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Screen related dysregulation and depression

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.

Screen time induced dysregulation and depression
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:

  1. 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]
  2. 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.
  3. 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. 
  4. 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.
  5. 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. 

 

Overstimulating from Too much screen time causes depression and dysregulation.

Is Your Child Overstimulated from Too Much Screen Time?

Could your child be overstimulated from too much screen time? Take this quiz to find out

*Originally posted on Dr dunckley’s Mental Wealth blog on Psychology Today. 

How much screen time is “too much”? How does one know? Blanket guidelines, such as those provided by the American Academy of Pediatrics, do not address individual needs and sensitivities. This quiz can help determine  whether your child may be experiencing screen time impacts – aka “digital side effects”- from using electronic devices, which can occur even when a child has limited (but regular) screen use.

Recognizing Electronic Screen Syndrome

Thankfully, there is now a growing awareness regarding technology addiction. But well before addiction sets in, a child’s sensitive nervous system can become overstimulated and hyperaroused from moderate but regular amounts of screen time. This causes the brain to be in a state of chronic stress and effectively short circuits the frontal lobe, creating a host of symptoms that mimic or exacerbate mental health, learning, and behavioral disorders.

The first step in addressing this state — what I call Electronic Screen Syndrome (ESS) — is recognizing the signs.

This is important because traditionally when experts discuss red flags for problematic screen time, they focus on addictive behaviors, many of which are readily apparent. In contrast, this quiz is designed to help parents see the not-so-obvious ways in which screen time might be impacting a child’s or teen’s behavior in a negative way.

Electronic Screen Syndrome Quiz:

Place a checkmark next to each question that applies to your child.

  • Does your child seem revved up much of the time?
  • Does your child have meltdowns over minor frustrations?
  • Does your child have full-blown rages?
  • Has your child become increasingly oppositional, defiant, or disorganized?
  • Does your child become irritable when told it’s time to stop playing video games or to get off the computer?
  • Do you ever notice your child’s pupils are dilated after using electronics?
  • Does your child have a hard time making eye contact after screen time or in general?
  • Would you describe your child as being attracted to screens “like a moth to a flame”?
  • Do you ever feel your child is not as happy as he or she should be or is not enjoying activities as much as he or she used to?
  • Does your child have trouble making or keeping friends because of immature behavior?
  • Do you worry that your child’s interests have narrowed recently, or that interests mostly revolve around screens? Do you feel his or her thirst for knowledge and natural curiosity has been dampened?
  • Are your child’s grades falling, or is he or she not performing academically up to his or her potential — and no one is certain why?
  • Have teachers, pediatricians, or therapists suggested your child might have bipolar disorder, depression, ADHD, an anxiety disorder, or even psychosis, and there’s no family history of the disorder?
  • Have multiple practitioners given your child differing or conflicting diagnoses? Have you been told your child needs medication, but this doesn’t feel right to you?
  • Does your child have a preexisting condition, like autism or ADHD, whose symptoms seem to get worse after screen time?
    Does your child seem “wired and tired” — exhausted but can’t sleep, or sleeps but doesn’t feel rested?
  • Does your child seem unmotivated and have poor attention to detail?
  • Would you describe your child as being stressed, despite few identifiable stressors?
    Is your child receiving services in school that don’t seem to be helping?
  • Do you and your child argue over screens (limits, timing, content, activities, getting a new device, etc.) on a regular basis?
  • Does your child lie about screen use, “cheat” when on restriction, or take their device to bed with them?
  • Is your child a “sore loser” or hyper-competitive when playing games or sports, to the point where it affects peer relationships or enjoyment of the activity itself?
  • Does your child prefer socializing online over face-to-face interactions?
  • Do you avoid setting screen time limits because you fear your child’s reaction, you’re too exhausted, or because you’d feel guilty doing so?
  • Do you avoid spending time with your child because you predict it won’t be enjoyable or because you harbor negative feelings toward your child?

Quiz Scoring:

Overall points: Count the number of checked boxes/items endorsed.  Needless to say, the more questions that resonate with your family’s situation the higher the likelihood that screen time is affecting your child’s nervous system—ESS. At the same time, a higher score reflects risk for tech addiction—even if the amount of screen time is “average” or even less than your child’s peers.

1-5 points: Some risk for ESS. Your child has some difficulties whose primary underlying cause may or may not be related to screen use. However, all mental health, learning and behavior issues will improve when screen time is properly addressed. This is similar to how restoring sleep tends to have a panacea-like effect on mental conditions across the board.

5-12 points: Moderate risk for ESS. Your child has some significant difficulties, likely in more than one area (school, home or in relationships). There’s a good chance that your child may remain “stuck” or see limited improvements if ESS and screen time are not addressed. On the other hand, if you’re catching ESS early and aren’t too stressed yourself, now would a good time to nip it in the bud.

