activities: Parents should encourage other activities that don’t involve screens, such as reading, playing outside, or engaging in hobbies.
  • A 2021 study proves that participating in physical activity can counteract the negative impact of screen time among kids. (Khan et al., 2021). Children who spent less time using electronic devices and more time being physically active had better mental well-being.

• Create screen-free zones: Parents can create screen-free zones in the home, such as bedrooms or the dinner table, to encourage conversation and other activities. Try to have a “screen-free” policy during bedtime, mealtimes, and family time. Make sure to put your own phone away as well and communicate with your children instead.
  • Arundell et al., (2020) highlights the importance of family screen time interventions. The reason is that “screen time in the home can be influenced by the home environment, parental behaviors, and role modeling, child preferences as well as school policies”.

• Set a bedtime routine: Parents should establish a bedtime routine that doesn’t involve screens, such as reading a book or listening to music. This helps children wind down and get a better night’s sleep, which can also help prevent screen addiction.

Additional tips, according to Emali Early Learning Centre:

• Choose media wisely: Parents should choose media that is age-appropriate, educational and promotes positive values. Before allowing kids to watch or play anything, parents should research the content and read reviews to ensure it aligns with their family’s values. Parents should also prioritize media that promotes social interaction, creativity, and physical activity.
• Monitor your child’s online activity: Parents should be aware of how much time their child spends online and what they are doing while online. This includes monitoring their social media use and posts, as well as any interactions they have with others online.

According to Li et al., (2022), “parents need to be active companions to their young children and replace negative, excessive screen activities with positive ones, such as frequent parent–child reading, parent–child games and outdoor trips with their children.”

We live in a world that is dependent on technology for communication. However, just because technology is utilized and is popular, doesn’t mean you have to let your child or yourself use it excessively.

It is important to find balance between not using screens at all and using them excessively.

Due to the increase in dopamine and association by the brain—we must be careful to self-monitor and not accidentally let screen use creep further and further into our free time.

Setting a timer on our phone.

Setting a goal of a non-screen time activity.

For children this is especially important.