The Dangers of Too Much Screen Time — A Talk with Victoria Dunckley, Author of Reset Your Child's Brain
By Victoria Dunckley
1. What is Electronic Screen Syndrome (ESS), and under what circumstances should parents worry about it? Is it different from video game or tech addiction?
Electronic Screen Syndrome is a condition in which the nervous system becomes overstimulated from too much screen-time. It’s essentially a syndrome of dysregulation
, where various brain mechanisms start to malfunction due to chronically high levels of arousal, or what we call hyperarousal
. The concept of Electronic Screen Syndrome was born out of a need to describe a constellation of symptoms I was seeing in children that tended to resolve once use things like video games and computers had been eliminated, regardless of the child’s diagnosis. ESS symptoms can take on a variety of forms, but typical ones include irritable mood, poor focus, and disorganized or defiant behavior. Children with ESS become tearful, frustrated, or angry very easily, and tend to have meltdowns over minor incidents. They’re often struggling in school because they can’t get their work done, and display immature behavior that’s off-putting to peers, such being a “sore loser” or arguing all the time. Regarding leisure activities, they may have lost interest in anything that isn’t electronically-based, and show little imaginative play or creative expression.
Although we already know that children can suffer effects from screen-time and that use of electronics has skyrocketed, what’s surprising is how little screen-time it takes to induce dysregulation symptoms. For some kids just thirty minutes a day of iPad use causes huge problems that disappear once the iPad is removed. Since regular exposure to electronics is virtually a given these days, parents, teachers, and clinicians should always consider ESS when a child is dysregulated and can’t modulate mood, attention, or arousal levels in ways that cause distress or dysfunction in the child’s life. A child need not be “addicted” to technology per se to suffer effects from using it.
2. How are the brain and body affected by electronics?
Because screen-time provides unnaturally high levels of stimulation, the brain interprets all screen-based activity as a form of stress
. With each interaction, the entire nervous system goes into varying degrees of fight-or-flight. Our brains and bodies are meant to handle some
stress, but too much stress too often overwhelms our ability to adapt. Also, high stress levels can only renormalize if stress is accompanied by an appropriate discharge of energy — like fighting or fleeing. But typically the stress of screen-time is accompanied not by intense physical activity, but by lots of sitting! So what happens? It gets released in a tantrum, or in some other dysfunctional way. Meanwhile, if we were to look inside of a brain engaged in screen-time, we’d see the brain getting too much
activity in some areas, such as the reward pathways and the pathways sensitive to light, and not enough
activity in other areas, such as the regions associated with empathy, reading social cues, and delayed gratification. Over time this leads the brain to develop in a fragmented fashion, making it less flexible and less resilient.
One of the best researched areas is screen-time’s impact on sleep. The bright light emitted by an electronic screen mimics daylight, so it tricks the brain into alertness, in part by suppressing the sleep signal melatonin. Lack of melatonin desynchronizes the body clock, resulting in shallow sleep, altered brain chemistry, and disrupted hormone cycles. In fact, some of the weight gain and high blood pressure effects related to screen-time is not just from being sedentary and out of shape, but from chronically high stress hormones.
3. Explain how electronics use is contributing to misdiagnosis of psychiatric disorders in children.
One of the ways the brain is affected by chronic stress, including electronic stress, is that the front most part of the brain, or the frontal lobe, gets less blood flow. Because the frontal lobe governs emotional regulation, attention, impulse control, and social competence—among other things—when it starts to malfunction the child can suffer from any combination of symptoms related to any or all of these functions. Thus, a child who is inattentive and impulsive from poor frontal lobe functioning might look like they have ADHD, while a child with who is raging and reactive might be suspected of having bipolar disorder. As you can imagine, hyperarousal itself can cause symptoms too, such as insomnia or panic attacks.
Another potential source of misdiagnosis is screen-time’s impact on dopamine, a brain chemical involved in a wide variety of brain functions such as attention, movement, mood, and even grooming behavior. We know from brain scan research that screen activities can release large amounts of dopamine that may make the brain both over-sensitized and desensitized to dopamine at the same time. For example, too much dopamine in certain areas may result in tics or compulsive movements, while too little in other areas may make a child depressed or unable to concentrate. Frontal lobe and dopamine functioning are just a couple examples of mechanisms that may explain the development of mental health symptoms, but there are others as well. The result is that virtually any psychiatric disorder can be mimicked. Likewise, in children who have truly have an underlying psychiatric disorder, sooner or later screen-time will likely make it worse.
