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.
“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.