Tag: ADHD

August 25, 2024

Electronic Screen Syndrome: An Emerging Disorder of Dysregulation

A growing body of research links screen time to the unprecedented rise of mental health disorders in children.

*Adapted and updated from article originally published on Psychology Today.

Attribution: freepix

“He’s revved up all the time.”

“He can’t focus at all and is totally defiant. Getting ready for school or bedtime is a daily nightmare.”

“She’s exhausted and has meltdowns even when she’s slept enough.”

“He flies into a rage over the slightest thing. The other kids don’t want to play with him anymore.”

“Her grades have gone downhill this year and we don’t know why.”

The above complaints are so common nearly every parent will relate to one or more of them. Psychiatric symptoms from various disorders contain a lot of overlap, and this is especially true when it comes to children. This overlapping nature coupled with today’s overstimulating high-tech environment has led to an epidemic of misdiagnosed mental disorders, which in turn lends itself to inappropriate psychotropic medication prescribing and misuse of precious resources.

The two most overdiagnosed disorders in the pediatric population that I’ve encountered over the last 10 years are attention deficit hyperactivity disorder (ADHD or ADD) and childhood bipolar disorder—both of which can lead to taking medication with significant side effects. Diagnoses for both of these conditions have risen sharply in the past 2 decades[1] [2] [3]. Likewise, there have been sharp rises in psychotropic prescribing in children in the same time period, including antipsychotics and stimulants.[4] [5] [6]. Meanwhile, it shouldn’t be news to anyone that we’re seeing an epidemic of depression, anxiety, suicidal thinking, and subsequent antidepressant prescribing, in young people as well.

I don’t feel parents – or clincians – are looking for an “easy fix.” I think there really are more kids with serious mental health issues. And because distressed parents are coming through their doctor’s door desperate for an answer, physicians and other clinicians feel pressure to provide relief. But more importantly, I think folks are barking up the wrong tree and not addressing the root of the problem. Might something environmental be to blame?

Electronic Screen Syndrome: An Unrecognized, Modern-Day Disorder

If you’re familiar with my work, you’ll know that I attribute the growing rise in mental health concerns to the effects of screen time (particularly the interactive kind). Indeed, the unnaturally stimulating nature of an electronic screen device—irrespective of the content it brings—has ill effects on our mental and physical health at multiple levels.

Screen-related effects can present in many shapes and forms. Although varied, many of the effects can be grouped into symptoms related to mood, cognition, and behavior. The root of these symptoms appears to be linked to repeated stress on the nervous system, making self-regulation and stress management less efficient.

Because of the complicated and varied nature of screens’ effects, I’ve found it helpful to conceptualize the phenomena in terms of a syndrome—what I call Electronic Screen Syndrome (ESS). ESS can occur in the absence of a psychiatric disorder and mimic it, or it can occur in the face of an underlying disorder, exacerbating it.

ESS is essentially a disorder of dysregulation. Dysregulation can be defined as an inability to modulate one’s mood, attention, or level of arousal in a manner appropriate to one’s environment.

Interacting with screens shifts the nervous system into fight-or-flight mode which leads to dysregulation and disorganization of various biological systems. Sometimes this stress response is immediate and pronounced (say while playing an action video game), and other times the response is more subtle and may happen only after a certain amount of repetition (say repeatedly texting or checking social media feeds). The mechanisms for screens causing a stress response are varied and are discussed elsewhere; the most complete descriptions can be found in Reset Your Child’s Brain. In short, though, interacting with screen devices causes a child to become overstimulated or “revved up.”

ESS Signs and Symptoms in Children

Although symptoms and presentation can vary from child to child, depending on underlying makeup, here are some general characterizations of ESS:

The child exhibits symptoms related to mood, anxiety, cognition, behavior, or social interactions that cause significant impairment in school, at home, or with peers. Typical signs and symptoms mimic chronic stress and include irritable, depressed or labile mood, excessive tantrums, low frustration tolerance, poor self-regulation, disorganized behavior, oppositional-defiant behaviors, poor sportsmanship, social immaturity, poor eye contact, insomnia/non-restorative sleep, learning difficulties, and poor short-term memory.[7]
ESS may occur in the absence or presence of other psychiatric, neurological, behavior or learning disorders, and can mimic or exacerbate virtually any mental health-related disorder.
Symptoms markedly improve or resolve with strict removal of electronic media (an “electronic fast” or “screen fast”); three- to four-week electronic fasts are often sufficient for symptom reversal but longer fasts may be required in severe cases. Longer fasts build on gains across a range of domains.
Symptoms may return with re-introduction of electronic media following a fast, depending on a variety of factors. Some children can tolerate moderation after a fast, while others seem to relapse immediately if re-exposed.
Vulnerability factors exist and include: male gender, pre-existing psychiatric, neurodevelopmental, learning, or behavior disorders, co-existing stressors, and total lifetime electronic media exposure. At particular risk may be boys with ADHD and/or autism spectrum disorders. In the past decade, however, teen girls seem to be at higher risk for developing ESS due to social media and smartphone use, which typically presents as depression, anxiety, and/or anhedonia (lack of pleasure or enjoyment of things).