4. How does screen-time specifically affect mood? Focus? Behavior or social skills?
Mood can become depressed, irritable, or dysregulated, with lots of mood swings. Cognitively, focus, organization, and deep thinking are affected. Behavior can be defiant, immature, or impulsive. Socially speaking, screen-time negatively affects children’s ability to make eye contact, read social cues, and handle conflict, so everything from friendships to romantic relationships are impacted. And unfortunately, when children who are socially awkward hide behind screens, they tend to become even more isolated and more depressed.
5. How kind of impact does screen-time content—or what’s being viewed or played—have on these kinds of negative effects?
One of the biggest misconceptions about screen-time is that content matters a great deal. The fact is that studies show that total
amount of screen-time is a much better predictor than content. Parents often mistakenly believe that non-violent video games are not harmful, and that educational games give children an “edge.” The truth is that although violent content carries its own risk, non-violent content is still way too stimulating for the brain to process, so the difference is essentially negligible. I tell parents that it’s the nature of the screen itself, and interacting with that screen, that does much of the damage. Regardless of message content, the unnaturally bright light, fast pace, and vivid colors overload the visual system, while the rapid interaction taps into hard-wired psychological needs, activating reward circuits. All technology industries, including the “ed-tech” or educational technology industry that is now infiltrating public schools, exploit these properties to keep children engaged and coming back for more. In other words, “it’s the medium not the message” that causes harm.
6. Why do you feel interactive screen-time—such as computer use or gaming-- is even more harmful than passive screen activities like watching TV?
Two reasons. One is that studies suggest that while both passive and interactive screen-time can cause mental health and learning issues, interactive screen activities are more likely to cause addictive behavior, more likely to disrupt sleep, and more likely to cause mood and behavior issues. Indeed, all kinds of interactive screen activities—including gaming, internet use, social media, and even texting, have been linked to mental health conditions. The second reason relates to what I mentioned earlier: that clinically, even small but regular amounts of interactive screen-time can cause brain functioning to go haywire. In my work, when I’m trying to “reset” a child’s overstimulated nervous system, I find that I’m usually able to do so if the parent continues to allow small amounts of slow-paced TV, but that it’s virtually impossible if interactive screen-time continues to take place.
7. You recommend that children undergo a strict three to four week “electronic fast” any time parents and doctors are considering medication treatment. What does the fast accomplish that simply cutting back on electronics doesn’t?
Once a child’s nervous system has become dysregulated, it tends to stay that way. Even small amounts of interactive screen-time seem to maintain chaotic effects of hyperarousal. And because kids are getting so much screen-time these days, simply cutting back doesn’t allow the nervous system to relax and rest. Cutting everything out for a few days can help, but the effects won’t be as dramatic and won’t be sustained. I’ve seen parents try many ways and can tell you from doing this hundreds of times that most parents will be wasting their time by just trying to cut back, because if the child continues to be dysregulated, we still won’t know how much of the problem can be attributed to electronics. For some kids, the fast results in complete resolution of symptoms, and thus medication is no longer a consideration. For others, it greatly reduces symptoms, so even if medication is needed, the effective dose will be lower. So the fast has three important benefits: it clarifies diagnoses, it improves symptoms and functioning, and it allows other treatments to work as they should. For example, therapy might start progressing faster, or tutoring in math might suddenly become more effective.
After the fast, parents can decide if they want to try to reintroduce a small amount of electronics use in a slow and careful way, with certain safeguards in place. These include always pulling back if and when symptoms return, and treating screen-time as a privilege, not a right. Some children will be able to tolerate a small amount of screen-time, and some won’t, but at that point it’ll be easier to determine how much is too much.
8. What do you say to parents who insist it’ll be too hard to orchestrate the electronic fast? Are there some rules-of-thumb parents can follow?
