Transcription:
Screentime: the Good, the Bad and the Ugly

Dr Anne Walters (Host): The American Academy of Pediatrics, AAP, offers parents specific guidelines for managing children's exposure to screens, whether it be TVs, tablets, or phones. Previous guidelines discourage screen time for children under age two and recommended limiting screen time to two hours a day for children over age two. These are very broad guidelines and were developed prior to the explosion and development of apps and games targeting young children. And they were most certainly updated prior to the pandemic.

Most parents now are struggling with finding a balance. Kids as young as five may be receiving their schooling through their Chromebook. Others may be quarantined for periods of time, and technology may be a primary connection with friends while trapped at home. Is there a right answer for how long is too long to spend on a screen?

Bradley Hospital Psychologist Justin Parent joins us today to help us with the good, the bad and the ugly when it comes to technology. Thanks for joining us, Justin.

Dr Justin Parent: Thank you for having me.

Dr Anne Walters (Host): This is MindCast: Healthy Mind, Healthy Child, a podcast from the mental health experts at Bradley Hospital, leaders in mental health care for children. I'm Dr. Anne Walters with my colleague and cohost, Dr. Greg Fritz.

Dr Greg Fritz (Host): So Justin, good to see you. I think Anne really hit the nail on the head when she said we were here to talk about the good and the bad and the ugly when it comes to technology. We'll sort of take a look at each of those things.

When I think of technology, I think of the ways it brings us together, most certainly, in terms of coming together and communicating during pandemic times. I think that's obviously a huge positive. But I also know that the downsides just from talking to friends and family who tell me that technology is a struggle for almost every one of them. And it's difficult to try and find a balance.

So we're interested in your point of view as to how parents should be handling this so that it comes a healthy relationship and is part of the day rather than the whole day for kids. Specifically, I think one of the major concerns that parents have is what does all the screen time do to my child's social skills? What are your thoughts about this if you could share it with us? If people are communicating via screen, or maybe even just texting and not actually speaking or in person, what are the implications for kids and for their development?

Dr Justin Parent: Yeah, it's a question that almost all families have. It's also a new struggle. Screen time used to be, even a generation ago, with the debate of a TV in a bedroom or not. And now, it's much more complex. There's, as you saw earlier, for me, I have a screen on my wrist and in my pocket and it's all over and it's harder to monitor and manage. And it's harder to just set a timer, because it becomes a major part of schooling, of social life, of family life. So it's really hard for parents to navigate this. And the social skills is another new aspect of it, because it's hard to say what's having a negative impact versus how is social interaction perhaps changing in a way that some people don't like, and some people do.

What we know is that for really young kids, they've had a few studies, not many, but a few show that kids who are in preschool or younger with higher rates of media usage had lower social skills at entry to school. But much of that research shows that those effects become smaller and smaller as they get older. And in fact, we have some work to show that actually kids who use more screening time that doesn't negatively impact their sleep can have a positive impact on their peer associations and their peer problems. So what that means is that we looked at one of those ways screen time is really negative is because it impacts their sleep. They're up at night. Kids are texting them, or if someone drops them into a group chat at 2:00 AM and all of a sudden, there's a huge conflict in the middle of the night and the way screen time disrupts that can have a negative impact across attention, emotion regulation, and academics, peer functioning.

But we found that if you sort of take that out of the sort of total pie of the picture for the kids, where it isn't having an impact on their sleep, they actually report fewer peer problems than those kids who use less screen time. And that's just because whether it's TikTok or Fortnite or these games, this is a major area of social topic. It used to be what TV show was on, but now it's the TikToker or YouTuber, what video game they're streaming. So it's a major part of social life. And I don't think we can get to a point anywhere where we can say that you can just avoid it and everything will be okay. We're well past that now.

Dr Greg Fritz (Host): Are those studies longitudinal or are they just comparing kids with high amount of screen time versus lower amount in a cross-sectional?

Dr Justin Parent: Most are cross-sectional. There are one or two published in the last couple of years that are longitudinal, but even then I think what you're probably getting at is that it's hard to control for everything. It's not randomized. And the kids who tend to have more screen time where they're really younger, tend to have earlier problems with maybe ADHD, tend to have perhaps come from lower socioeconomic backgrounds and may struggle early with initiation of school. So there's a lot of confounding factors to say, does that cause it? I'm not sure. Studies have tried to control for some things, but it's really hard unless you randomized a two-year-old to sort of use over two hours or not.

Dr Anne Walters (Host): So both you and Greg have touched briefly on some of the positives. And I think that we know from the pandemic that for some children, at least for a period of time, that this may have been the only social avenues for children, was via gaming or via FaceTiming or via Zooming or whatever else people were doing to try to maintain social connection. But could you tell us more about the positives of screen time and also whether there are any studies that are sort of coming out of the pandemic when clearly there was an increase in the amount of time kids spend on screens and fill us in a little bit about that?

