Problem: What Is the Appropriate Screen Time?
“Fortnite is his favorite game to play on his PS4. He gets frustrated when he cannot communicate with others or if he is playing with an aggressive player. Would love for him to learn that there is a time limit for playing the game.”
—Concerned parent of an eight-year-old
One of the biggest challenges parents and children face is determining what is a normal amount of time that can be allotted to the iPhone, social media, video consoles, etc. This is something I hear echoed in my practice almost daily. Parents reporting screaming matches due to excessive video gaming or phone usage. Chores and homework not completed. Parents giving up and allowing their kids to make the rules. Kids refusing to follow rules, not valuing education because there are many successful teens now that make a lot of money without schooling or education. Parents and children struggle with setting limits on screen time because screen time is part of the culture in the home today. We as parents have to learn how to appropriately integrate playtime into their and our schedule.
Things have changed since we were growing up. Do you remember when you were younger? What did you do when you came home from school? Maybe you did your homework and if you were lucky you went out and played with your neighbors, then came back home to have dinner, then went to bed. Or maybe, after you completed your homework, you completed chores and were allowed to talk on the phone for a brief time(because your phone service did not include call waiting) or played board games with your siblings. All these activities seem harmless compared to what happens now. Our kids come home and give us a hard time completing their homework. I often hear from parents that their kids state they are tired stressed, and need to rest. They utilize their phone or play video games to feel relaxed until we yell at them to stop. They are cranky and uninterested in conversation, they want to be on their phone, or play video games while having dinner. Ahh . . . the joys of parenting.
Children now are often waking up and playing video games as they are getting ready for school and teens are going to bed while playing video games. In fact, many of the parents who see me at the office report that they catch their teens up at night playing video games or on their phones when they had turned off the lights and put them to sleep. Long gone are the days when a parent was catching their child watching TV or reading when
they should be sleeping. Albeit, screen time is not all bad, we just have to find the right balance. Digital technology can be a useful tool while doing homework, play, and even for the home. The problem now remains, what is a healthy amount of screen time?
Child’s Perspective (Statements commented to me)
What’s the big deal? I am not using the phone and I can do my homework while my phone is next to me. I need my phone to do my homework. I need it for a group project, to use the dictionary. It doesn’t stop me from doing my work or my chores. I am bored, there is nothing to do. My friends are online and I need to talk to them. Why can’t my parents just let me play—or be on the phone or internet, etc.?
Parent’s Perspective (Statements commented to me)
They are hooked to their electronics from the moment they wake up. They are constantly checking their phones for messages or new information. They come home and are in some way always connected to the outside world, whether with video games or the phone. All these stimuli cause difficulties in my child completing their work, their chores, and sharing in family time.
When they are playing or engaging in screen time, I finally have free time. It’s like a babysitter. They are able to sit down and eat while watching something on the tablet. The video games/iPad calms them down. I wonder if the video games/ iPad games make them aggressive or mad.
Technology and screen time today can help my child read and learn information that they may not already have access to.
Voice Your Concerns:
What are your concerns in regard to social media/video games and screen time? Do you fi that your child is inhibited from doing their work due to the use of social media/video games? Do you fi that you are always reminding them to stop? Are you often repeating yourself? Are you find it different for them to follow any established screen time? How many hours do you estimate they are on the phone or playing video games?
Insert your concerns here:
What the Research Says:
Though there is a continuous body of research on social media and technology with youth today, it’s still growing, and more research would continue to facilitate this debate. Unfortunately, this book will only present a sample of the actual research studies available for this subject. Research in regard to this subject is ever-evolving and at times contradictory. However, this chapter will represent most of the currently accepted consensus regarding screen time. For the purpose of this book, the word technology will refer to all forms of technology, such as social media and video games.
Appropriate screen time is a hot debate among parents. It raises quite a few questions concerning its eff on academics, attention, family relationships, psychological well-being, and physical health. Kids are born into this technological world and they should know how to use it responsibly. Honestly, I have met one- and two-year-olds who know how to handle a phone better than me. The new wave of technology is part of life now. Let’s accept it, embrace it, and ensure that we and our children become responsible and educated users. The chapter will walk us through some of the main concerns as we determine what the appropriate screen time for our children should be.
