Screen "addiction" and mental health

What you need to know about a new study that's making headlines

Welcome back, sapiens!

Today’s post is a collaboration with Dr. Cara Goodwin, child psychologist and founder of the nonprofit Parenting Translator. You may be familiar with her hugely popular Instagram and newsletter, particularly if you (like me) love a good piece of research-backed parenting advice.

What you may *not* already know is that Cara and I overlapped in the Clinical Psychology PhD program at UNC Chapel Hill—and when I search for Cara’s name in my inbox, there’s a 13-year-old (!) email from her, very kindly offering to pick me up from the airport for my campus visit.

I do not remember this car ride well,¹ but I can only assume Cara was as skilled at driving as she is at delivering actionable, digestible, and evidence-based guidance for parents. If you’re not already following her newsletter, I highly recommend subscribing here!

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7 min read

Maybe you’ve noticed: in the past few weeks, the latest round of scary, screen-related headlines has arrived:

“Real Risk to Youth Mental Health Is ‘Addictive Use,’ Not Screen Time Alone, Study Finds” (The New York Times)

“Why Parents Should Focus on Screen Addiction Over Screen Time, Says New Study” (Parents)

“Screen addiction and suicidal behaviors are linked for teens, a study shows” (NPR)

So, what should we make of these findings? Should we get rid of screen time limits? Is “screen addiction” a real diagnosis? And where do we go from here?

Tell me about the study

For this new paper, published last month in JAMA, researchers analyzed data from the Adolescent Brain Cognitive Development (ABCD) Study, a massive, ongoing study of child health that’s following thousands of kids across the U.S.

This particular project involved 4,285 tweens² who participated at three time points, spanning ages 10 to 14.

The following measures were collected:

• Addictive screen use. The kids filled out surveys assessing addictive use of three types of screens: phones, social media, and video games.

• Screen time. Kids also reported the total number of hours (0-24) they spend per day on screens for non-school activities.

• Mental health symptoms. Parents reported whether kids had symptoms of a range of concerns, like depression, anxiety, and behavior problems.

• Suicidal ideation and behavior. Both parents and kids were interviewed about whether the child had any suicidal thoughts or attempts over the past few years.

The researchers then looked at patterns in how kids’ addictive screen use changed over time.³ For some, it started low and increased. For others, it started low (or high) and stayed that way.

What did the researchers find?

“Addictive use” was very common, and increased over time.

• 49% of kids showed addictive patterns of phone use, and 25% showed increasing levels over time.

• 10% showed addictive patterns of social media use, and 31% showed increasing levels over time⁴

• 41% showed addictive patterns of video game use

In general, addictive patterns of screen use were associated with worse mental health outcomes.

• Kids who showed highly addictive social media or video game use were at greater risk for suicidal thoughts, suicidal behavior, and other mental health problems

• Kids who showed highly addictive phone use were also at greater risk for suicidal thoughts and behavior

• Interestingly, total amount of screen time was not associated with any mental health problems.

• Findings do not prove that addictive screen use causes mental health concerns— only that these behaviors are linked. There could be other factors, like poor self-regulation or disrupted sleep, driving both.

First things first

Before we start further analyzing this study, let’s pause and highlight what’s most important: too many children are struggling with their mental health.

In this study, 5.1% of kids ages 10 to 14 had engaged in suicidal behaviors, and 17.9% had thoughts of suicide. These numbers are consistent with other recent national estimates. There’s no way around it: this is heartbreaking, and something we need to continue taking very seriously.

If your child is struggling with their mental health, or if you’re concerned that they are using screens in addictive or problematic ways, you should talk to a professional. Your pediatrician is a good place to start, as is this list of resources. If they (or anyone you know) are having thoughts of suicide, you can call or text 988 or visit 988lifeline.org.

Okay, now, what should we make of this study?

What does “addictive screen use” actually mean?

The researchers used three different measures to assess each of addictive social media use, phone use, and video gaming, but here are some common criteria:

1. Difficulty stopping or limiting screens: "I’ve tried to use my social media apps less, but I can't” or “I have been unable to reduce my phone use”

2. Distress, irritability, anxiety, or depression when not using screens: “I’ve become stressed or upset if I am not allowed to play video games.”⁵

3. Using screens to regulate emotions: “I use social media apps so I can forget about my problems."

4. Thinking about using screens frequently: "I often think about my phone when I am not using it"

5. Screen use causing problems in other activities, like work, school, relationships, or sleep: “I play video games so much that it has had a bad effect on my schoolwork” or “Arguments have arisen with others because of my phone use.”

So, is screen addiction a real diagnosis?

Here’s where things get complicated.

On the one hand, some of these screen-related behaviors are definitely concerning. These results confirm that there are many children whose screen use is problematic—it’s interfering with their lives in important ways, it’s causing distress for them and the people around them, and they cannot stop even when they want to—and it is linked to worse mental health.

It’s also worth noting that many of the types of screens they’re using are designed to be highly engaging and hard to put down, which is likely exacerbating these behaviors. This should not be the case.

