Elsevier

Environmental Research

Volume 164, July 2018, Pages 149-157
Environmental Research

Adverse physiological and psychological effects of screen time on children and adolescents: Literature review and case study

https://doi.org/10.1016/j.envres.2018.01.015Get rights and content

Abstract

A growing body of literature is associating excessive and addictive use of digital media with physical, psychological, social and neurological adverse consequences. Research is focusing more on mobile devices use, and studies suggest that duration, content, after-dark-use, media type and the number of devices are key components determining screen time effects. Physical health effects: excessive screen time is associated with poor sleep and risk factors for cardiovascular diseases such as high blood pressure, obesity, low HDL cholesterol, poor stress regulation (high sympathetic arousal and cortisol dysregulation), and Insulin Resistance. Other physical health consequences include impaired vision and reduced bone density. Psychological effects: internalizing and externalizing behavior is related to poor sleep. Depressive symptoms and suicidal are associated to screen time induced poor sleep, digital device night use, and mobile phone dependency. ADHD-related behavior was linked to sleep problems, overall screen time, and violent and fast-paced content which activates dopamine and the reward pathways. Early and prolonged exposure to violent content is also linked to risk for antisocial behavior and decreased prosocial behavior. Psychoneurological effects: addictive screen time use decreases social coping and involves craving behavior which resembles substance dependence behavior. Brain structural changes related to cognitive control and emotional regulation are associated with digital media addictive behavior. A case study of a treatment of an ADHD diagnosed 9-year-old boy suggests screen time induced ADHD-related behavior could be inaccurately diagnosed as ADHD. Screen time reduction is effective in decreasing ADHD-related behavior.

Conclusions

Components crucial for psychophysiological resilience are none-wandering mind (typical of ADHD-related behavior), good social coping and attachment, and good physical health. Excessive digital media use by children and adolescents appears as a major factor which may hamper the formation of sound psychophysiological resilience.

Introduction

Current young generation experiences electronic media as a central part of their lives. Children and adolescents use for leisure an increasingly growing variety of digital media devices. Rapid technological improvements allow condensing into the users' experience a growing variety and faster-paced stimuli which is accessible almost any time and place through mobile devices, consequently, drawing youth to an excessive screen time use over the recommended 2 h per day limit (Henderson et al., 2016). In many of western and some far-east countries appear a continuous rise in youth's digital media consumption. In 2011, 52% of 0 to 8-year-old children had access to a mobile device. This access had increased, by 2013, to 75% (Chassiakos et al., 2016). In 1999, the average screen time of 8–18 year-olds was 6.21 h per day and had increased by 2009 to 7:38 h, (Magee et al., 2014). Additionally, a shift in the youth's device of choice appears to be occurring. With more than 75% of families owning some mobile device, use of smartphones and other Internet-enabled small devices is rising (Lauricella et al., 2015). Consequently, adolescents owning a smartphone are likely to have higher screen time compared to adolescents with a conventional mobile phone because they have higher online and calling/sending messages time (Lemola et al., 2015). Thus, the use of mobile devices which allows access to most types of content, and encourages multi-screening (Cain and Gradisar, 2010, Cajochen et al., 2011), is creating a growing concern (Falbe et al., 2015) and is drawing research attention.

Along with advantages associated with access to information and fast communication, in recent years many studies associated screen exposure to health and psychological problems among infants, children, and adolescents. This article reviews screen time effects on sleep, the cardiovascular system, orthopedics, and vision and screen time psycho-neurological and social outcomes. A case study of an ADHD diagnosed nine-year-old boy presents an example of screen time in-the-field-effects and will assist to conclude the role of screen time in the formation of the psychophysiological resilience of the young generation.

Section snippets

Screen time effects on sleep

Children in 2011 were estimated to sleep, on average, one hour less per night when compared with children of the early 20th century (Magee et al., 2014). In Britain, 20–30% of young children experience sleep problems (Cheung et al., 2017). Sleep is highly important for neurodevelopment of infants and toddlers. Accumulating evidence indicates that inadequate sleep, both in duration and quality may compromise youth's physical and mental health and psychosocial functioning. Additionally,

Cardiovascular system

For more than three decades evidence has been accumulating regarding negative health outcomes of TV viewing as 'sitting' time. Along with technological advancement, this field of interest expanded to examine also a computer and video game time (Biddle et al., 2017). Screen time sedentary behavior is claimed to increase the risk for obesity, HDL dysfunction, and high blood pressure which are major risk factors for cardiovascular morbidity (Merghani et al., 2015, Goldfield et al., 2011, Tucker et

Sympathetic arousal

Chronic sympathetic arousal can act as a risk for cardiovascular diseases (Curtis and O’Keefe, 2002). Higher levels of sympathetic arousal were found in young adults (Hsieh and Hsiao, 2016) and among school-aged children with Internet addictive behavior. The authors hypothesized that high arousal might be a partial cause for disrupted sleep (Lin et al., 2014).