Are There Any Psychological Effects?
Research indicates that there are negative psychological effects associated with too much social media and other forms of technology. Chapters 7 and 8 will discuss psychological effects covering depression, anxiety, body image, ADHD, and autism in more detail, but this chapter will briefly review the effects of too much screen time on overall psychological health.
“My daughter has to be bipolar. One minute she is smiling and talking to me, she glances at her phone, and the next minute she looks sullen and angry. Doesn’t want to talk to me and looks like she is about to cry.”
—Mother of a fourteen-year-old girl
Parents often speak to me in regard to their mental health concerns for their children. Parents often voice their concerns by asking me if I think their children are bipolar, aggressive, or lazy. In truth, none of those statements truly describe what is happening with their children. The behaviors they exhibit are an expression of their interactions in the online world. These interactions are fast-paced and it’s hard for children and teens to catch up, which is what we see as we interact with them in the real world. Let’s further explore the effects of technology on mental health.
A recent survey demonstrated that psychological well-being is lower in teens who use communication devices.2 The survey spanned from 1991 to 2016 and found that adolescents who spend more time with electronic communication and devices are less satisfied or have less psychological well-being than those who spent less time with these devices. The researchers defined psychological well-being as a measure of self-esteem, life satisfaction, and happiness. Electronic communication and screens were defined as social media, the internet, texting, and gaming. Non-screen activities were defined as in-person social interaction, sports or exercise, homework, and attending religious services. The findings indicate that adolescents who spent a small amount of time on electronic communication were the happiest when compared to children who use electronic communication frequently.
Similarly, the frequency and tone of the feedback in social networking sites have been shown to cause changes in self-esteem.3 Namely, positive feedback improved and enhanced
2 J. M. Twenge, G. N. Martin, &W. K. Campbell, “Decreases in psychological well-being among American adolescents after 2012 and links to screen time during the rise of smartphone technology,” Emotion 18, no. 6 (September 2018): 765–780
3 P. Valkenburg, P. Jochen, & A. Schouten, “Friend networking sites and their relationship to adolescents’ well-being and social self-esteem,” CyberPsychology & Behavior 9, no. 5 (October 2006): 584–590.
the child’s well-being and social self-esteem, while negative feedback decreased well-being and self-esteem. Another review also concluded that online technology in certain instances increases social support and self-esteem, while harmful possible effects were cyberbullying, social isolation, exposure to harm, and depression.4
In addition to the possible harmful eff of reducing psychological well-being, research also suggests that it can aff the person’s attention abilities. Beresin and Olson reported the majority of research indicates that increased viewing of noneducational programming and gaming causes attentional problems and ADHD-type symptoms.5 Brain and audiovisual stimulation lead to later cognitive differ due to their eff on the density of neuronal synapses during periods of rapid brain growth. In essence, too much brain and audiovisual stimulation in a growing child lead to changes in the density of neuronal synapses leading to differing executive functioning. Additionally, neuroimaging studies indicate associations between video game playing and reduced gray matter in the hippocampus. This is concerning because the hippocampus is responsible for long-term memory storage and other regulatory measures, like stress. However, the fi regarding the eff of the hippocampus is cautionary.
4 P. Best, R. Manktelow, & B. Taylor, “Online communication, social media, and adolescent wellbeing: A systematic narrative review,” Children and Youth Services Review 41 (2014): 27–36. http://dx.doi.org/10
5 E. V. Beresin &C. K. Olson. Child and adolescent psychiatry and the media (St. Louis: Elsevier, 2019).
In sum, it appears that technology has psychological eff
on children and teenagers. Some studies indicate that children who use more media will lead to lower psychological well-being like lower self-esteem, happiness, and life satisfaction. Other studies indicate that media can be positive if the child is exposed to positive feedback, but it can also lead to poorer psychological well-being if receiving negative feedback. Finally, other concerns were the eff of media on attention and memory (more of this will be discussed in later chapters). As parents, let’s be sensitive in regard to this virtual world that we may not be privy to and recognize that it can aff their psychological health.
Are There Any Academic Effects?
“My son refused to do any summer homework this summer. He is starting the fifth grade and although he always struggled with summer homework this is the first summer he simply refused to do it. No amount of cajoling, begging, or pleading would help. All he wanted to do was to play with his iPad or video games. And that is all he did.”