Dr Justin Parent: Because of what gets attention in the media, there's a lot more focus on the negative. And we could talk about there are negatives, but there are a number of positives. There are some research and, in particular, in academics where they've shown that they can make video games really fun and engaging and enhance kids' learning. They've shown that some kids that use some of these video games might have better spatial skills or some cognitive abilities that it helps train them to do. Minecraft, for example, is like Legos times a million, sort of like whatever the edges of your imagination. You couldn't build your Legos in the sky and there's a lot of positive skills there.

And I think when it's not unlimited, so when families and parents, it's not an unlimited amount of screen time, you get a certain amount each day, it can be a really empowerful, positive reinforcer. So whether it's chores or finishing homework or working on a coping skill, earning screen time is something that is really useful for parents because it's readily available. You don't have to come up with a new toy, like the industry is making new games, new videos every second. So that's always something that can be useful that might be reinforcing. It's only then it's not very useful in that way if you can have eight hours a day already and you can earn 30 more minutes, then it's not going to be very impactful.

So there's many ways in which it can be positive. And I think that's really the focus for families now is how can I find a way to put a little more control to that chaos, so that we can build up the positives and try and dampen the negatives. It's the internet, it's media. There's no way to never come across anything negative there. But if you start early especially, you can find ways to really build up those positives.

Dr Anne Walters (Host): I think you're raising a really good point though. And that as therapist, it can be tricky when we're working with a family where a child has had almost unlimited access, because then you're sort of trying to, you know, close the barn door after the horse is already out, right? You're going to say, "Well, now we're going to restrict your access, so that you can have a reward." And the kid is like, "No, I'm not interested in doing that." So that can get a little tricky.

Dr Justin Parent: No, it can be very tricky. And certainly, the ideal setup as we've done some of these workshops, for example, where we kind of combined some parenting skills with Geek Squad technology skills. And we do them for younger kids, like 12 and under, mainly because once we get to teens, it becomes much more complex and harder to manage. But the ideal setup is from a very early age, even preschool, to start setting these boundaries and limits and then be able to slowly grow how they have access. Because then if you do that, then it's more about part of developing into more autonomy with your screen time, what you get to access. Whereas if you jump into that when you're 12, it's going to initially create a conflict.

I still find that kids still like the idea of earning it. So it's always about fine tuning it. Like if it was eight hours a day, then probably that's not going to work. But, if you can slowly decrease it and then allow them, that child, to be the ones sort of in charge of earning more time, then you'll find that they might be especially motivated because they were used to having a lot and they want to get back to having more of that time.

Dr Greg Fritz (Host): So how about some of the negatives, maybe you could share some examples of the kinds of problems you've encountered in the kids you work with that are based on the internet or screen time?

Dr Justin Parent: So there's a few to think about. I think the first one, which is the case if the screen time is very sedentary, that we know that long periods of sedentary behavior have a negative impact on health, whether it be weight or other factors. But of course, with Pokemon Go like four or five years ago, there was more and more games that are active. So that's not a total part of the picture.

There's also a longstanding set of research trying to connect video games with aggression. And in general, that's pretty mixed to small at best, that high amounts of aggressive content. For some kids, it can have a small negative impact on their mood or aggression. For example, we showed with early teens that for those kids who have lots of screen time that's very high in violent content, some of them could play Call Of Duty 24 hours a day and never be aggressive. But we found that kids in a stress task whose stress physiology was more reactive, so there are kids that are a little more sensitive, more likely to be emotionally dysregulated or harder time managing their physiological stress, those are the kids that saw the negative impact longitudinally over time. So in this conversation is always like for whom? For some kids screen time can have a really huge impact. And clinically at Bradley, I think we see that sometimes kids do fit more of what is being talked about like a gaming disorder. I'm still, in my opinion, seeing it's incredibly rare, but there are some kids that even a little bit of time is just sort of this big amplifier of all of the problems they're having. And they're not able to manage it in moderation.

But then the other area, not to go too long, is I think sleep. In my opinion, sleep's the biggest factor. What we see clinically, as we see teenagers who are up in the middle of the night, chatting for hours on end, it's harder to manage. Even if it's not in the middle at night, it's hard to go from playing Fortnite or FaceTiming with friends to sleep. We need that time to calm. And if you're on there, the blue light itself can have a negative impact on melatonin, but even just the stress, our melatonin, our thing that make us sleepy and our cortisol, that stress hormone, they will act in opposite ways. So if you're super stressed or activated right before bed, it's going to mean you have a hard time falling asleep, and then you might have lower sleep quality.