13 or more: High risk for ESS. If you’ve answered “yes” to more than half the questions above, it is highly likely your child has Electronic Screen Syndrome and may also be at risk for technology addiction. Many, many families fall into this category. You may feel you’re in crisis mode, all the time. Fear not—being in this state can be highly motivating, and you’re likely to see more dramatic and even “life-changing” benefits when ESS is reversed.

Specific problematic areas:

In contrast to the overall score, this section can help flesh out specific challenges your child may be experiencing. In turn, this can help you choose areas in which to track progress if you decide to try the screen fasting protocol.

Hyperarousal/overstimulation: Virtually all these questions relate directly or indirectly to hyperarousal, but in regards to physiological arousal look to items 1-7, 10, 16-18, and 22.

Mood dysregulation: Items 9, 11, 13, 17 and 22.

Cognition/focus: Items 4, 11-15, 17 and 19.

Behavior/social skills: Items 4, 7, 10, 20, 22 and 23.

Attachment: Items 7, 9, 10, 20, 21, 24 and 25.

Addiction: Items 5, 8, 9, 11, 12, 20, and 21, 23 and 24.

Misdiagnosis: Items 12-15, and 19. Since ESS can mimic or exacerbate psychiatric disorders, its presence is commonly missed. The presence of ESS doesn’t rule out other underlying conditions, but it will virtually always make them worse. Further, when ESS is left untreated the underlying disorders become harder (if not impossible) to address.

 

Electronic Screen Syndrome characteristics

In general, ESS is marked by high levels of arousal (hyperarousal, or being “revved up”) and an inability to regulate emotions and stress levels (dysregulation).

Symptoms vary and can mimic virtually any psychiatric or learning disorder and many neurological disorders. However, a classic presentation of ESS is irritable mood, poor focus or disorganization, low frustration tolerance, and problematic behaviors such as argumentativeness or poor eye contact. Depressed or anxious mood is also common.

You might notice that the quiz questions above cover a wide variety of dysfunction, but they all represent scenarios that can occur when a child starts operating from a more primitive part of the brain—which is what happens when children get more screen time than the nervous system can handle.

Now what?

The presence of ESS is good news—because whenever we can identify a culprit, we can point to an avenue of treatment. (Compare this to going in circles because you don’t know what’s going on and you’re wasting time/energy/money trying to figure it all out.)

Importantly, it doesn’t matter if there are underlying diagnoses or stressors contributing to the child’s symptoms; indeed these factors only make the child more vulnerable to overstimulation. And though screens may seem so ubiquitous that they’re impossible to control, the truth is that with education, support, and a concrete plan, parents can take back control, turn ESS around, and boost quality of life for not just your child but the entire family.

Screen fasting provides relief and clarity, and helps form new habits

The keys to success lie in grasping the physiology and dynamics behind screens and the nervous system as well as understanding how to systematically reset and resynchronize a child’s brain. This is achieved with a strict, extended electronic fast (aka a tech fast or screen fast) of at least three weeks’ (sometimes longer) duration.

Though the thought of this might seem overwhelming, most parents find the fast easier than they imagined it would be. Once the child’s nervous system is reset to its natural baseline, parents can either continue being (mostly) screen-free, or they can methodically determine how much screen time the child can tolerate without triggering symptoms or dysfunction.

Why not just cut back, you ask? Because screen exposure has potent biological effects including overactivation of the brain’s reward pathways, desynchronization of the body clock, sensory overload, release of stress hormones, and electrical excitability. These systems tend to stay in a disorganized state without complete removal of the offending agents. Removing screen stimulation allows the brain to get deep rest, resynchronize the clock, rebalance brain chemistry and hormones, quiet overactive pathways, and restore mental energy.

At the same time, the child’s play changes naturally, to being more physical, social, and creative. Instead of being bombarded by electronic stimulation while “waiting for the next fix” in between screen sessions, the child forms new habits and new routines, for example going directly outside after school, and reading or wanting to be read to in the evenings. Family dynamics change too, as members talk more, listen better, make more eye contact, and even laugh and smile more.

In short, recognizing and addressing overstimulation and ESS from screen time can have a profound impact on mood, focus, and behavior in children, teens—and even young adults—in a matter of weeks, while restoring peace and harmony in the home.

RECOMMENDATIONS:

1. For the complete guide on ESS and the Reset Program (screen fasting protocol), see
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.
Reset Your Child's Brain book

2. Prefer to watch or listen? Check out Screen Time and Your Child’s Brain webinar.  
The webinar includes footage of a real family doing the electronic fast with their 2 kids.

Screen Time and Your Child's Brain webinar

 

Victoria L. Dunckley, M.D. is an integrative child, adolescent and adult psychiatrist, the author of Reset Your Child’s Brain, and an expert on the effects of screen-time on the developing nervous system.