—Mother of a ten-year-old boy
A study conducted by Cambridge University researchers found that of the eight hundred of the fourteen-year-olds surveyed, academic grades fell for those students who spent an extra hour a day on screens (e.g., use of video game consoles, phone, TV, computer).6 They found that the additional hour each day
6 K. Corder et al., “Revising on the run or studying on the sofa: Prospective associations between physical activity, sedentary behavior, and exam results in British adolescents,” The International Journal of Behavioral Nutrition and Physical Activity 12, no. 1 (2015): 106.
contributed to a decrease of 9.3 points in grades at sixteen years of age. That difference is equivalent to a significant drop in grades for two subjects. Two additional hours of screen time was correlated with eighteen fewer points—or the equivalent of a drop in four subjects. Furthermore, the study indicated that the child still performed below the norm even if they attempted to compensate for the extra time with more studying. Therefore, more studying does not provide a balance for the extra exposure to screen time. Similarly, Kuss and Griffiths found that the increased usage of screen time decreases real-life social community participation and academic achievement.7
Other researchers recruited a sample of 3,095 Spanish adolescents aged from twelve to eighteen years to determine the effects of screen time on sleep and academic performance.8Their findings suggest that boys prefer to use video games while girls prefer to engage in technology via mobile phones. It also found that adolescents who performed the best were the youngest because they slept more and spent less time with screen media. The lowest academic performers were older, had increased screen time, and had less sleep. Those who spent five and a half hours with social media or video games slept an average of eight hours a day and the group with excellent academic performance slept nine hours a day.
7 D. J. Kuss& M. D. Griffiths. “Online social networking and addiction—A review of the psychological literature.” International Journal of Environmental Research and Public Health 8, no. 9 (2011): 3528–3552.
8 C. Peiró-Velert et al., “Screen media usage, sleep time and academic performance in adolescents: Clustering the analysis of a self-organizing map,” PloS One 9, no. 6 (2014): e99478, doi:10.1371/journal. pone.0099478.
Let’s stop for a second. Five and a half hours a day sounds like a lot, especially when you take into account your child’s school schedule. This means that the moment they arrive home until they go to bed, they are somehow connected to media. They extend the time on media and video game playing by sleeping late and using their phones while doing homework, eating, and sometimes while in the classroom. Additionally, media is affecting your child’s sleeping behavior. The more they play or interact with their phones, the less they sleep. The less they sleep, the poorer they will perform academically. Poor sleep alone leads to many other negative effects, like poor attention and concentration, irritable mood, and decreased medical health. The excessive amount of time children and teens dedicate to technology requires you as a parent to review and assess their digital time. Observe how they use their time: What are they engaging in, how much time are they actually spending? What is the extent of their reliance on social media and technology?
A Chapman University study found that college-aged students often accessed social media while in class, which often results in poor academic performance.9 Similarly, another study found that students who instant-messaged more than others tend to be more easily distracted during academic tasks.10 Students who instant-messaged while reading passages were found to read
9 K. Porter et al., “A study of the effects of social media use and addiction on relationship satisfaction,” Meta-Communicate 2, no. 1 (2012): 1–27, https://journals.chapman.edu/ojs/index.php/mc/article/view/340/735
10 L. E. Levine, B. M. Waite, &L. L. Bowman, “Use of instant messaging predicts self-report but not performance measures of inattention, impulsiveness, and distractibility,” Cyberpsychology, Behavior and Social Networking 16, no. 12 (2013): 898–903.
slower and score lower on comprehension tests than students who instant-messaged before reading or those who did not instant-message at all.11 Th studies further indicate that social media use by teens and young adults are often occurring in the classroom and negatively aff academic performance.
Clearly, technology affects academic performance. We learned that children are spending an average of 5.5 hours on school days connected to some type of technology. Studies indicate that spending more time with these mediums lowers academic performance, quality of sleep, and the ability to attend to the classroom appropriately. Developing healthy screen time will enable improved academic performance and motivation.
Are There Any Medical Effects?