And we've found longitudinally as well as some other work done in the adolescent units here as well by Jacky Nesi has found that sleep is one major mechanism explaining why it can have a negative impact. It's through how it impacts their sleep.

Dr Anne Walters (Host): What's the latest on blue light blocking glasses? Are they effective?

Dr Justin Parent: I don't know that there's much to show that they're effective. I still recommend it. So part of what I do with families is usually for example, on iPhone, on devices now, companies have gotten much better because parents were getting more and more upset because parental controls are still, but used to be almost nonexistent. And one of those parental controls is shifting to like night shift mode. And I still think it's a good recommendation. What they found was that in a lab setting, when you had an iPad on full brightness within I think six to twelve inches of the face, there was a measurable impact, but it's a little hard and there's not as much concrete evidence. So I think part of it may be melatonin, but other part of it is just you're playing Fortnite and yelling at your screen or your friends, and then all of a sudden you just to have to lay down in bed and fall asleep. And that's just really hard for anyone to do, especially kids.

Dr Anne Walters (Host): What about the sort of ugly side of technology? And I think what probably comes to mind for most of us is social media, and particularly for teens who are certainly the demographic that spend the most time on social media with an average of three hours a day. What do we know about the mechanisms for that becoming a problem? You think about social comparison or kids that may be struggling in other arenas where that could be problematic. So interested to hear your thoughts about that.

Dr Justin Parent: So I think there are a few things to consider, one, developmentally, so there is a recent study by Orben and colleagues that showed there are some sensitive windows and it depends perhaps on gender. So for girls who identify as girls and at between 10 and 13, they show that that was when the biggest effect on their life satisfaction was. So for girls, it was in that early adolescent as the onset of puberty. For boys, it was actually a little bit after, 14 to 16 is when they were seeing a major negative impact. So when social media is happening during these sensitive windows, and they have a lot of negative self-comparisons with that media, then you tend to have the most negative impact.

And of course, another sensitive stage that study found was in that 18 to 20. And that was for boys and girls, for basically everyone. When you're 18 to 20, that's a time where if you're spending a lot of time on social media, you're reporting lower life satisfaction. And in particular, one of those things is probably how you use it and what you use. So if you're looking at like for me the golden retriever videos on TikTok, that's sort of great. It makes me feel happy. I distress. But if you're looking at Instagram or doomscrolling, doing a ton of self-comparisons of everyone's best to your worst, it's going to amplify some of those negative self-talk. It also may serve as an opportunity for negative social contagion, which goes back a long time. But here, the social contagion may be around suicidal ideation, self-harm, that even I've seen this clinically where kids will talk about in a group chat at 2:00 AM, people were talking about hurting themselves and then sort of those things tend to spread. And that's why, for parents, we want to try and be proactive with setting some of those limits, with how long they're able to use it and during what times. For example, one thing that you can do on an iPhone on any teens' iPhone is you can set a sleep time so that all of the key features other than just the phone itself turn off at nighttime so that your teen who doesn't have that frontal lobe fully developed doesn't have that impulse control that the mom may have not to use it at night. They'll be a little less likely to use it if you've set that limit ahead of time, and then it's not a debate, the device helps you in that. But overall, I think it really comes to how you're using it and initially, maybe when, and that there's some key times right around puberty when it's particularly sensitive.

Dr Greg Fritz (Host): So the onset of puberty is earlier in girls than in boys and that corresponds to an earlier time of the greatest negative impact from social media in girls. It sounds like at the time of the stress of puberty onset is the time the when people are the most vulnerable.

Dr Justin Parent: Yeah. And this study just came out, but it fits with a couple of things. One, there's a study on the HPA axis, for example, showing that right around puberty, it might have the ability to recalibrate. So it is thought of as like a groundhog thing where around the onset of puberty, it pops back out. What is my environment like? Is it safe or is it not safe? And then, it adjusts. Whereas that maybe early maltreatment really ramped up that stress response system and kept it on. And then there's some research by Megan Gunnar and a few others showing that this early adolescence is another period where the body tends to recount. And then there's also research, for example, by Mary Corscadden here at Brown and Bradley for a long time, showing that that exact time is also when sleep becomes the most vulnerable, because naturally our phase is shifting to later in the day. So you have more pressure to stay awake, and maybe a less ability to fall asleep on the right time. And all of that is working against you. So there's sort of a lot of things going on here why that would make sense, but people are just starting to study it now.

Dr Greg Fritz (Host): It makes sense then that when parents are dealing with teens around screen time, that their approach should be somewhat different than with younger kids. Is that something that you bear in mind all the time?

