Self-Reflection and Digital Use

Awareness, with self-assessment of how much time is spent on digital media, including all screen time and what it is used for, are critical aspects of working toward digital wellness. There are currently a number of methods of assessing digital time. In most cases, computers and smartphones have an area that shows screen time, with itemization of how long each app or program was used. Individuals can compare their own estimates with the actual time recording as an objective measure. In addition, it is helpful to track what technology is used for in a log with categories such as schoolwork, games, social media, etc. Subsequently, reflecting on potential positive and negative effects their own digital use may be having on their lives is valuable.^[1]

Screen Time Research and Recommendations

There is evidence that too much screen time can be detrimental to health in many ways. Experts recommend that recreational screen time (outside of work/school) be less than 2 hours per day, less for those age 5 and under.*

Researchers have found an association between screentime and depression, with those spending six hours or more per day watching screens with a higher risk for depression. ^[2]

Type and quality of screen time make a difference. Large scale research has found that increased time spent using social media per day was associated with increased odds of reporting high levels of mental health problems.  Based on this research, researchers note that adolescents who spend more than 3 hours per day on social media may be at heightened risk for mental health problems. ^[3]

Research has shown that subjects who limited social media to 10 minutes per day over a period showed significant reductions in loneliness and depression over three weeks compared to subjects in the control group, who used social media as usual over a three week period. Both groups showed significant decreases in anxiety and fear of missing out over baseline.  This supports the benefit of increased self-monitoring.  Based on the findings, the researchers strongly suggest limiting social media use to approximately 30 minutes per day to support significant improvement in well-being. ^[4]

*For specifics regarding screen time recommendations for youth, see Recommendations for Families within the Utilizing Resources for Digital Wellness in Youth section.

Protection Against Algorithms

How can you protect your mental health against algorithms that seem to be designed to harm it? Try to be mindful of the content you consume and how it makes you feel, and try to limit exposure to it. Psychologists also recommend influencers produce more body-positive content and inform their followers about the adverse effects of algorithms. Ultimately, psychologists believe that social media companies should be responsible for protecting their users from unnecessary harm and being transparent about their algorithms and how they work, telling users why exactly certain content has been shared with them.^[5]

However, currently it is up to individuals to be aware and limit exposure to reduce the impact.

Autonomy vs. Regulation:

Unfortunately, instead of viewing policies that attempt to assist individuals with curbing distraction and supporting focus in a positive light, structure is often viewed as too restrictive. The goal of structure and expectations with digital use is to reduce distraction and support individual success. Schools and employers vary with regard to policies for digital use. Schools can implement lockdown browsers on computers to help with distraction by preventing use of other sites and activities. Employers can block sites with their servers. In many cases, users will find a way around these limitations if they want to. Personal devices will not have restrictions to help reduce influence and distraction if you do not set them. Some individuals have been reprimanded or forced to abstain from using some forms of digital technology at their place of employment due to productivity issues.

Preventing and Treating Smartphone Usage Disorder

Attempting to stop a smartphone usage disorder can be difficult. If self-help strategies are not helpful, Cognitive-behavioral therapy (CBT) is an evidence-based talk therapy that can help with overcoming impulsive behaviors. This approach can help change perceptions regarding the use of a smartphone and support healthy methods of coping with stress, anxiety, or depression.

There are support groups that can help. Internet and Technology Addicts Anonymous is one such group that can provide help for smartphone addiction. ITAA is a 12-step based program that offers in-person meetings as a support network for smartphone and other technological addiction.

Smartphone addiction can be a challenging disorder that can consume vast amounts of time and can reduce the quality of daily life. Finding deliberate ways to use this device can help reduce smartphone addiction and bring about a better quality of life.

Treatment of Internet Addiction:

A 2023 systematic review in the Journal of Clinical Medicine, analyzed treatment for children and adolescents who presented signs of internet addiction and problematic internet use. Various interventions were used, such as cognitive behavior therapy (CBT), electro-acupuncture (EA), medication, and solution-focused approaches. According to the review, CBT and EA are effective in reducing the signs and symptoms of internet addiction, internet gaming disorder, and unspecified internet use disorders. School-based programs also displayed effectiveness but additional research is necessary to determine the longevity of the effects.

