Visions Journal

Hazen Gandy, MD, FRCPC

Reprinted from the "Problem Gambling and Video Gaming" issue of Visions Journal, 2018, 14 (2), p. 34

Digital technology—such as laptops, tablets, cell phones, computer consoles and television—is now ubiquitous across the globe. Billions of people interact with digital technology on a daily basis. We are now seeing the first generation of children who have never known life without it. And from all reports, young people use digital technology a lot.

Canadian data from 2013 indicate that 96% of youth ages 15 to 24 use the Internet, accessing it through various devices.1 Research also suggests that Canadian teens spend an average of 4.1 hours of recreational time daily on screens of some form.^2,3

We can easily identify how technology has enhanced our daily lives. Communication is now effortless; we can access digital information and contact people around the globe 24/7. Access to an overwhelming selection of digital entertainment is at our fingertips. Vast libraries of information on any subject are immediately available to us. Arguably, the newest devices are as close as we come to magic, performing seemingly miraculous tasks in ways that the majority of us cannot describe and do not understand. Children seem to intuitively embrace each new digital advance. With their remarkable capacity for divergent thinking, they are capable of pushing new technologies in ever more interesting ways.

Yet despite the enhancements that digital technology offers, it’s not clear that it has actually improved the lives of our kids.

In the past several years, we have seen an alarming increase in mental health services utilization in children and youth in developed countries. In Canada, demand for child and youth mental health services is rapidly increasing.⁴ Visits to emergency departments for suicidal ideation, self-injurious behaviour, depression and anxiety are increasing year after year.⁴ Adolescents describe feeling increasingly stressed despite the ready access to digital technology seemingly designed to make their lives easier and richer.⁵ An Ottawa Public Health survey suggested that as many as one in nine adolescents seriously considered suicide or harming themselves in 2012.⁶

We know that the root causes of mental health problems are complex. But we don’t have a clear answer to the questions raised by these disturbing figures: Is there a relationship between technology use in children and youth and their mental health? Does our increasing use of technology threaten the mental health of children and adolescents?

What digital technology does to our children’s brains

From the research data emerges a picture of children and adolescents spending increasing amounts of time—largely unsupervised—in front of televisions, laptops, tablets and smartphones. Time spent with a screen may be perceived by young people as stimulating and entertaining, but it is still time not spent interacting in person with others.

Communicating face to face in person with other individuals is foundational for initiating and building meaningful intimate, safe social relationships and ultimately forging strong attachment bonds. This is the most important task of childhood: learning social skills. Mastering these skills requires the use of all our senses and takes constant practice and repetition. If this practice and repetition does not occur, the brain simply prunes out neurons and neuronal pathways used to perform social skills.

Developing meaningful social skills requires a visceral connection to our environment and each other that cannot be experienced through texts, tweets, emails or even video calls. Much of our most important communication is nonverbal—body posture and movements, facial expression, voice tone and volume, our rate of speech. Our physical personal space and physical contact with each other can convey enormous amounts of powerful information without a single word. We have a multibillion-dollar perfume industry premised on the notion that scent is a form of communication. Ever smelled someone through a text?

Some research shows that as screen time increases, social skills deteriorate.⁷ Many high-school teachers have observed that students who are heavy users of technology show a decreased ability to initiate conversation, make eye contact appropriately, accurately read nonverbal social cues and behaviours, identify emotional reactions in others and respond to others with empathy and compassion. Children and youth with social skills deficits are more likely to be socially anxious and are subsequently at greater risk for behavioural and emotional disorders.

Research is beginning to identify that our exposure to screens is experienced by the brain as stressful. Our “thinking brain” (the frontal lobe) may understand the sensory input as interesting, stimulating or exciting, but our “feeling brain” (the limbic system) experiences the exposure as a stress. Screen time is not restorative: it’s activating.⁸

The blue light emitted by screens has been shown to reduce the brain’s ability to initiate sleep.⁹ If we are exposed to screens for many hours of the day, over time our brains begin to develop a chronic stress response. Our bodies begin to produce more cortisol, a stress hormone that can impair brain function, including memory, focus, concentration and emotion regulation. This potentially increases our risk of developing anxiety and mood symptoms and impairs our emotional resilience.

Screen time is also physically passive. A growing body of research links increased screen time to increasing rates of obesity in children and adolescents.10 Poor physical health outcomes are associated with higher rates of mental health problems.

Screen use steals time away from developing healthy attachment behaviours and weakens attachment relationships. These constructs, first described by British psychologist and psychoanalyst John Bowlby in the 1950s, are foundational to a person’s sense of belonging and validation in their interactions with others and are instrumental in developing a strong sense of psychological and emotional resilience in the face of adversity. Digital technology also tends to promote virtual, online relationships among peers in the absence of adult supervision or input, which can increase the number of opportunities for young people to exercise poor judgement and make poor choices when it comes to their social interactions online and in person. It may even prevent young people from accessing supports that could help them develop and sustain their resiliency.

Much of the digital content consumed by children and adolescents online (like games and social media) is carefully designed to be as addictive as possible. Social media, for example, is typically developed along the same principles as slot machines, employing the most powerful mechanism of addiction: intermittent positive reinforcement.¹¹ Because of their brain development, especially their synaptic plasticity, children and youth are particularly vulnerable to the addictive characteristics of the media. They are more prone to develop excessive patterns of use, and it’s more difficult for them to break these patterns once they are established.

Finally, social media continues to be plagued with challenges around promoting personal, emotional and interpersonal accountability—the extent to which individuals take responsibility for their actions, comments and behaviours online. Personal accountability in relationships is also foundational in healthy social skills development.

A recent report from the UNICEF Office of Research¹² reviewed a large body of research on the impact of technology on children’s lives. The report suggests that for most children and youth, slight to moderate use of technology has positive impacts. No exposure to technology has slight negative impacts, while excessive use of technology is associated with mild to moderate negative impacts. The report stresses, however, that the relationship between kids and technology is very complex and not easy to study. It cautions that there are limitations and difficulties with the research questions and methods used and that much more research is required to definitively determine how technology affects the lives and brains of children and youth.

What we can do to counter the negative effects of digital technologies

In the face of these challenges, several strategies can reduce the potential negative impacts of digital technology on the developing brains of children and youth. These strategies encourage children and youth to think about how to use digital technologies in ways that enhance their social skills and their personal relationships. The strategies also help our children and youth incorporate digital technology into their lives in a balanced way.

1. Establish and follow a healthy technology routine. Create and maintain technology routines at home with children and youth. These routines should have clear, practical expectations and limits that everyone knows. Create digital-free zones and digital-free times and stick to them. Be a good example to your children. If you have decided there will be no digital technologies at the dinner table, leave your own phone in another room at meal times.

2. Maintain an open dialogue with children and youth about their digital activities. Talk to your children about what they do online—not just once, but regularly. Talk about the potential hazards of online gaming and relationships, including the addictive qualities of social media platforms and the risks associated with online chat rooms and discussion groups. Establish a reasonable monitoring system so that you can see where your children are going online and how they spend their screen time. Tell them what you are doing so that everyone knows what the expectation is.

3. Educate ourselves. As parents, we must continue to educate ourselves on the broader impacts of digital technologies on our children’s psychological, physical and social development. We must then use our understanding to influence educators and policymakers in their decisions about how to use these technologies in our classrooms and in our communities.

Together we need to become more deliberate, thoughtful and vigilant about how digital technology is delivered to children and youth. We must balance the benefits and risks to ensure these powerful new tools enhance and enrich our children’s lives rather than impair the social development and mental health of the next generation of users.