Dr Justin Parent: I think of it a bit of what's the family's norms and values around it and how old the child is. So when I'm working with preschool to school age, before middle school, usually it's very much sort of the parent deciding, like, "This is what I think is important." Knowing that there's not a magical number, I wish I could tell you two hours is a magical number three or six. It depends, and that's why parents are probably the best to decide how much is too much, because they may have seen themselves when it gets to a certain level, "I see more aggression or reactivity or more irritability or negative reactions."

So parents, when their kids are young, I really encourage them to decide, like you hear some of the information and what fits with you and your values, because we found when we did a survey of about 1700 parents, we found that very few, like less than 5%, were following those American Academy guidelines. It's just incredibly rare nowadays, especially in this as pre-COVID, so even think of COVID and beyond. It's just so unlikely in the way society is currently functioning for kids to sort of use less than two hours, especially since some of that time is also just on their Chromebook, doing schoolwork as well.

But yeah, I start out initially with parents deciding, and then we pick, do we want to just set a limit? Or is it just, "I care about social media, so I want to limit only 30 minutes a day on social media," and we can use technology to help them set those limits.

But as they're getting older, middle school and then especially at high school, just like we would with anything, it's a great way to sort of slowly start opening the door for more autonomy, allowing the teen to have more of a voice in that decision. Maybe not the only voice, but more of a voice in that and then allowing them more control. And we definitely don't recommend the more authoritarian methods because it is possible to set up things on devices to monitor every text message, GPS location, you can have it all, but that really just doesn't foster a level of trust and connection.

And in part, this is probably why you hear it with everyone and sort of it's this little microcosm of anything that can be stressful in the family is screen time is just an extra big stressor for the same types of conflicts people have been talking about for 50 years in research. As teens get older, they want more autonomy. They want to have more social time. And now, it's just on their phone.

Dr Anne Walters (Host): I really liked the idea of using it as a way to sort of elaborate values within a family and having a discussion at different points of development about why it may or may not be helpful to engage in certain kinds of screen activity, social media or others. And we know that families lead busy lives and there was a lot of stress during the pandemic and sometimes having a child sit in front of a screen is the only break. And so it's not realistic to say that that's not going to happen.

Dr Justin Parent: No. And they shouldn't feel guilty. I think that's the thing is like screen time is bad, so then more feeling guilty as a parent. But it's okay. In moderation, it's incredibly useful if I got a work meeting and I'm cooking dinner and I need my child to be busy for a few minutes, that's a great tool for you to have in your tool belt. It's only when it becomes an excess, like many things, that it becomes a problem.

And I think it's also a nice opportunity. Usually, when I do this work with parents, I sort of bring myself and then think of them in the conversation. For example, I'll say that when I use social media for more than about 30 minutes a day, I've noticed that I feel a little more down and sort of it doesn't really fit with my values. So I'm not getting as much joy out of it. So I, on my own phone, have a limit that I set for social media of 30 minutes. And we encourage parents to set a limit for themselves, because really they're the model as well. And in our data, the best predictor of child screen time is parents' screen time, and that kids tend to follow along and it's helpful for adults too, to set some of those limits. Because I know with the work we do, the phone, I've turned off notifications, for example. My email doesn't ping all the time, because it's hard to turn off. The devices are designed to keep your attention, and for kids especially.

Dr Greg Fritz (Host): Well, Justin, this has been really interesting. I think many parents are dependent on screen time and technology to be able to occupy their kids while they are getting their own work done, like you were saying. As we emerge from this pandemic and more and more schools are returning to in-person learning and parents are returning to the office, I bet we'll be seeing a shift in these behaviors again, to some degree. What's your feeling about that?

Dr Justin Parent: In my opinion, I think in a variety of ways, on both the parent and the child side, and it's not going to go back fully. I think that when you survey parents, for example, workers, that majority of them want to continue some type of hybrid or remote work. So I think technology is going to continue both in a school sense in our treatment with kids and then the parents work is going to continue to be in this more hybrid-like way. So more and more over time, I think it's more about living within this hybrid technology environment and how to help it boost up what's the best part of us, which is sort of like boosting connection and ideas and innovation, and then trying to pull down some of those negative effects of things. And hopefully, we'll see that happen. I think there's a lot of people interested in that. There are some certainly that are they're motivated by the clicks on your phone and trying to get more of that. But I hope that over time, we see this shift to where it's a little more of harmony,

Dr Anne Walters (Host): Justin, what a great discussion. Thanks so much for joining us today on MindCast.

And if you found this podcast helpful, please share it to your social channels and check out our entire podcast library at bradleyhospital.org/podcast for topics of interest to you. This is MindCast: Healthy Mind, Healthy Child, a podcast from the experts at Bradley Hospital. Dr. Anne Walters with Dr. Greg Fritz. Thanks for listening.