Teens and Screens
Social Media and other screen time doles out the dopamine but takes a toll on kids
My daughter is a “digital native.” She never knew a world without the ability to retrieve any obscure fact with a simple internet search or to virtually befriend people all over the world. She started playing on my computer when she was 8, got her first electronic device—a tablet—at 12, and a smartphone at 13.
Like most parents, I was concerned about the amount of time she spent on her phone and about how social media, in particular, could bring her to rages or tears.
But it wasn’t until years later that I discovered the extent of the damage all that screen time caused.
It turns out, during her teen years she was staying up most of the night texting friends and scouring posts and then slogging through her classes in a bleary-eyed haze. She brooded over friends’ posts of the antics at unchaperoned parties that her father and I had not allowed her to attend. And she became convinced she was overweight (she was not) by comparing herself to unrealistic—probably Photoshopped—bodies she saw in online ads.
She nearly stopped eating, covering her shrinking body with bulky clothes so I wouldn’t notice.
Screens and social media were not the only culprits in my daughter’s adolescent trials by any means. She says they were not even the primary cause of her bouts with depression and anxiety. I’m not so sure.
Today, my daughter is 24. She’s still glued to her phone, but she has a job she likes, a thoughtful, steady boyfriend and a loyal circle of friends. In other words, she is doing okay. I do wonder, however, if those screens have left any scars.
I’m hardly alone. Parents, along with educators, health professionals, and policymakers all over the world are grappling with the herculean hold technology and screens have over the lives of children.
Concern has risen to such levels that in May 2023, US Surgeon General Vivek Murthy issued an advisory warning about the impact social media is having on the mental health of young people.
Advisories are reserved for significant public health challenges that require the nation’s immediate action. Murthy, who calls youth mental health the defining public health issue of our time, said children and teens have become unknowing participants in a decades-long experiment and stressed the urgent need for more research and action.
“I was heartened by the Surgeon General’s report drawing attention to this issue,” says Daniele Fallin, James W. Curran Dean of Public Health at the Rollins School of Public Health. “As a parent of a teen and preteen, I feel this concern deeply. Navigating screen time and social media is a constant struggle, and we don’t have a clear roadmap based on evidence about what is best for our children and feasible in our society.”
Janet Cummings, professor of health policy and management at Rollins School of Public Health
Janet Cummings, professor of health policy and management at Rollins School of Public Health
Justine Welsh, director of Emory Healthcare Addiction Services and medical director of the Addiction Alliance of Georgia
Justine Welsh, director of Emory Healthcare Addiction Services and medical director of the Addiction Alliance of Georgia
Daniele Fallin, James W. Curran Dean of Public Health at Rollins School of Public Health
Daniele Fallin, James W. Curran Dean of Public Health at Rollins School of Public Health
"What is going on? Why is the mental health of youth and teens nosediving? We should all be asking ourselves what has changed, what is behind this trend.”
Depression and Anxiety Skyrocket Among Teens
Alarms began being raised about mental health issues among children and teens more than a decade ago. Since 2010, reports of depression and anxiety among teens and young adults have risen steadily, along with emergency rooms visits resulting from self-harm or suicide attempts. By 2018, suicide was the second leading cause of death for people ages 10–24 years.
The pandemic, with its isolation and uncertainly, added fuel to an already alarming fire. To take but one example, emergency department visits for suspected suicide attempts increased nearly 51 percent among girls ages 12–17 years in early 2021 compared to the same period in 2019, according to the CDC. The agency also found nearly 45 percent of high school students were so persistently sad or hopeless they were unable to engage in regular activities. The American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association declared a national state of emergency in children’s mental health.
Why is the mental health of youth and teens nosediving? “We should all be asking ourselves what has changed, what is behind this trend,” says Janet Cummings, professor of health policy and management in the Rollins School of Public Health. “One thing that has certainly changed and that is severely underresearched is how teens are spending their time.”
They are spending it, more and more, on their phones, tablets, and computers. Consider the timeline. The internet started becoming mainstream in the early 1990s. MySpace launched in 2002 and Facebook two years after that. Apple introduced the first iPhone in 2007, basically allowing teens to carry all the social media platforms in their pockets 24/7.
Fast forward to today and the use of social media by children and teens is almost universal. Up to 95 percent of youth ages 13–17 report using a social media platform, and more than a third say they use social media “almost constantly,” according to the Surgeon General’s advisory.