“I love playing video games, there was a time that’s all I did. It gave me purpose and I felt important. However, I did nothing but play video games. I gained weight and became sloppy. All I did was order food or eat whatever junk was available to me. I lost my job, stopped showering, and eventually lost everything, moving back to my parents’ house. A very long time later, I decided to quit playing video games, I started bathing and developed a daily exercise routine, among other good habits . . . I have never felt better.”
The example above is an extreme case, but it highlights a few important facts in regard to the long unchecked use of video game
11 L. L. Bowman, L. E. Levine, B. M. Waite, & M. Gendron,“Can students really multitask? An experimental study of instant messaging while reading,” Computers and Education 54, no. 4 (2010): 927–931.
playing. More media time will directly lead to a sedentary lifestyle and long-term sedentary behaviors can lead to unhealthy results, including obesity.
Two major medical professional associations have issued warnings regarding the effect of media on physical health. The American Academy of Pediatrics stated in 2016 that its research demonstrates that media contributes to childhood obesity and late screen time affects a child’s sleep, which is directly correlated with childhood obesity, implying less sleep equals increased weight.12 The American Heart Association has also expressed concerns about the effects of screen time on children. They recommend parents significantly limit or cut the hours their children and teen are allowed to use video games, phones, computers, and tablets. In other words, sitting around and playing with technology leads to a more passive lifestyle.
Sedentary behavior due to social media and gaming has been well researched and can lead to cardiovascular disease, obesity, and high cholesterol. Findings from the American Heart Association state that children between the ages of eight to eighteen spend seven hours or more a day, looking at screens. They urge parents to limit screen time to no more than two hours per day. Children aged two to five, recommend no more than one hour per day of screen time. I find these recommendations to be stringent but a good guide.
12 American Academy of Pediatrics, “American Academy of Pediatrics announces new recommendations for children’s media use,” 2019, https://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/ American-Academy-of-Pediatrics-Announces-New-Recommendations- for-Children's-Media-Use.aspx.
Let’s calculate how many hours a day a child or teen has to determine the right amount of time for your family. On the weekdays, perhaps they spend one hour waking up and getting ready for school, and having breakfast. Let’s add another hour to commute to and from school. Another seven hours in school, for a total of about nine hours. Roughly, if their day starts at 6 a.m., their school day ends at 2:30 p.m., and they arrive home at 3 p.m., they are now free for about six hours—if their bedtime is at 9 p.m. Six hours to eat and complete their homework and chores. For teens, their bedtime may be a little later and they may have fewer hours if they engage in after-school programs or other extracurricular activities. Take all of this into account as you determine what their screen time should be. How many hours do they need to complete their necessary tasks and how many hours are you OK with allocating to them to de-stress and unwind with their technology? They view their use of video game playing and phone time as a way to connect and disengage with their responsibilities. On the weekends they may have twelve hours or more. In no scenario is it OK for them to spend all day and night playing video games or using their phones. Their day should be filled with other activities and again, you should stick to about no more than two hours per day—or the amount of time you deem appropriate during the weekdays—even on the weekends. They should have their technology time but ensure there is a balance.
Hingle and Kunkel recognized that weight status improved when screen time was reduced.13 Simply put, children were less obese or overweight with the reduction of screen time.
13 M. Hingle &D. Kunkel, “Childhood obesity and the media,” Pediatric Clinics of North America59, no. 3 (2012): 677–692
Similarly, a systematic review of research articles about screen time and child well-being found evidence that more screen time is associated with a host of health concerns, including depressive symptoms, unhealthy diet, adiposity, and lower quality of life.14Both studies also indicate that food advertised on social media exposes children to unhealthy food items and encourages poor eating choices.
Rosen et al. surveyed 1,030 parents of children between the ages of four and eighteen. Their findings indicate media consumption caused dysfunction within the areas of physical health, psychological health, attentional difficulties, and classroom behaviors.15 Specifically, for children and preteens, total media consumption predicted dysfunction while for preteens specific technology uses, including video gaming and electronic communication, predicted dysfunction. For teenagers, nearly every type of technological activity predicted poor health. Even when you add daily exercise and healthy eating habits to a child’s or teenager’s routine who has excessive digital time, it will still result in problems within the areas of physical and psychological health. Again, indicating compensatory measures such as increasing physical fitness is not as helpful as reducing screen time.
