Emotional well-being and positive human interaction is crucial for healthy individuals, healthy families, and a healthy society. Researchers are finding that the overuse of interactive devices such as computers, cell phones, video games, and other mobile electronic devices can have a direct effect on our well-being and mental health. (5,19) With excess technology use, mental health experts are reporting psychological and physiological effects on the central nervous system, especially in children, leading to impairment of physical and mental functioning. Psychiatrists and psychologists are seeing a disquieting rise in tech addiction, cyberbullying, depression, insomnia, loss of empathy. and impaired social-emotional learning in their young patients. (1,3,10) )  Internet game overuse has been found to have psychological and neural effects similar to other types of impulse control disorders and addictions which are both substance and non-substance-related. (10) Even adults can overuse technology affecting their parenting along with their child’s development and behavior. (43)

Risks of Social Media

Social media, however useful to communication, is increasingly recognized as a risk to children and teens as their frontal cortex is not mature enough to manage social media’s distractions and temptations from peers. (1,3) Online communication is now replacing authentic face-to-face communication giving us a superficial and false sense of connection. Consequently, as Sherry Turkle states in Together Alone, we then “expect more of technology and less of each other”. (40) With diminishing opportunities for eye contact or human voice to distinguish subtle emotion, this technology can have a dehumanizing effect on relationships and erode communication skills. Empirical observation and research on the adverse outcomes of social media are mobilizing mental health experts, educators, and schools to develop materials to address this issue and find solutions.

Digital Technology and Developmental Delays

There are significant concerns regarding digital media replacing creative play, lowering memorization skills, reducing language development, diminishing self-regulation, and altering development of relationships and empathy. As more schools are rapidly switching from book learning to screen-based software and programs, educators, administrators, and policymakers need to ensure that implementations are done in alignment with tenets of research on healthy child development.  The devices are being introduced in many classrooms without appropriate safety testing or assurances that they would not have short or long term adverse effects on learning and/or development.

Researchers at the University of Toronto in 2017 reported for the first time that smartphone or tablet use before the age of 2 caused a delay in speech development. The 4 year study showed that for each 30-minute increase in handheld screen time, researchers found a 49 percent increased risk of expressive speech delay. (4)

Studies indicate that excess screen time itself, regardless of content, can contribute to obesity and insulin resistance. (1, 28, 32) The American Academy of Pediatrics regularly evaluates and updates recommendations with regards to screen time. (13)

Academic Performance with Technology

Children are using cell phones, tablets and computers at younger ages in and out of the school environment with unintended consequences now being revealed. The use of technology can be distracting and appears to cause an erosion of students’ sustained attention and deep thinking which can ultimately translate to poor academic performance.

A recent West Point Academy study backs up prior research finding that students performed better academically when laptops and tablets were removed from the classroom. (44)

Another experiment on smart phones and brain power conducted at the McCombs School of Business at the University of Texas at Austin measured 800 smartphone users and how well they completed tasks. Participants were given a series of tests requiring full concentration and then had their smartphones put in silent mode on the desk face down, in their pocket or bag or in another room. They found that the participants with their phones placed in another room outperformed the other participants. The researchers note “The mere presence of their smartphone was enough to reduce their cognitive capacity.” (51)

Technology also appears to contribute to a need for instant gratification and increased impatience as the internet allows quick retrieval of information. (44,55) While certain digital technologies can enhance education, researchers are now finding digital media can adversely affect learning and sleep as well as increase stress levels, anxiety, depression and aggression in students. (70)

Human Connection and Child Development

Critical factors for healthy child development are human connection, motion, touch and exposure to nature. Healthy human interaction, especially in youth, creates a sense of security, love, confidence and resiliency leading to healthy human interactions later in life. Electronic devices are increasingly used by children as entertainment replacing these critical factors. A 2010 Kaiser Foundation study found that youth from ages 8 to 18 devote an average of 7 hours and 38 minutes per day using entertainment media. They point out that heavy use is driven by easy access. (26)

Virtual Violence, Mobile Screens and Aggression

The American Academy of Pediatrics in 2016 published a report “Virtual Violence Impacts Children on Multiple Levels” noting that hundreds of studies show that violent media raise aggression in children. (71) A study in JAMA showed that in 2000 every G rated movie contained violence as did 60% of the prime time shows. (72)  It is estimated that by middle school a typical child would have seen 8,000 murders and 100,000 acts of violence including rape and assault. Portable smartphone cameras broaden the scope of violence youth are exposed to enable as they can produce, view and share real-life violent images without parental knowledge or supervision. This exposure can result in feelings of distress, victimization, fear and desensitization (73,74)

The report advises

*Policy-makers should consider legislation to prohibit easy access to violent content for minors and should create a robust and useful “parent-centric” media rating system.

  • The entertainment industry should create content that doesn’t glamorize guns or violence, doesn’t use violence as a punch line and eliminates gratuitous portrayals of violence and hateful
  • The news media should acknowledge the proven scientific connection between virtual violence and real world aggression and stop portraying the link as controversial. (71)

The Digital Divide: Computers from School to Home

In their well-researched report “Scaling the Digital Divide” Vidgor et al. noted the many initiatives to provide computer access to children at home for the purpose of improving grades. They carefully looked at research, research methods as well as cost. They concluded that the “introduction of home computer technology is associated with modest, but statistically significant and persistent negative impacts on student math and reading test scores. Further evidence suggests that providing universal access to home computers and high-speed Internet access would broaden, rather than narrow, math and reading achievement gaps.” Their explanation for a lack of positive effects on students with worsening outcomes may reflect “displacement of social activities and attendant loneliness and depression, exposure to inappropriate violent, sexual, or commercial content, and physical problems, including increased obesity and injuries to the eyes, back, and wrist.” (64)