This is not happenstance. Video games and social media platforms are specifically designed to dole out dopamine hits with likes, shares, and intermittent reinforcement. In short, they are designed to be addictive. “We know apps and games are written to suck people in,” says Fallin. “Years ago, I had a friend with a PhD in clinical psychology, and he was employed by a gaming company. His entire job was to help build the programs in a way that encouraged gamers to play more and more.”
It has worked.
Understanding the Dark Side of Screen Time
“I see quite a number of adolescents presenting with depression and/or anxiety who spend massive amounts of time on screens each day,” says Justine Welsh, director of the Emory Healthcare Addiction Services and medical director of the Addiction Alliance of Georgia. “They struggle to balance their internet gaming or social media use with the other things they need to be doing. Reducing screen time can be a nightmare for parents. I’ve actually had young patients hospitalized after their parents took their phones away because they harmed themselves or threatened suicide.”
While Emory Healthcare adolescent psychiatrists don’t specifically treat screen addiction or screen overuse, they see it in their practices at a growing rate. Jennifer Holton, program director for Emory’s Child and Adolescent Psychiatry Fellowship Program, often deals with issues around screens in her practice. “I work with many families that struggle with screen use,” she says. “While screen time isn’t inherently a bad thing, for many children I work with getting off screens can be incredibly hard and can result in emotional and behavioral outbursts including aggression at times. I spend a lot of time working collaboratively with parents and problem-solving around this issue. Monitoring use and limiting access to appropriate material can also be challenging for parents.”
As Holton said, not all screen time is bad. Some children and teens find a community of like-minded people through social media and internet gaming they are unable to find in their neighborhoods. Children with autism, or lesbian, gay, bisexual, transgender, queer, and other youths, for example, can connect with peers and find social support that might otherwise be lacking.
For many children and teens, however, the harms of excessive screen time outweigh any benefits. “There are two main issues,” says Holton. “There is the amount of time people are spending on the screens, and then there is what they are doing on the screens. You have to consider both.”
“Children’s screen time is one of the biggest sources of strife in families today.”
The time teens spend on their screens equals the time they are not doing other things. Consider the defining aspect of a teen’s life—hanging out with friends. In her book Generations, psychologist Jean Twenge found that since 1976, the number of times per week teens go out with friends—in person and without parents—held steady for nearly 30 years. In 2004, it slid a bit. Then in 2010, it fell off a cliff. “Forget about actually getting together with friends, this next generation doesn’t even call—they text,” says Welsh. “They are constantly creating artificial barriers between each other.”
Getting Dopamine Hits from Gaming
Time playing a video game or monitoring social media is also time not spent playing sports, doing homework, walking the dog, or sleeping—all elements necessary for healthy development.
What adolescents are viewing on their phones and tablets plays a large role in the mental health impact of such devices. Internet gaming, for example, seems to come closest to mimicking an addiction. “Gaming is based on intermittent reinforcement and surges of dopamine,” says Welsh. “Researchers have demonstrated by neuroimaging that gambling and gaming are very similar in their levels of reinforcement to other types of addiction.”
Social media, the focus of the US Surgeon General’s report, seems even more fraught. Through Instagram, Snapchat, TikTok and similar apps, teens see unrealistically filtered and photo edited images of friends and influencers living amazing lives and often come away feeling left out and unattractive. Girls especially seem prone to developing distorted body images after spending time on social media, which can lead to eating disorders.
“I’ve had patients who find ‘secret’ groups online that engage in self-harm, for example,” says Charles Gillespie, a psychiatrist with the Emory Child and Adolescent Mood Program. “They would share pictures and talk about ways to engage with it. There are groups for anorexia that glamorize dangerously thin bodies and discuss ways to avoid eating. These teens are developing a sense of community, but in a way that is pathological and makes things worse.”
Social media challenges have resulted in deaths, and drug dealers and predators lurk online. Nearly six in 10 girls say they’ve been contacted by a stranger online in ways that make them feel uncomfortable, according to the report.
Cummings hopes the surgeon general’s report will be a clarion call.
“Every product aimed at children has to clear innumerable hurdles proving it is safe before it can be brought to market. Why is the same not true for technology?” she asks. “We desperately need more research so we can inform policies to put some guardrails around these technologies for our kids.”