Identifying diagnostic criteria for these types of conditions is a challenge in identifying the need for treatment in children and adolescents. This carries over into properly evaluating the effectiveness of the treatments provided. The DSM-5 recognizes Internet Gaming Disorder, but more standardized criteria is needed for there to be more accurate reporting for other conditions involving internet use.^[6]

Utilizing Resources for Digital Wellness in Youth

The complexity with ever changing technology can make dealing with digital devices and children quite daunting. The worst thing we can do is throw our hands up and hand out the devices and then put our head’s in the sand. It is a great disservice to youth not to be educated and intentional when making decisions about digital devices and screen time. There are too many negative potential outcomes to ignore. Remember that youth benefit from structure, expectations, and support, to build healthy habits and digital wellness. The National Institute of Health provides a summary document that can be helpful for youth. Can Too Much Screentime Harm You? article

For Parents/Guardians:

There is no exact guidebook for how to navigate the digital world with youth, however, it is beneficial to use the available research, along with consideration of your child’s age and maturity level. Common Sense Media has helpful articles regarding all types of issues that arise, from when to give a child their first cell phone to what to do if a child views pornography. They also provide reviews for movies and shows to help determine what might be appropriate for your child. ^[7]

A cell phone contract can be useful for awareness of expectations and consequences.  This agreement can help guide youth in creating healthier habits related to device usage.  Involving the youth in creation of the document as appropriate, based on age, can be helpful. There are many types of contracts available online that can be utilized or revised based on what works for an individual family.

Supervision and monitoring of device usage are critical, particularly for young people. The amount and quality of potential exposure is vastly different than what was out there a generation ago. Structure and guidance, including discussion and examples of what is appropriate versus inappropriate and safe versus dangerous, are very important aspects of digital wellness. Children do not have the ability to discern without help from adults. Adults can also help prevent behaviors that turn into addiction. Research has shown that perceived care from both father and mother had significant indirect effects on Internet addiction problems. Research supports the need for family-based prevention and intervention programs to address Internet addiction.^[8]

For Teachers:

There is no simple answer to how to approach the use of digital devices for your students in your particular classroom. It is a balance of autonomy versus regulation and determining if and when the benefits of device use in class will outweigh the potential for distraction. Having discussions with students about the pros and cons of technology can help support more open attitudes, as they learn how structure and expectations correlate with student success. Harvard’s article on Technology and Student Distraction has a number of good points to consider.

Regarding Youth with Disabilities:

Keep in mind that there are a number of youth whose level of maturity or ability may lag behind their chronological age. The physical appearance of these youth often does not match their actual mental, intellectual or social abilities. Even youth who are very articulate can have executive functioning challenges. In terms of digital wellness, this means that they may have difficulty discerning safe versus unsafe behaviors while using technology.

ADHD and other disorders with similar characteristics can make management of digital wellness particularly challenging. High levels of impulsiveness and distraction are often impeded further with the use of technology.

Recommendations for Families from the American Academy of Pediatrics

• Avoid digital media use (except video-chatting) in children younger than 18 to 24 months.
• For children ages 18 to 24 months of age, if you want to introduce digital media, choose high-quality programming and use media together with your child. Avoid solo media use in this age group.
• Do not feel pressured to introduce technology early; interfaces are so intuitive that children will figure them out quickly once they start using them at home or in school.
• For children 2 to 5 years of age, limit screen use to 1 hour per day of high-quality programming, coview with your children, help children understand what they are seeing, and help them apply what they learn to the world around them.
• Avoid fast-paced programs (young children do not understand them as well), apps with lots of distracting content, and any violent content.
• Turn off televisions and other devices when not in use.
• Avoid using media as the only way to calm your child. Although there are intermittent times (eg, medical procedures, airplane flights) when media is useful as a soothing strategy, there is concern that using media as strategy to calm could lead to problems with limit setting or the inability of children to develop their own emotion regulation. Ask your pediatrician for help if needed.
• Monitor children’s media content and what apps are used or downloaded. Test apps before the child uses them, play together, and ask the child what he or she thinks about the app.
• Keep bedrooms, mealtimes, and parent–child playtimes screen free for children and parents. Parents can set a “do not disturb” option on their phones during these times.
• No screens 1 hour before bedtime, and remove devices from bedrooms before bed.
• Consult the American Academy of Pediatrics Family Media Use Plan, available at: www.healthychildren.org/MediaUsePlan.^[9]

Helping Youth Develop Healthy Habits and Prevent Digital Addiction

Many young people do not understand the negative impacts that can be associated with too much screen time. This is especially true when it comes to the convenient form of having a screen that is small enough to fit in a hand and can go almost anywhere. The strategies below may be helpful in curbing an addiction issue.

