Latency-age children (ages 5 to 10 years). Screen media present highly arousing, abnormal sensory input to the brain’s activating system.20 (Slow-moving shows are not harmful in this respect. However, most latency-age children have moved on from Dora the Explorer to Sponge Bob Square Pants or re-runs of Buffy the Vampire Slayer.) Downstream effects of arousal include the release of catecholamines, increased vigilance and irritability, motor behavior problems, a decreased attention span, and sleep problems.21 Chronically high levels of monoamines sensitize the threat response system to catecholamines.21 Thus, heavy early exposure to screen media puts the child at risk for having altered sensitivity to environmental stress. In particular, all novel experiences are unconsciously felt as threatening.21
Four young children—ages 5 and 6—from loving, stable families who had no psychiatric risk factors besides heavy screen consumption (over 20 hours a week) presented with new-onset anxiety disorder: panic attacks, enuresis caused by simple phobia at school, pervasive obsessive-compulsive disorder (OCD), and trichotillomania.
Two of the children were obsessive viewers of the Harry Potter movies: in the first child, the panic attacks stemmed from a conviction that his parents were dead and were never returning, accompanied by the overwhelming image of Voldemort and Harry’s dying mother. For the second child, the enuresis was based on a phobia linked to the ghost who haunts a school toilet. The symptoms stopped when the obsessive viewing of the videos stopped and a very brief course of play therapy was initiated. In the other children, OCD remitted immediately on ending computer access. The trichotillomania was behaviorally associated with television watching and remitted when the television was removed and new activities were substituted along with a simple behavioral system.
Excessive screen media viewing produced a variety of symptoms because of the dual effects on the arousal system and imagination in these young children. The content of children’s television, with heavy emphasis on vivid facial expressions, is particularly potent. Children are wired to seek out and engage faces, but the screen’s “response” to the child is abnormal. It is noncontingent, affectively exaggerated, and often chaotic. Interactive computer programs lack the complex but modulated sensory experience a developing brain needs. Under normal circumstances, inhibitory influences on the threat response system include:
• Movement: children who are sitting and watching a screen are extremely still
• Cortical input (conscious use of coping strategies): children who are excessively exposed to screen media have a smaller repertoire of strategies because of decreased opportunities to develop symbolic thought and the experience of mastery, including manual dexterity and knowledge of traditional games20
• Impact on the hippocampus, the site of processing of explicit memories: if it has been abnormally loaded with early, excessive screen media exposure, it has a limited repertoire of soothing memories available for comparison, analysis, and generalization20
• Parental comfort: children who are engaged in screen media rarely seek their parents, and their parents are unaware of their distress
While the children in the Case Vignette do not illustrate standards for scientific evidence, their cases demonstrate the potent effects of media at vulnerable developmental stages. A comprehensive review of studies on the effects of television viewing on the mental life of latency-age children indicates a negative impact on creative problem solving and play. The caveat is that with appropriate programs and in limited amounts (eg, potency and dose), television is not necessarily detrimental. Several studies have shown that the introduction of information from the television can be incorporated positively into play.20
Effects on adolescents. The literature on screen media and teens is more contradictory. The Kaiser Family Foundation study found little correlation between hours of screen exposure and grades in high schoolers. This finding represents a change from a previous survey that found that low-performing students watched more television.22 Statistically significant correlations occurred only between time spent reading and good grades, and time spent playing video games and bad grades. On measures of contentedness, highly contented teens watched 1.5 hour less than teens who described themselves as having low personal contentment. A systematic review reiterated that violent outcomes in teens are correlated with multiple, covarying factors, of which media viewing is only one. We need better statistical methods and research methodology before we can come to firm causal conclusions.23
The ability to access a wide circle of support or information through the Internet can sometimes be very positive for teens. A comprehensive data review on social networking and teens, a phenomenon too new for reliable research, requires more time.24 In my clinical experience, screen media can exacerbate mental illness in vulnerable teens and can contribute to disrupted sleep-wake cycles, obsessive preoccupations, social isolation, alienation from parents, bizarre behavior as a coping strategy, or weakening of reality testing in highly anxious or psychotic individuals.
Mindfulness or media?
Mindfulness—the capacity to reflect on one’s feelings and thoughts on a moment-to-moment basis—has emerged as an effective therapeutic tool for most psychiatric illnesses. In fact, the more we understand about psychotherapy, the more we understand it as retraining the brain to respond to novelty and adversity in planned, flexible ways. No studies on the impact of media on mindfulness are listed in PubMed. However, common sense informs us that multitasking and constant visual scanning for new electronic input is antithetical to this meditative practice.17
Making toxicology recommendations is tricky. Epidemiological studies rarely answer individual clinical questions. However, even on the basis of the limitations of our knowledge, there are several things to keep in mind, including windows of vulnerability, a child’s personality, and environmental factors. The Table presents recommended guidelines for managing screen media that I use in my practice.