Cortisol

Cortisol is a hormone produced by the hypothalamic-pituitary-adrenal (HPA) axis and is considered a stress biomarker for pediatric

Vision

Considerable computer screen viewing can lead to eye fatigue, blurred vision, eye dryness, headaches, and discomfort. Such symptoms can be a result of glare, poor lighting or improper viewing setting (Akinbinu and Mashalla, 2014). The Multi-Ethnic Pediatric Eye disease Study (MEPEDS) examined the causes of ocular disease. Finding confirmed that prevalence of childhood myopia in the U.S. has more than doubled over the last fifty years (Varma et al., 2006).

Recent studies have associated vision

Orthopedics

Sedentary behaviors, or non-exercising seated activities, may result in significant orthopedics effects. Screen time, primarily of small-screen handheld devices is argued to affect posture and creating musculoskeletal load and discomfort symptoms. Such symptoms may be a result of the intensive repetitive wrist and arm movement, and head inclination found mostly during video game playing (Lui et al., 2011). Another significant orthopedic effect relates to youth's bone density. Boys' video game

Depression and suicidal behavior

Depression represents a growing public health concern and is a prevalent disease among adolescents. Findings have linked overall screen time to depression and suicidal behavior among adolescents (Wood and Scott, 2016, Maras et al., 2015). Liu et al. (2015) found a nonlinear dose-response relation between depressive symptoms and overall screen time among children in the age range of 5–18 who were using digital media for over two hours per day.

Symptoms of sleep disturbances are known to precede

Attention deficit/hyperactivity disorder (ADHD)

Attention deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by symptoms of inattention and hyperactivity/impulsivity with an early onset in childhood and adolescence. Children in the general population may display various ADHD symptoms (attention problems, hyperactivity, and impulsivity) on a continuous basis. Such behavior is referred to as ADHD-related behavior and is associated with screen time (TV and video games) (Nikkelen and Valkenburg, 2014).

Screen

Addictive screen time behavior

Literature relating to digital media addictive behavior has focused mostly on Internet use and video games, yet the growing use of applications and texting (mostly used on mobile devices) may also lead to addictive behavior (Love et al., 2015). While males appear to demonstrate video game addiction, the addictive behavior of females is found to be focused primarily on social networking (Andreassen et al., 2016).

Predictive behavior

Violent behavior is rarely an outcome of a single distinct cause and is likely be a result of often prolonged, effect of multiple factors. More than other risk factors, exposure to aggressive behavior during childhood is the best predictor of violent behavior in older adolescent and adulthood. Decades of studies suggest that exposure to violent content in TV and video games increases the risk for future violent behavior in the same manner as growing up surrounded by real violence. (Huesmann and

Radiation

Concerns about the potential vulnerability of children to radio-frequency electromagnetic radiation (RF-EMR) fields is increasing as children's exposure to wireless devices is on the rise. Children are considered potentially more vulnerable to RF-EMR fields because of the susceptibility of their developing nervous system. Additionally, their brain tissue is more conductive, consequently allowing more RF-EMR penetration relative to the size of their head. Moreover, they will be exposed to RF

Background information

Mark is a nine-year-old Caucasian male who was referred for behavioral intervention treatment of ADHD. Mark was living with his parents and his sixteen-year-old sister and thirteen-year-old brother. At intake, Mark's parents reported that he exhibits restlessness and hyperactivity. He also was described as easily distracted, having difficulties listening and following instructions and had difficulties playing quietly. His parents said that he was always "jumpy."

Mark was attending third grade.

Discussion

The variety of digital media devices is increasingly growing and advancing digital media offer users an increasingly more vivid and faster paced digital environment. Children and adolescents appear to adjust to new technologies seamlessly. However, a growing body of literature associates excessive screen time with physical, psychological, social and neurological adverse health consequence. Additional screen time effects include developmental effects, the effects of exposure to pornography and

Funding

No external funding.

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    This article is based on the author's lecture at the 2017 IIAS/EHT Wireless Radiation and Health: An Expert Forum - The Israeli Institute for Advanced Study (The Hebrew University at Jerusalem) and Environmental Health Trust (https://www.youtube.com/watch?v=7_1Ik7ddjHA)

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