• Research before giving a child a device – Starting out by giving a child a device with full access has been likened to setting a child free in a candy store. Some parents, including those who have developed the technology themselves, have limited or even eliminated their own children’s screen time. A number of factors, including the maturity level of the child should be taken into consideration when deciding what device and what services would be safest. “Wait Until 8th,” is a movement that encourages parents to sign a pledge to wait until 8th grade to give their children smartphones.18 Eden et al
• Monitor and supervise – It is not realistic to think that children will have the capacity to deal with the content that is available online. They also need guidance with learning how to communicate with others on a device. Do NOT assume that youth will share what they are doing or seeing. Monitoring and supervising their online and phone activity provides opportunities for teachable moments and for preventing undesirable and unsafe situations.
• Discuss the potential negative consequences of smartphone use and addiction. Youth need to know about the forces that exist behind the scenes that have the goal of maintaining their attention and influencing them to spend money. Safety aspects should be discussed as well. Also, learning about issues with excessive use can help target the underlying issues that lead to smartphone addiction.
• Set a positive example – Young people watch and mimic what adults do. Demonstrate that you do not need to be attached to a device. Avoid checking your phone during activities such as watching movies, eating a meal or having conversations. Do not use your phone when driving. Otherwise, young people think these behaviors are acceptable.
• Teach digital literacy with appropriate interactions and verification of sources of information.
• Create device-free time to show that certain times are for connecting in real life rather than online. No phones at the table can be a very helpful policy. No phone in the bedroom is an excellent guideline that helps to prevent a myriad of issues, from inappropriate digital behaviors to interference with sleep.
• Implement a media limits. Technology use (computers, video gaming, or mobile phones) may also contribute to late bedtimes. Setting an endtime for technology use and removing these technologies from the bedroom supports digital wellness.
• Utilize functions that assist with boundary setting to help support awareness and good habits with recreational time management. Downtime and app limits can be set and can be very useful in teaching young people to budget their time. Decreasing the amount of data accessible can also help with limits. Discussing the benefits of limits and encouraging youth when they use less social media can help them to develop healthy behaviors.
• Discuss Quality and Quantity. Digital usage concerns aren’t just about the duration of use, but the quality of what is being utilized on the device. Obviously, increased exposure increases influence. Evidence from the literature implies that social media exposure should be the greatest concern. Apps that have disappearing messages and photos are also very problematic. In contrast, having a verbal conversation with a friend would not be as much of a concern.
• Other activities should be encouraged to reduce screen time. Outdoor activities, art, music, cooking, and other projects, events or activities is an important aspect of creating balance in life and time away from mobile devices.

Further Action – The Future of Digital Media:

While more research is needed to determine the full impact social media use has on nearly every teenager across the country, children and adolescents don’t have the luxury of waiting years until we know the full extent of social media’s effects. The Surgeon General’s Advisory offers recommendations stakeholders can take to help ensure children and their families have the information and tools necessary to make social media safer for children:

• Policymakers can take steps to strengthen safety standards and limit access in ways that make social media safer for children of all ages, better protect children’s privacy, support digital and media literacy, and fund additional research.
• Technology companies can better and more transparently assess the impact of their products on children, share data with independent researchers to increase our collective understanding of the impacts, make design and development decisions that prioritize safety and health – including protecting children’s privacy and better adhering to age minimums – and improve systems to provide effective and timely responses to complaints.
• Parents and caregivers can make plans in their households such as establishing tech-free zones that better foster in-person relationships, teach kids about responsible online behavior and model that behavior, and report problematic content and activity.
• Children and adolescents can adopt healthy practices like limiting time on platforms, blocking unwanted content, being careful about sharing personal information, and reaching out if they or a friend need help or see harassment or abuse on the platforms.
• Researchers can further prioritize social media and youth mental health research that can support the establishment of standards and evaluation of best practices to support children’s health.^[10]