Wednesday 26 January 2022
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Children Interrupted By Gadgets

Excessive use of mobile phone for gaming, internet, social media has been associated with several adverse physical, mental and neurological consequences

Since the time the Covid-19 pandemic hit the world, most people have been forced to stay cooped at home. While adults were compelled to work from home, children were given smartphones to facilitate classes. Not only did the children have to cope with the loss of extracurricular activities and contact with close friends, they now also had access to the internet, gaming and social media, quite often unsupervised by unsuspecting parents who were trying to adjust to the ‘new normal’ of work-from-home. The pandemic has threatened physical health and well-being and has also been instrumental in increasing mental health issues. Specifically, it has had a significant impact on the child and adolescent population that has been the most vulnerable during this period. Although schools have reopened recently, mental health clinics are seeing a surge of parents seeking help for children presenting with several behavioural and emotional difficulties. One of the most common complaints reported by the parents is excessive screen-time, often bordering on addiction.

Excessive use of the mobile phone for gaming, internet access and social media has been associated with several adverse physical, mental and neurological consequences. Unfortunately, in the modern technology-based age, many children are being exposed to cellphone or television screens way before they start to crawl. Parents may resort to using devices in order to either engage the child or to distract them from temper tantrums, often unaware of the harmful effects this may have on the child.

Several studies show that excessive screen time is detrimental to the child’s brain and mental health. For instance, Tzipi Horowitz-Kraus and John Hutton in 2017 recruited 19 healthy American children from a private school and requested their parents to complete a survey on how many hours their children spent on independent reading and screen-based media time, including smartphones, tablets, desktop or laptop computers and television. The children then underwent magnetic resonance imaging. The researchers found that screen time was directly linked to a poorer neuronal connection between the visual word form area of the brain and the language, visual and cognitive control regions of the brain. They found that the time spent on reading was positively correlated with higher functional connectivity. In another cross-sectional study of 47 healthy prekindergarten children by John Hutton and colleagues in 2020, greater screen use was associated with lower measures of microstructural organization and myelination of brain white matter tracts that support language and emergent literacy skills and corresponding cognitive assessments. Further, early results from a landmark study by the National Institutes of Health, which began in 2018, indicated that children who spent more than two hours a day on screen-time activities scored lower on language and thinking tests. Further, children with more than seven hours a day of screen time experienced thinning of the brain’s cortex, the area of the brain related to critical thinking and reasoning.

But how does this impact the child in terms of mental health? Several researchers have reviewed the overall effects of excessive screen time on children. For example, Eliana Neophytou and colleagues reviewed 44 studies from 16 countries recently, and found that overall increased screen time was associated with negative outcomes such as lowered self-esteem, increased incidence and severity of mental health issues and addictions, slowed learning and acquisition, and an increased risk of premature cognitive decline. Similarly, Neza Stiglic and Russell Viner conducted a systemic review and found strong evidence for associations between screen time and greater obesity, poor diet, higher depressive symptoms and poorer quality of life. Researchers such as Gadi Lissak in 2018 have associated screen time with poor quality sleep, attention problems, hyperactivity, antisocial behaviour, decreased prosocial behaviour, social isolation, decreased motivation, depression, aggression, suicidal behaviours, and academic decline. Apart from the direct effects screen time has on the brain, it also has an impact on individual behaviour. Excessive internet, gaming or social media can reduce the amount of time the child spends on social interaction or in the mastery of skills. This has important repercussions because normal social interaction and play are useful for the of skills such as social skills, emotion regulation skills, healthy coping mechanisms, and so on, which are very important to process, handle and navigate through the complexities of life.

Although the physiological mechanisms that underlie the adverse health outcomes related to screen-time are unclear, it is generally believed that fast-paced content seen on the screen activates dopamine and the reward pathways, which sets the threshold for pleasure high. Normal day to day activities, games, social interaction, etc. which used to be pleasurable, no longer produce the same pleasure once screen time is introduced. Simple tasks such as going for a walk, talking to a friend, etc., become boring, difficult, and less pleasurable, and the child turns to screen for dopamine boost. This is because dopamine, a neurotransmitter that is present in reward processing and addiction is released during mobile use, gaming or other addictive behaviours. Addictive screen time use involves craving behaviour that resembles drug or alcohol addiction.  Recent brain imaging studies have also shown that screen addiction and cocaine affect the brain’s frontal cortex in the same way.

While the magnitude of the adverse consequences of excess screen time is being understood, there is little information available for parents on how to manage their child’s problematic screen use. Parents often become helpless, because they are the first-generation parents who are yet to learn safe use of devices themselves. While it is impossible to completely remove these devices from one’s life, it is possible to set limitations on their uses. However, it requires an authoritative stance and role modelling. Telling children to stop playing with mobile phones while parents continue to watch TV is an example of poor role modelling. Hence it is important for parents to ensure that they themselves limit their screen time outside of work, and to engage the children proactively. Likewise, handing smartphones to children and expecting them to use them responsibly is counterproductive. Children have poor self-regulation, and hence may not be able to manage their cravings, emotions and behaviours. Hence it is up to the parents to regulate their child’s screen time by giving structure to their day, providing alternative activities and setting limitations to screen time.

The American Academy of Paediatrics offers the following advice for screen time:

  • Completely avoid screen time in children under two years of age.
  • Limit screen time in children older than two years to not more than 2 hours a day.
  • Establish “screen free” zones in your home, such as in the bedroom and dining room.
  • Offer your child educational media and non-electronic content in the form of books, newspapers, and board games
  • Encourage your child to play outside, read, participate in hobbies, and use their imaginations in free play
  • Educate your child on harmful impact of the screen time.

studies cited above clearly indicate that excess screen time by young children can affect their brain development and mental health. If the parents are unable to manage their child’s behaviour or screen time, there is help available. There are several mental health professionals such as clinical psychologists, psychiatrists, etc., who can guide the parents, by identifying maladaptive parenting practices that could possibly be contributing to or maintaining the child’s problem, and teach skills and techniques to handle the child’s problems. If the child is presenting with other behavioural problems such as attention deficits, hyperactivity, anxiety, depression, conduct problems or other emotional and behavioural problems, then a visit to a mental health professional is a must, because such problems require professional help. Sometimes, medication may be necessary, however, the decision to use medication depends on the clinician’s evaluation of the child’s problems, the severity of symptoms and the potential benefit it can offer the child apart from behavioural intervention.

Sahithya BR
Dr Sahithya BR., MSc, MPhil, PhD. is a Clinical psychologist working in the mental health sector with vulnerable children, adolescents and adults. She is also actively involved in research and training. She is currently working as an assistant professor of clinical psychology at DIMHANS, Dharwad

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