Still, more research demonstrates how media aff sleep. Buxton et al. surveyed over eleven thousand parents of children
14 N. Stiglic &R. M. Viner, “Effects of screentime on the health and well- being of children and adolescents: A systematic review of reviews,” BMJ Open 9, no. 1 (2019): e023191, doi:10.1136/BMJ open-2018-023191
15 Rosen et al., “Media and technology use predicts ill-being among children, preteens and teenagers independent of the negative health impacts of exercise and eating habits,” Computers in Human Behavior 35 (2014): 364-375, doi:10.1016/j.chb.2014.01.036 between the ages of six and seventeen in regard to sleep patterns.16 The fi indicated children had poor sleep if they had access to technology in the room at bedtime. It also suggested children and teens fare better with the presence of household rules and regular sleep and wake schedules. Another literature review of sleep and screen time demonstrated that 90 percent of studies on screen time indicate that it negatively impacted sleep for teenagers and school-age children.17 Simply put, technology in the room aff onset of sleep and duration of sleep.
A review of research conducted by Stiglic and Viner further substantiated and summarizes all the issues discussed thus far in this chapter.18 They reviewed a host of research to answer the question, “What is the evidence for health and well-being effects of screen time in children and adolescents?” Their findings include the following:
• Reasonably strong evidence for associations between screen time and greater obesity and adiposity
• Reasonably strong evidence for associations between screen time and higher depressive symptoms
• Moderate evidence for an association between screen time and less healthy diet
• Moderate evidence for an association between screen time and poorer quality of life
16 O. M. Buxtonet al., “Sleep in the modern family: Protective family routines for child and adolescent sleep,” Sleep Health 1, no. 1 (2015): 15-27.
17 L. Hale and S. Guan, “Screen time and sleep among school-aged children and adolescents: A systematic literature review,” Sleep Medicine Reviews 21 (2014): 50-58.
18 Stiglic & Viner, “Effects of Screentime.”
• Weak evidence for associations of screen time with behavioral difficulties
• Weak evidence for associations of screen time with metabolic syndrome and poorer cardiorespiratory fitness
Their review also suggested weak associations with screen time leading to hyperactivity, poorer cognitive development, anxiety, suicidal ideation, and poorer psychosocial health.
Due to the potential effects on medical, psychological, and social well-being, the American Academy of Pediatrics made recommendations regarding children and teens and the level of acceptable screen time and media consumption:
American Academy of Pediatrics Recommendation
The American Academy of Pediatrics (AAP), a professional group of physicians that specialize in child medicine, recommended the following:
• Limited video chatting for children younger than eighteen months but no other screen media time
• For toddlers between the ages of eighteen and twenty-four months, high-quality age-appropriate programming to watch with them
• For children ages two to five years, one-hour screen time per day of high-quality programs with information that can be integrated into current surroundings and environment
• For six and older ensure that screen time does not interrupt their sleep, eating, and physical activities.
They should have established limits on the time that they spend using media—my expert opinion: media and technology should not be what they spend most of their time in; there should be a time of exploration and making friends.
• Allot for media-free times together, like at dinner
• Make media-free locations at home, such as bedrooms
• Continuous communication about online safety and treating others with respect online and offline
The AAP also developed an interactive, simple-to-use online tool to help families create a personalized Family Media Use Plan. It can be created once and be used as your roadmap or you can return and re-create it as needed as your digital plan evolves.19
Change of cultural/societal norm
Past: Socialization almost always occurred face-to-face and involved some form of physical contact—limited to time constraints
Present: socialization often occurs in the digital space and there are no time constraints; it can occur at any time during the day or night. It, therefore, has the ability to affect sleep, academics, and physical activity.
19 You can access it at https://www.healthychildren.org/English/media/ Pages/default.aspx
Spending time on social media and gaming is the way for this generation of children and teens to stay connected. It is not that they prefer to connect in this way, it is the way to connect. Friends and school are connecting in this manner. In fact, some schools may now give you access to their grades and teachers are now more readily available via these formats, which traditionally were limited to parent-teacher conferences or phone calls. Schools are embracing the efficiency of email and technology to better communicate with parents.
