June 24, 2018

Screens and Teens: The Downside

Azadeh Sami, DO, MSPH
A typical encounter for pediatricians:  We walk into a room to begin a well check for a teenager, whose eyes are glued to a cell phone.  We gently ask for the teen’s attention to begin the visit, as he/she reluctantly turns the phone over to the parents.  When reviewing lifestyle habits, we discover that although a 9:30pm bedtime is reported, actual sleep onset occurs 2 hours later.  When asked what they typically do before bed, the teens’ answers consist mainly of “on the phone”, “texting”, or “on my computer.”  Homework is online, texting maintains social status among peers, study breaks consist of video games, and by the end of the day, the teen has spent at least 6 hours of the day on the screen.  Parents note, by the way, that the patient has recently been feeling very fatigued.
Thankfully, journals and websites have raised awareness of this overwhelming problem, in ways that are now hitting home for many families.  Recently, Forbes magazine published an article effectively illustrating the link between screen time and shifts in brain activity.  The infographic in this article strikingly notes that brain imaging research shows screen technologies and cocaine affect our brain’s frontal cortex in the same way.  This correlation is exactly what we as pediatricians need to help make our advice more concrete for the new generation.
 The article presents a Cincinnati Children’s Hospital study examining brain activity in those who spend more time on screens versus reading books.  Screen time was linked to poorer connectivity in areas that govern language and cognitive control. Reading, on the other hand, was linked to better connectivity in these regions.  Furthermore, another study cited in the article demonstrated that GABA levels were increased in those who were addicted to the internet. More specifically, the rise in GABA levels is believed to be a functional loss of integration and regulation of processing in the cognitive and emotional neural network.  But no need to worry, as these changes generally reversed when the teens went through cognitive behavior therapy (CBT) for their addiction.
I recently gave a community lecture regarding How to Increase Your Child’s Success in School, incorporating the AAP’s recommendations as well as studies done by psychologists regarding the true  qualities needed for success in life.  In preparing for this lecture, I learned about the role of excess screen time on the balance between the visual system and the vestibular system.  When the two are not in sync, as when the visual system has been overly stimulated by the bright screen, without allowing the rest of the body to “catch up”, young children begin to feel restless.  For that, I like to recommend to patients to put a timer near the screen.  For every hour spent on the screen, when the timer goes off, they must stop and engage in some sort of physical activity for one hour.  The invention of the Wii seemed initially to be the answer to our struggles, but to our disappointment, we have discovered that levels of physical activity did not significantly change with the coming of this exciting “exer-gaming” concept.
Not to mention the added effects of social media. Patients who are perpetually exposed to their peers’ posts about the car they drive, the parties they went to, or the vacations they took, acquire a feeling of inadequacy.  Over time, the sense of inadequacy can become so uncontrollable, it ultimately develops into depression.  The Forbes article cites a study showing that about 48% of those who spent five or more hours a day on their phones had thought about suicide or made plans for it, as compared to 28% of the teens who spent only one hour per day on their phones.
With regards to sleep onset and quality, we know that the type of light emitted by screens is primarily blue light.  This blue light is what the sun emits, which in turn suppresses melatonin.  
The bottom line is this:  the effect of screen time is multi-fold.  Poor vision.  Depression.  Inactivity, and thus, obesity.  Delayed sleep onset.  Poor sleep quality. Poor brain connectivity leading to poor school performance.  Suicide.  It’s overwhelming.

I hope the information presented in this blog is helpful for those pediatricians who feel they are truly struggling to convince their patients the dangers of excessive screen time.  At least I’m sure you can all relate.

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