Surgeon General Vivek Murthy
Surgeon General Vivek Murthy
Surgeon General issues new advisory about impact of social media use on youth
“The most common question parents ask me is, 'Is social media safe for my kids?' and the answer is that we don't have enough evidence to say it’s safe. In fact, there is growing evidence that social media use is associated with harm to young people’s mental health,” said U.S. Surgeon General Dr. Vivek Murthy. “Children are exposed to harmful content on social media, ranging from violent and sexual content, to bullying and harassment. And for too many children, social media use is compromising their sleep and valuable in-person time with family and friends. We are in the middle of a national youth mental health crisis, and I am concerned that social media is an important driver of that crisis – one that we must urgently address.”
TIPS FOR REDUCING SCREEN TIME STRIFE WITH CHILDREN AND TEENS
For now, the onus of monitoring—and restricting—screen time falls almost solely on parents. “Children’s screen time is one of the biggest sources of strife in families today,” says Dean of Rollins School of Public Health Daniele Fallin. “It’s a near constant battle of parents saying, ‘No more screen time,’ and kids saying, ‘But this is the main way I socialize. It’s how I get my information. It’s the way I do homework.’ ” Here are some ways Emory experts suggest helping children and teens take control of their screen time:
Jennifer Holton, program director for Emory’s Child and Adolescent Psychiatry Fellowship Program, and her children.
Jennifer Holton, program director for Emory’s Child and Adolescent Psychiatry Fellowship Program, and her children.
Create a family media plan. Your plan can outline your children’s responsibilities in earning screen time and establish technology boundaries, including social media use. The American Academy of Pediatrics can walk you through creating such a plan at healthychildren.org/media plan.
Child and adolescent psychiatrist Jennifer Holton (below) created a system in which her 6- and 10-year-old can earn points and cash them in for privileges, including screen time. Even with enough points, though, screen time is generally off limits on weeknights, and on weekends the most they might get is an hour and a half. “Every family is different, but things tend to go more smoothly in our home when screen time is limited that way,” says Holton.
Establish “tech-free zones” and encourage children to foster in-person relationships. We’ve all seen tables at a restaurant where everyone, even the parents, are on their phones rather than talking to one another. The same can happen in the home. Make sure it doesn’t. Child and adolescent psychiatrist Justine Welsh’s children are 2 and 4, so she isn’t overly worried about screens just yet. “But my husband and I have already started talking about it,” she says. “We are starting to set expectations now. We have no phones at dinner—all phones are plugged into the charging station when we sit down to eat.”
Discuss tech’s benefits and risks. Talk to your kids about the importance of respecting privacy and protecting personal information in age-appropriate ways. Have conversations about who they are connecting with, their privacy settings, their online experiences, and how they are spending their time online. “I have a 6-year-old and her main source of screen time is TV,” says Rollins Professor Janet Cummings. “But we’ve already started having conversations with her. One time she didn’t realize how long she had been watching cartoons, and we discussed how getting lost in screens can happen to anybody and what we could be doing instead. We talked about setting goals for the time she spends watching TV to make sure she has time for all the other things she loves to do, like art projects and play dates. As she gets older, I plan to continue to talk with her as we introduce one platform at a time.”
Walk the talk. Parents need to have the relationship with their smartphone they want their kids to have, so don’t scroll through Facebook as your daughter is telling you about her latest friendship drama.
“Like everyone else, my husband and I are on our phones and computers quite a lot,” says Fallin. “But we make a concentrated effort to turn them off when we are with our children. We not only want to be present for our kids, we want to model that type of behavior.”
Limit notifications on smartphones. All those dings, rings, and buzzes draw teens’ attention back to their devices and demand immediate attention. Limit the number of apps that produce audio notifications.
Turn off the smartphone before bed. Teens are foregoing sleep to stay connected with friends and happenings on their smartphones and tablets. Nearly one in three teens report using screen media until midnight or later. Fallin allows her 12- and 13-year-olds to have their phones in their bedrooms, but they are required to turn them in at a certain time every evening. “No one is allowed to have a phone in the room overnight,” she says. “Otherwise, I’d worry about their sleep.”
Each child needs to be considered individually. “I start by asking parents what their child is doing on their device and how it is impacting them,” Holton says. “We need to meet them where they are and go from there. But one thing is clear—parents and kids need more guidance.” EHD
By Martha Nolan, illustrations by Jon Krause, design Peta Westmaas
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