What children watch and how they watch TV has changed. There is a steady flow of media content and information available via YouTube alone and you may find children prefer watching it over regular cable TV—YouTube is the second most used search engine in the world. YouTube is amazing; it can help someone understand their math assignment, create their own crystals, or even apply makeup like an expert. It can also give you access to pornography and violent content not appropriate for your child. Its use can be both a blessing and a curse. Children and teens love YouTube—perhaps you, too, have found its benefits. It is the new and easy way to find content and information: goodbye encyclopedias, goodbye regular TV. Hello, smart TV, Roku, Amazon Fire Stick, Apple TV, or any other streaming device.
Digital connectivity can foster friendships, education competence, and self-esteem by offering new avenues of communication. Accepting these forms of entertainment and communication will help your child and teen exist appropriately in their culture. However, it is your responsibility to place the appropriate limits and ensure it is utilized in a healthy way.
My Professional Recommendations
1) Establish rules, including time for play and use of these devices. But remember to follow them yourselves. You are the role model and there is no easier way for a teen to ignore your rules if you don’t set the tone.
2) Participate in your child’s digital world. Be interested in what they watch and listen to. Talk to them about their experiences with Facebook, Instagram, Snapchat, etc. Help them process what they see and how they understand the material that is presented to them.
3) Violent video games, shooting games, etc. should have strict limits. Th are differ to stop. Children/ teens and even adults become so engrossed in these games that reality pales and they forget what they need to be doing. It is important to take the time to stop and help the child explore what it would mean if those actions occurred in real life. You do not want your child to lose sensitivity to these types of crimes. For example, in the game Grand Th Auto, you gain points by engaging in antisocial behavior, like running over people or shooting a police officer. It may seem obvious that your child and teen know that behavior is not acceptable. However, watching and acting on violence in an indirect format such as the above is internalized by the gamer. The means that without the person’s awareness, they begin to normalize this behavior and can play out some of these behaviors in their own lives like being more aggressive, disrespectful, or violent.
4) Process video games or negative social media, not only by asking them directly, “What do you think that person or their family members are experiencing?” but help place these experiences within their own circle. So you would ask questions like, “How do you think the family feels about the death of that grandma?” (playing Grand Theft Auto) or “How would you feel if that were to happen to your grandmother?” or “How do you think the child and the family feel about the bullying?”If a child is being bullied on social media, “How would you feel if that were to happen to you?”These questions are difficult but they help children/teens understand the emotional consequences of these actions, which are often forgotten or ignored when interacting with these games. In one of the later chapters, we talk a little more about the desensitization of emotions and feelings in regard to social media.
5) Ensure your child has more physical activity time than social media time. There are so many psychological and health benefits when interacting with the physical world, outside of social media. I recommend that if you have social media time, you should also have physical activity time. Remember that face-to-face interactions and hands-on exploration is essential to critical and social learning.
6) Use apps to help control the time and the content accessed by your child or teen on social media in the event that you are having a difficult time with your child finding balance.
In sum, parents today are facing a new media setting that requires monitoring and acceptance. Keep in mind that most things are OK in moderation. It is important to be actively engaged in the digital world with your child. Participate and be part of what they are doing. Do not attempt to be overbearing; just be there and around for them. Are you leading by example? Are you glued to your phone? Is Facebook/ Instagram calling you every few minutes? Remember, you are your child’s mentor. Teach them how to use these tools to learn, create, and connect with others. Create the ideal tech environment in your home; define it and teach your family rules and expectations; enforce the environment but ensure that the rules and expectations are realistic and digitally and culturally sensitive. As you have learned in this chapter there are many dangers of screen time but it is a necessary and essential way for your child and teen to communicate and interact with the world today.
Warning: Do not skip out on monitoring your child’s screen time. As a parent, it is your job to ensure they are safe and healthy. Having no limits and trusting that your child is doing as he should is not safe or healthy. You may be saying: “How dare you tell me not to trust my child!”You should trust your child; however, you are still responsible for setting boundaries. Boundaries are an essential component in a trusting relationship. Boundaries allow the child to understand the real world. Once he leaves the home, your child must interact within the confines of social rules and expectations. It is from the home that he first learns about boundaries. It is then extended to the school and any other environments that he interacts with.