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By Dr. Harold Koplewicz
October 28, 2019
IDEAS
Dr. Harold S. Koplewicz is the founder and president of The Child Mind Institute, an independent nonprofit dedicated to transforming the lives of children and families struggling with mental health and learning disorders.

Is “time” really the problem with “screen time”? Researchers have described the negative effects of large amounts of time online and the beneficial effect of moderation. For instance, a 2019 study of more than 6,500 12- to 15-year-olds found that more than three hours of social media use a day is linked to depressive symptoms, while a 2017 study suggested that moderate online gaming and interaction, around an hour a day, is protective against mental health symptoms.

But emerging research shows that it isn’t just how much time kids spend online, but how and why they spend time online that impacts their social, emotional and behavioral health. As we try to better understand and help with the mental health challenges associated with internet use, researchers and clinicians are turning more to lessons from the substance abuse field for guidance.

Kids themselves seem to understand the risks of “using” the internet. In a 2016 survey, half of teenagers said they “feel” addicted to their mobile device, and 72% said they felt the need to immediately respond to texts and social networking messages.

Just because kids are aware of their attachment to devices and the internet doesn’t mean they are impaired by this use — but a subset are. This impairment is captured by the concept of problematic internet use (PIU), which affects up to 10% of children and adolescents. PIU is assessed with a scale developed for substance abuse and focuses on the intensity and dysfunction of internet use rather than trying to define when use is “excessive” or “too much.” Sample questions from the assessment include:

  • How often do you find that you stay online longer than you intended?
  • How often do you form new relationships with fellow users?
  • How often do others in your life complain to you about the amount of time you spend online?
  • How often do you lose sleep due to being online?
  • How often do you choose to spend more time online over going out with others?

At the Child Mind Institute, we asked these questions to more than 500 young people ages 7 to 15 who participated in our Healthy Brain Network study, and we’ve found links between PIU and depressive disorders and attention-deficit hyperactivity disorder (ADHD). These preliminary results are summarized in the Child Mind Institute’s 2019 Children’s Mental Health Report on social media, gaming and mental health.

We’ve also found that PIU is linked to impairment in everyday functioning at home, at school and with friends — even when accounting for the impairment of a co-occurring mental health disorder. Similar to drug use, PIU can make symptoms worse for kids who are already vulnerable or struggling with a mental health disorder. If a teen has PIU and ADHD, for instance, PIU adds an extra level of impairment above and beyond his ADHD symptoms.

When should you worry? Online habits are problematic when they become compulsive, are motivated by the desire for mood alteration or are related to offline interpersonal problems. Examples of this would be a teen disappearing into a game to forget about a breakup or using social media to avoid feelings of depression.

By the same token, there are online habits that may be benign or even beneficial despite the seemingly “excessive” amount of time young people devote to them. Many things kids do on their devices are age-appropriate activities that have simply been done offline in the past: socializing with peers, pursuing hobbies, shopping, listening to music, doing schoolwork and watching TV.

And the therapeutic power of the internet is just being unlocked. One example is the online from Stony Brook University, which is showing that a single “dose” of self-administered intervention can significantly reduce youth mental health problems, especially depression. Another is the PsyberGuide, an online resource operated by the University of California and Northwestern University and funded by the nonprofit One Mind, which provides expert evaluations of mental health apps.

Parents can encourage the kind of online experiences that can be beneficial beyond the measure of their hours by being an engaged “digital neighbor” to kids. You can look out for signs of depression, model your own balanced use of connected devices and practice something called parental “mediation” of your kids’ internet use — that is, co-viewing or co-playing and being online together. It’s also a good idea to establish phone-free time before sleep for all family members. And finally, you can help your kids practice “mindful” use of social media by pausing to reflect on how being online makes them feel in the moment, whether it’s bad or good.

The real challenge is not to let caution blind us to the incredible potential of the online world to help our kids learn, grow and even help themselves.

Contact us at editors@time.com.

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