The Advantages of Acknowledging and Treating ESS

I recognize that “discovering” a new diagnosis will be met with skepticism and criticism, but I’m willing to risk that in order to increase awareness. I’ve observed the stressful effects of screen time in my practice for more than two decades, and have utilized a prescribed electronic fast in more than 1000 children, teens, and young adult patients.

Since the early days of this discovery, I’ve expanded the program from my patients to the general population; it’s not just kids with psychiatric problems that benefit. If ESS occurs in addition to a true underlying psychiatric disorder, the fast—if done correctly—is effective about 80 percent of the time and typically reduces symptoms by at least half. In the general population, there is often a complete resolution of symptoms. It really can be quite dramatic.

So what have I seen improve by addressing ESS? Resolution of aggression. Brighter moods. Increased compliance. Improved grades. More eye contact. And with these improvements comes, of course, less-stressed parents.

Further, while I’ve been observing the negative effects of video games and other screen-time effects for more than 20 years, the research is now consistently finding links between screen time and dysregulated mood and behavior.

And lastly, consider that the most recent DSM version names a new childhood diagnosis called Disruptive Mood Dysregulation Disorder which is a syndrome characterized by severe recurrent temper outbursts that are inconsistent with developmental level.

Coincidence? I think not.

For more on overstimulation and how an electronic fast can dramatically improve how a child feels and functions, check out Reset Your Child’s Brain: A Four-Week Plan to End Meltdowns, Raise Grades, and Boost Social Skills by Reversing the Effects of Electronic Screen-Time.

References

[1] Moreno, et al. “National Trends in the Outpatient Diagnosis and Treatment of Bipolar Disorder in Youth” Arch Gen Psychiatry. 2007;64(9):1032-1039. http://archpsyc.jamanetwork.com/article.aspx?articleid=482424

[2] LeFever GB, Arcona AP, Antonuccio DO. “ADHD among American schoolchildren: evidence of overdiagnosis and overuse of medication.” Sci Rev Ment Health Pract. 2003;2:49-60.

[3] Visser SN, Lesesne CA, Perou R. “National estimates and factors associated with medication treatment for childhood attention-deficit/hyperactivity disorder.” Pediatrics. 2007;119(suppl 1):S99-S106.

[4] Mayes R, Bagwell C, Erkulwater J. “ADHD and the rise in stimulant use among children.” Harvard Rev Psychiatry. 2008;16:151-166.

[5] Olfson M, Marcus SC, Weissman MM, Jensen PS. “National trends in the use of psychotropic medications by children.” J Am Acad Child Adolesc Psychiatry. 2002;41:514-521.

[6] Vitiello B, Zuvekas SH, Norquist GS. “National estimates of antidepressant medication use among U.S. children, 1997-2002.” J Am Acad Child Adolesc Psychiatry. 2006;45:271-279.

[7] Author’s note: Other symptoms that can be triggered by ESS include tics, stuttering, panic attacks, OCD and even hallucinations and subtle seizure activity.

Additionally, the research on mental health trends and the link between screen time and mental health disorders continues to grow. Updated research will be presented in a revised edition to Reset Your Child’s Brain, slated for 2025. That said, it’s only more of the same, and the book stands as is.

November 11, 2015

Screentime is Making Kids Moody, Crazy and Lazy

6 ways electronics use can make children angry, depressed, and unmotivated

Children or teens who are “revved up” and prone to rages or—alternatively—who are depressed and apathetic have become disturbingly commonplace. Chronically irritable children are often in a state of abnormally high arousal, and may seem “wired and tired.” That is, they’re agitated but exhausted. Because chronically high arousal levels impact memory and the ability to relate, these kids are also likely to struggle academically and socially.

At some point, a child with these symptoms may be given a mental-health diagnosis such as major depression, bipolar disorder, or ADHD, and offered corresponding treatments, including therapy and medication. But often these treatments don’t work very well, and the downward spiral continues.

What’s happening?

Both parents and clinicians may be “barking up the wrong tree.” That is, they’re trying to treat what looks like a textbook case of mental disorder, but failing to rule out and address the most common environmental cause of such symptoms—everyday use of electronics. Time and again, I’ve realized that regardless of whether there exists any “true” underlying diagnoses, successfully treating a child with mood dysregulation today requires methodically eliminating all electronics use for several weeks—an “electronic fast” —to allow the nervous system to “reset.”