At the same time, the term “addiction” may not be the right one. There is no official definition of “screen addiction,” and it is not a true medical diagnosis. When we use this term, we run the risk of lumping problematic screen use together with addiction to substances (like alcohol or drugs), which operate differently, and require different treatments. We also run the risk of overly pathologizing certain behaviors. Is it really a disease, for example, if a child is often thinking about using their phone to text friends?

“Addiction” is a convenient shorthand for describing patterns of screen use that are problematic, but we need to be careful about what, exactly, we mean when we say it.

Overall translation

This study is important. It reminds us to pay attention to our children’s relationship with screens, and to be on the lookout for behaviors that could signal more serious mental health concerns.

It also offers an important distinction between “overall screen time” and “addictive patterns of use.” These things are, of course, related—kids with excessive screen time are also at risk for addictive use—but the specific number of minutes our children are spending with screens likely matters less than their relationship with screens.

Are screens interfering with other activities? Causing them significant distress? Causing problems in other areas?

What should I do with this information?

If you are concerned about your child’s relationship with screens, reach out to a professional.

Here are some other things to keep in mind:

1. Set clear boundaries on screen use

Try to involve your child in deciding on limits, and keep them firm but flexible–for example, You get X hours of screen time everyday (predictable), but you can choose when to use it (flexible).

2. Model a healthy relationship with your own devices

This one is hard, but important! Talk to your child about why screens can be hard to put down, and the strategies you’re using to curb your own use.

3. Be aware of the red flags in your child’s screen use

Many children have some difficulty stopping their screen use, or get upset sometimes when screen time is over—but if you sense that your child’s reactions may be extreme, if they’re lying about their screen use, or if it’s causing problems with school or friends, it may be time to talk to a professional.

4. Try mindfulness

Encourage your child (and yourself!) to take a moment to consider why they’re using screens, and how they’re feeling afterward. You can also try “urge surfing,” which involves observing the rise and fall of a “craving” (e.g., the urge to unlock a phone) without acting upon it.

5. Substitute with other things

Instead of simply cutting off screen time, consider other behaviors that meet the same need. For example: to manage boredom, help them create a list of screen-free activities; to deal with strong emotions, help them think of other coping skills; to socialize, create opportunities for in-person hangouts.

6. Change the environment

Our environments play a major role in shaping habits. Try altering your physical environment to limit screens (e.g., creating screen-free times and places, like in the bedroom or at dinner) and your digital environment to do the same (e.g., by using apps like Freedom, Forest, or Stay Focused).

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The Scroll

Your quick burst of updates, news, and links from the worlds of parenting and tech. Email technosapiens.substack@gmail.com if you’d like to see your news (e.g., articles, press releases) featured in the future!

• Lovevery launched The Reading Skill Set—a fun, new way to teach kids to read through play—and were kind enough to send one my way. My 4-year-old loves books and stories⁶ (so much that I sometimes fear I’m raising a future academic-turned-Substack-writer), so I cannot wait to try this out with him!

• New study that reviews interventions to address problematic social media use in teens: "Programs that teach adolescents cognitive or behavioral strategies to engage with social media in a healthy manner appear to be more effective…than interventions that completely restrict social media use or warn adolescents of its negative effects.”

• Interesting take on the “education crisis” for boys—makes me want to dive deeper into the data! (New York Times)

• Well, it was only a matter of time. I finally downloaded the Merlin Bird ID app, and now I can’t stop walking around my neighborhood identifying bird calls. Highly recommend.

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1. I haven’t asked Cara whether she remembers this car ride, but after a brief, cringeworthy foray into the emails it seems I was sending back in 2012, I pray I did not embarrass myself too badly.

2. Note: I’m using the terms “tweens” and “kids” interchangeably here, with apologies in advance to any 10- to 14-year-olds who might be reading this. It’s a hard age range to describe!

3. In research-speak: “Latent class linear mixed models were used to identify addictive use trajectories based on age and quadratic age terms.” In regular speak: “They looked at how addictive use changed over time.” No fault of the authors of this paper—this is the correct way to describe their analyses, and required by journals for publication—but scientists may want to consider that this is why people don’t read academic papers?

4. Note that the study started when kids were age 10, so many were not really using social media yet—kids in the study were spending an average of 7 minutes per day on social media at age 10, but this increased to 70 minutes per day by the age 14.

5. A related worry I have is that parents will see some of these items—like, “I’ve become stressed or upset if I’m not allowed to play video games/use social media”—and assume this is a sign of that their child has a screen addiction “disorder,” leading to counterproductive solutions. For example, it could prevent parents from actually trying to understand and problem-solve around the reasons why the child is upset—maybe they’re supporting a struggling friend via text message, maybe dropping out of a game right in the middle will ruin it for the friends they’re playing with, maybe the app they’re using is specifically designed to make it hard to stop.

6. My 4-year-old truly does not discriminate on the quality of book or story, either. I’ve somehow fallen into a nightly ritual of telling him stories about “Volky” and “Cano,” two volcanoes who live in Hawaii, have three children (Smoke, Ash, and Fire), and like to tell each other “I lava you.” To be clear, the stories are not good. And he loves (lavas) them!