First, I ask them to keep in mind that it’s almost always
much more difficult to deal with a dysregulated child than it is to implement a fast. Second, if they think of the fast as an experiment, it’s easier to contemplate, and easier to get other adults in the child’s life on board too. And third, that since the fast represents an intervention that is 100% safe, free, and highly effective across a broad range of symptoms, they should keep it in mind as an option if other interventions or treatments don’t work. That said, a general rule of thumb that parents can follow is that seeing signs of dysregulation often means overstimulation and hyperarousal are present, and thus at the very least electronics should be cut back. Signs like falling grades, missing assignments, disrespectful behavior, or the inability to follow direction are examples of ways dysregulation can manifest. Protective measures against screen-regulated dysregulation include physical exercise, one-on-one time with a parent, a regular bedtime, and daily chores.
9. Parents are continually being told their children need to be tech savvy to succeed in today’s world. Won’t children with limited electronics exposure be left behind?
Success in life is largely dependent on how healthy the frontal lobe is, and how integrated the entire brain is. How well the brain works
and how resilient it is will always trump what the brain knows
. This general rule is not going to change no matter what the future looks like. For example, because the frontal lobe governs emotional regulation and empathy, it determines how well we get along with others, and our capacity for intimacy. Because it determines executive functioning, it determines how far we go in school, how well we can plan and complete complicated tasks in our job. This is why frontal lobe and brain health in general should always take priority over tech knowledge. I work with a lot of very bright young adults who are tech savvy but who repeatedly drop classes or get fired from jobs because they’re irresponsible and have trouble taking direction. Often they’re lonely and long for emotional connection, but don’t know how to go about it.
Currently, research suggests that computer skills are being given way too much emphasis in school, often at the expense of other subjects that are known to promote brain development, like PE, art, and music. Screen-based learning also reduces eye contact and face-to-face conversation, activities essential for learning to read, write, and speak well. We also know that risk for problematic tech use, currently at 5-15%, increases the more often it’s used and the earlier it’s introduced. For the first time in history, we’re forcing kids to use something known to be addictive. Additionally, computer skills are relatively easy to learn at any age, even for children and adults with disabilities. And studies suggest that for most jobs, computer skills don’t predict wages, while reading and math skills do. We need to pace introducing technology much more slowly and mindfully. The current pace is harmful to all children, but is disastrous for kids with vulnerabilities.
10. What about the positive findings of video games—don’t studies show they can help with coordination and attention?
Playing video games essentially makes kids better at playing video games. For example video games may improve some aspects of visual attention, for skills like tracking an object. Some have speculated that better visual attention could mean better driving skills, but research shows that gamers tend to be more reckless drivers and are more likely to have car accidents. This may be because gaming and screen-time in general make executive attention, which is what we need to plan, organize, and complete tasks in real life, worse. Gaming also makes impulse control worse. So any cognitive advantages that video gaming may bring are eventually overridden by the negative effects on executive attention and impulse control, as well as the emotional dysregulation I mentioned earlier. It’s simply not worth it.
11. What are some of the long-term or developmental concerns regarding pervasive use of electronics?
Earlier I mentioned how the electronics stress the brain, and how screen-time tends to shut down the frontal lobe while overactivating the brain’s visual and reward pathways. Over time this leads the brain to develop in an uneven and fragmented fashion, making it less flexible, less resilient, and less integrated. Additionally, a large amount of the frontal lobe development occurs during puberty, so whatever activities the child is engaging in during that time determines which connections get reinforced and which get lost: what gets fired gets wired. So when screen activities crowd out healthier activities, this may negatively affect brain development in a way that’s irreversible. We’re already seeing signs of this, that children’s brains are less connected, less integrated than they should be, and that boys in particular are really struggling. Perhaps the grand irony of all this is that the best way to help kids use technology in a healthy and productive manner as adults may be to restrict technology use when kids are young.
Victoria L. Dunckley, MD
, one of the leading psychiatrists practicing integrative, holistic psychiatry with children, is a prominent and award-winning voice for greater understanding of the effects of electronic screens, the environment, diet, and medication on behavior. She lives in Los Angeles, CA and has been a featured expert on the Today
show, NBC Nightly News
, and the Discovery Channel. Her websites are www.DrDunckley.com and www.ResetYourChildsBrain.com.