If done correctly, this intervention can produce deeper sleep, a brighter and more even mood, better focus and organization, and an increase in physical activity. The ability to tolerate stress improves, so meltdowns diminish in both frequency and severity. The child begins to enjoy the things they used to, is more drawn to nature, and imaginary or creative play returns. In teens and young adults, an increase in self-directed behavior is observed—the exact opposite of apathy and hopelessness.

It’s a beautiful thing.

At the same time, the electronic fast reduces or eliminates the need for medication while rendering other treatments more effective. Improved sleep, more exercise, and more face-to-face contact with others compound the benefits—an upward spiral! After the fast, once the brain is reset, the parent can carefully determine how much if any electronics use the child can tolerate without symptoms returning.

Restricting electronics may not solve everything, but it’s often the missing link in treatment when kids are stuck.

But why is the electronic fast intervention so effective? Because it reverses much of the physiological dysfunction produced by daily screen time.

Children’s brains are much more sensitive to electronics use than most of us realize. In fact, contrary to popular belief, it doesn’t take much electronic stimulation to throw a sensitive and still-developing brain off track. Also, many parents mistakenly believe that interactive screen-time—Internet or social media use, texting, emailing, and gaming—isn’t harmful, especially compared to passive screen time like watching TV. In fact, interactive screen time is more likely to cause sleep, mood, and cognitive issues, because it’s more likely to cause hyperarousal and compulsive use.

Here’s a look at six physiological mechanisms that explain electronics’ tendency to produce mood disturbance:

1. Screen time disrupts sleep and desynchronizes the body clock (link is external).

Because light from screen devices mimics daytime, it suppresses melatonin, a sleep signal released by darkness. Just minutes of screen stimulation can delay melatonin release by several hours and desynchronize the body clock. Once the body clock is disrupted, all sorts of other unhealthy reactions occur, such as hormone imbalance and brain inflammation. Plus, high arousal doesn’t permit deep sleep, and deep sleep is how we heal.

2. Screen time desensitizes the brain’s reward system.

Many children are “hooked” on electronics, and in fact gaming releases so much dopamine—the “feel-good” chemical—that on a brain scan it looks the same as cocaine use. But when reward pathways are overused, they become less sensitive, and more and more stimulation is needed to experience pleasure. Meanwhile, dopamine is also critical for focus and motivation, so needless to say, even small changes in dopamine sensitivity can wreak havoc on how well a child feels and functions.

3. Screen time produces “light-at-night.”

Light-at-night from electronics has been linked to depression and even suicide risk in numerous studies. In fact, animal studies show that exposure to screen-based light before or during sleep causes depression, even when the animal isn’t looking at the screen. Sometimes parents are reluctant to restrict electronics use in a child’s bedroom because they worry the child will enter a state of despair—but in fact removing light-at-night is protective.

4. Screen time induces stress reactions.

Both acute stress (fight-or-flight) and chronic stress produce changes in brain chemistry and hormones that can increase irritability. Indeed, cortisol, the chronic stress hormone, seems to be both a cause and an effect of depression—creating a vicious cycle. Additionally, both hyperarousal and addiction pathways suppress the brain’s frontal lobe, the area where mood regulation actually takes place.

5. Screen time overloads the sensory system, fractures attention, and depletes mental reserves.

Experts say that what’s often behind explosive and aggressive behavior is poor focus. When attention suffers, so does the ability to process one’s internal and external environment, so little demands become big ones. By depleting mental energy with high visual and cognitive input, screen time contributes to low reserves. One way to temporarily “boost” depleted reserves is to become angry, so meltdowns actually become a coping mechanism.

Source: Chubykin Arkady/Shutterstock

6. Screen-time reduces physical activity levels and exposure to “green time.”

Research shows that time outdoors, especially interacting with nature, can restore attention, lower stress, and reduce aggression. Thus, time spent with electronics reduces exposure to natural mood enhancers.

In today’s world, it may seem crazy to restrict electronics so drastically. But when kids are struggling, we’re not doing them any favors by leaving electronics in place and hoping they can wind down by using electronics in “moderation.” It just doesn’t work. In contrast, by allowing the nervous system to return to a more natural state with a strict fast, we can take the first step in helping a child become calmer, stronger, and happier.

For more on this topic, check out my new book, Reset Your Child’s Brain: A Four Week Plan to End Meltdowns, Raise Grades and Boost Social Skills by Reversing the Effects of Electronic Screen Time.

September 30, 2010

Misdiagnosed? Bipolar disorder is all the rage!

Feel Lost and Confused? You're not alone!