A worldwide educational initiative, One Laptop Per Child (OLPC) created by Nicholas Negroponte, which aimed to provide computers for millions of children including those most impoverished has also not had the expected outcomes. (65)

Internet, Texting and Gaming Addictions: A Public Health Issue

Interactive wireless mobile devices, computer games and social media can exert a powerful influence on the brain like other addictive substances such as tobacco, sugar and heroin. (5-17) Internet Addiction Disorder (IAD) and Internet Gaming Disorder (IGD) are becoming serious mental health issues globally. (5) The prevalence of Internet Gaming Disorder is estimated at 5.9% in South Korea,  0.3-1.0% in North America and 1.6% in Germany. (14) Studies are showing these disorders are associated with cognitive dysfunction and neuro-structural changes in the gray and white matter. (9,10) According to a 2015 PEW report, 87% of American teens ages 13 to 17 have access to a desktop or laptop and 81% of teens 13 to 17 have access to a game console such as a Playstation, Xbox or Wii. (63)

Engineering Addiction into Devices

It is not clear how much addiction to gaming and the internet is a result of a predisposition in some individuals or due to the design of the media. It is known that computer games and an abundance of internet sites are persuasive and their creation is based on behavioral design and addiction. (12) Addiction can cause both psychologic and physiologic changes. ( 4-11, 13, 14, 15, 21-24, 28, 42, 46, 51, 52, 54)

In a recent eye-opening piece “Brain Hacking” Tristan Harris, a former Design Ethicist at Google, describes how technology companies frame our experience and lead us on a path to get “hooked” on social media sites pursuing an intermittent reward. Textbook psychological strategies are built into the product to keep people returning to the site. (46-50)

Interactive sites and gaming affect the brain by stimulating pleasure enhancing dopamine receptors. With overuse the nerves ultimately respond by decreasing dopamine or permanently eliminating the dopamine receptors causing the brain to seek more interaction to calm the brain. This physiologically maintains the addiction. While children may seem soothed when returning to play the game this only reinforces the addictive neural response. (52,53) Internet Gaming Disorder causes symptoms of depression, anxiety with more impulsiveness and aggression. A technology detox program along with cognitive behavioral therapy can offer a favorable prognosis. (1, 5, 6)

Compulsive texting is now a growing problem as well, leading to poor academic achievement, social dependence, poor coping skills and low self-esteem. It is estimated that 4% of teens in the U.S. have problematic internet overuse. (16) The median number of texts per day is about 100 with some studies showing some who text up to 2,000 times per day.

Children’s Privacy Protections

The use of digital devices, electronic games and toys for entertainment can be a vehicle for companies to mine personal information about children for profit.  This can result in lucrative targeted third party advertising directed at youth.  In 1999 the Federal Trade Commission (FTC) developed the federal Children’s Online Privacy Protection Act (COPPA) to protect children under the age of 13 from collecting and using their personal data from online websites and popular game apps for commercial purposes without the consent of the parents.  (75) Violations of this act continue to occur. (76, 77, 78)

Structural Brain Changes in Internet Addicted Youths

 Internet addiction now spans the globe with an estimated 24 million youth addicted in China. In 2011 a radiologic study was done to examine brain changes in internet addicted teenagers. The researchers found a consistent atrophy of gray matter in parts of the brain and shrinkage on the surface of the brain in those with addiction. Lower gray matter density was found in the limbic system, the cingulated gyrus and insula. These areas are in charge of controlling emotions, mood and motivation as well as cognition. The effects were worse the longer the addiction. They concluded these structural abnormalities could affect their concentration and memory. (66,67)

Another study by Loh and Kanai in 2014 confirmed the above findings. They looked at multimedia tasking over time and structural changes in gray matter. Results showed that found those with the higher Media Multitasking Index (MMI) scores had smaller gray matter density in the anterior cingulate cortex. They state this could correlate with “observed decreased cognitive control performance and socio-emotional regulation in heavy media-multitaskers.” (68)

Sleep, Melatonin, Light at Night and Technology

There is growing evidence that light at night, blue light from LED bulbs, and even electromagnetic radiation from wireless devices reduce melatonin, alter a person’s circadian rhythm and cause insomnia. (35, 37, 54, 55, 56) Neuroscientists acknowledge that sleep is critical to store and process information learned during the day. (38) In addition, the lack of sleep and reduced melatonin levels have been associated with a number of disease states including cancer, diabetes, cardiovascular risks, obesity, mood disorders and age-related macular degeneration. (36, 39, 57-60) The International Agency for Research on Cancer (IARC) classifies shift work in group 2A of “probable carcinogens to humans”  due to its involvement in circadian disorganization. (59) Melatonin is a potent endogenous antioxidant present in almost all organisms. (61)

Digital Detox: Treatment for Digital Overload

As research demonstrates negative health consequences of the overuse and overdependence on digital technology, physicians play a critical role in counseling children, adolescents and adults about the risks and in offering reasonable guidance for digital use. Mental health professionals have developed methods to treat overuse syndromes both at home and at a growing number of internet rehabilitation centers. (1,18,19) Cognitive neuroscience is demonstrating the positive effects of “mind wandering” when not involved in tasks. Digital downtime may have benefits for both mood and executive function. (24)

As digital technology is rapidly integrating into every moment of our daily lives, it is critical to consider the growing research highlighting the potential hazards and the scientists call for precaution.  As physicians, the Hippocratic Oath directs us to follow ethical standards including the most well-known, “First do no harm”, the original precautionary dictum. It would be wise to apply this to public policies at large.

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