Recently I gave a presentation to U.C. Irvine Medical Center’s Neuropsychiatry Department, entitled “The Negative Effects of Video Games and Electronics on Mood, Behavior, and Brain Development“. At the last minute, I added in a slide on children being misdiagnosed with mental disorders when the child was really suffering from being over-stimulated by electronics. A good portion of the audience were residents and medical students, and I wanted them to be conscious of this issue when they were assessing a child or adolescent for diagnosis or treatment.

Later that day I added a blurb about children being misdiagnosed on a post introducing a new minicourse (Save Your Child’s Brain) I’d been working on. Within hours I received an email from an old friend who saw the post on Facebook. Here’s her message:

COMMENTS: Wow am I glad I read this post on FB.
My 6 year old son loves video games and once he got his Wii he would play for as long as we would let him. Over the last few months we have been weaning him slowly because we knew that too much is harmful but not knowing where that line is we still allow him about 3-6 hours a week.

I just recently took my 6 year boy to the pediatricians for behavioral issues. She immediately implied that she thought that he was bipolar and urged me to get him to the psychiatrist and on meds asap. We decided to take it slow and try taking sugar out of his diet and modifying our reaction to his temper tantrums in lieu of rushing him to therapy.
This has really been a timely find and I look forward to
learning more.

I got a chill after reading it. How many children were being put on psychotropic medication unnecessarily? Her story reaffirmed my conviction that people need information on this topic!!

Here’s another disturbing story: A colleague recently told me her 10 year old son had been given 4 medications in the space of 6 months’ time, and was diagnosed at first as ADHD, then autism, and finally as bipolar. This was a child with no problems until the 5th grade, and who was now failing all subjects, depressed, and suicidal. After a little sleuthing, we tied his symptom onset to him getting his first cell phone at the beginning of the school year. He played games on the phone for several hours every day, and well into the night, to the exclusion of all else.

This mother came to me asking for advice on what she should do next. It occurred to me how many children I’d seen that were diagnosed as bipolar over the years who eventually stabilized and were taken off medication. (Bipolar disorder is chronic, lifelong, and progressive). The fact that they stabilized and continued to be stable off medication meant those children were NOT bipolar, but only looked that way.

Video gaming is one of the environmental factors that can create mood instability, and therefore its influence became even more ominous to me. Were video games contributing to the shocking rise in psychotropic medication usage?

Due to a serious shortage of child psychiatrists, most children are first seen by their pediatrician- who have about 2 months of training in child psychiatry. Yes, you heard that right–2 months. Where do they get their education? Well, mostly from drug reps. Since drug reps are only allowed to talk about what’s FDA approved, and since most of us child psychiatrists use “off-label” medications the vast majority of the time, our methods are very different.

For example, I might use an older, milder, benign, and generic (read:cheap) mood-stabilizer when treating mood problems, especially if it’s unclear why the child is having mood swings. I normally would not head for the heavy duty drugs first- even though those are the ones that are FDA approved for “bipolar disorder” and “treatment resistant depression”. Most of those drugs are actually anti-psychotics, and have serious side effects such as weight gain, metabolic syndrome, and movement disorders. Those drugs have their place, can save lives, and improve a truly bipolar person’s long-term prognosis- (don’t get me wrong, I do use all of them, regularly-) but it is very difficult to diagnose bipolar disorder in a child, especially during a 15 minute visit!! A pediatrician may be more likely to use medications that are FDA-approved for a particular disorder, and to use newer brand-name drugs. Those drugs may be effective for that disorder, but with major side effects. What if the diagnosis is wrong?

Ever since “The Bipolar Child” was published, parents have read this book and think, “Whoa! That’s my child!” Again, don’t get me wrong– this book is a classic and a gem– but many, if not most, childhood mental disorders have a mood component to them, and many clinicians mistakenly think that severe mood swings and aggression=bipolar disorder. Children’s threshold for aggression is much lower than ours, because they have poor impulse control. Furthermore, many disorders, including ADHD and video game addiction, affect the frontal lobe, which is the dashboard for impulse control. Ergo rage and aggression. All that rages is not bipolar!

The point is, parents need to take a hard look at environmental influences, in this case video games and electronic screens. You’ll need to eliminate this factor before you can really tell what’s going on. Sure, your child might still have symptoms after you remove these things, but they will be less severe. Your child’s teacher, doctor, therapist, tutor–everyone!–will have a much clearer picture of what’s going on if you remove these factors.

To read more about the science behind the electronics’ toxicity and how to address it with your child, sign up here to receive a free, 4 day mini course. If nothing else keep an open mind and just read a little.

Trust me, your child’s brain will thank you:-)

Big thanks to RJS who shared her story with me and allowed me to share it with you. If you feel this article might be helpful to someone else, please pass it on– you never know whose life it might change!