Parents are a child’s first model. Does that work with screens as well? Screenagers explore if this is true or a myth below:
For years parents have said to me, “I know I am part of the problem. I should be modeling screen time better.”
I first respond by validating them in some way, such as, “It is really great that you are thinking and talking about this issue of modeling screen time. It is so important.”
Then, my next response often surprises them. Rather than say something like, “Yes, yes, I know we all need to do that better,” I gently point out that there is a major problem with the goal of “trying to model better” — the problem lies in the ambiguity of the goal — ambiguous goals never go well.
So much of what I do as a doctor is helping patients recognize and try to change unhealthy behaviors. Issues around behavior change are something I have been fascinated with and researching for years. One fundamental aspect of behavior change is choosing a definable and reasonable goal.
So to parents, I say, rather than having a vague goal like, “I should model screen time better,” pick a specific goal, and then model how you are going to try to reach that goal. Helping youth learn skills around behavior change through one’s own efforts is such a valuable gift to them.
For example, I had a habit of reflexively going onto my laptop to work after dinner. Did I really want to do that almost every night of the week? No, I didn’t. Furthermore, I did not want to model this for my kids.
I wanted to change my behavior. So, I decided that every Tuesday I would try to not go back on screens after dinner, and, instead, treat myself to a creative and relaxing evening. I wanted to make earrings and be more available to my family. On the first Tuesday, I completely forgot, and automatically went on my computer. The next Tuesday, I did not do enough prep, so I still had emails I needed to write.
When I failed on those first few Tuesdays, I shared my failure with my kids. I told them about my setbacks, and the actions I would do to try to prevent future failures. After the first week, I put a big reminder on the refrigerator. For the second week, I put a note on Tuesday morning’s to-do list to finish all emails before dinner.
We were all able to laugh at my setbacks, and I was happy to ask them to help me remember my goal.
A goal can be even something like changing the type of shows one decides to watch. Last week, for example, my husband announced to the family that he decided to stop watching the crime-drama, Ozark. He told us the reason he was stopping was that it was adding to his feelings of the bleakness about the world. He said that he didn’t like how the show made him root for people that he did not feel good about cheering for. So, to replace that activity, he planned to start a new book.
Examples of parents setting specific goals
Over the years, parents have told me about screen time behavior changes they wanted to make. They told me variations of the examples I give here.
After checking my email, my goal is to turn off the Wifi on my computer for 1 hour each weekday morning, so I can get my writing done and not get tempted to check my email.
I am going to try to resist checking my phone when we are setting up for dinner and at the table, so I get to talk with my family in a more connected way.
My goal is to take a full weekend off of screens one weekend this month and see how I feel afterward.
I plan to no longer have my phone in my room at night, just like I have decided I don’t want my teens to have theirs.
I plan to delete my favorite sports app off my phone because I check it too often. I want to see if I can keep it off permanently and only look up sports on my computer.
A model for effective behavior change that I love
If you have a change that you would consider announcing and trying, there is a model for behavior change I love in Joshua Klapow’s book, “Living Smart.”
The one from Living Smart goes like this:
S = Set a reasonable small, and actionable goal.
M = Monitor your progress by doing something like noting on a calendar each time you succeed.
A = Arrange for success like I did when I put my beading tray on the kitchen table Tuesday mornings. I knew exactly where it was, and I was ready to go that evening when my screen-free night arrived.
R = Recruit people to help hold you accountable. I told my kids, husband, and some friends about my goal and asked them to ask me about it now and then. Wanting the ego lift of being able to report success, gave me some extra motivation. Honestly, though, knowing my kids were witnesses to my attempts was the strongest motivation. When I slipped-up, I asked them for their suggestions of what I could do, and they loved giving me advice.
T = Treat. My favorite part! Choose a personal reward you value, like having a special dessert. All the data shows that sustained behavior change comes when we get rewards for our change. For example, if one does not like the gym where they do the elliptical, over time, they will stop going. But if they allow themselves to watch their favorite show, only when they are on the elliptical, it can be enough of a reward that they stick with it. Or, they get the reward that they actually start to enjoy the movement of an elliptical.
I don’t mean to say in this blog that modeling screen time is not important or doable — of course, it is both important and doable. But modeling is complex and is a superb topic to be discussing with your kids. Let me give you an example. If a family has a rule that devices are put away at mealtime, it would be a real disconnect if a parent sat on their phone night after night at dinner. If now, and then, the parent has to step away from dinner for an urgent work call, then ideally the parent would say something like, “I am sorry, I have to take this call for work — but I will tell them I will call them back shortly.” This parent is doing a great job of modeling even though they have actually “broken the rule.”
And how did it turn out for me on Tuesday nights? The habit did take hold for a couple of months, and then I decided that I didn’t want to do it anymore. I do continue to work to take nights off from my screen though.
Ideas for conversation starters:
This weekend I was hit hard by a disturbing article in The New York Times (NYT) about kids targeted by sexual predators via direct chats and in multiplayer video game chat rooms.
In a chat, people with bad intentions can pretend to be any age. They can say they are a friend-of-a-friend as a way to enter the chat. Children are susceptible because they are unsuspecting, and by the time they may realize something is not right, shame and threats may already be in place to keep them quiet and scared.
People have been reporting problems much more frequently than just a few years ago. According to The New York Times article: “Six years ago, a little over 50 reports of the crimes, commonly known as “sextortion,” were referred to the federally designated clearinghouse in suburban Washington that tracks online child sexual abuse. Last year, the center received over 1,500. And the authorities believe that the vast majority of sextortion cases are never reported.”
These predators connect to kids who play games like Minecraft, Fortnite, and any game that has a chat function, slowly “grooming” their victims (“grooming” is such a creepy word—which is fitting— and refers to a perpetrator working to gain a child’s trust with the intent of doing sex related crimes).
Things to know:
This kind of extortion happens with many games. A Seattle man was convicted for posing as a teen and getting explicit photos from boys via Minecraft and League of Legends.
The NYT article reports how Roblox, a game for small children, allows players to chat with others. Youth are socializing online through the chat functions on the games themselves but also on third-party chat sites like Discord and Omegle (whose tagline is Talk to Strangers), where interacting with strangers is the norm. Discord is a chat feature with text, video, and voice chat to meet up “live” while gaming. Once predators establish a “trusted-relationship” in an open space chat room, they will try to move these interactions to private conversations on platforms like Kik and Facebook Messenger.
As parents, teachers, and counselors, let’s be proactive by having conversations about warning signs and red flag behaviors before our youth get targeted. It is critical to consider how we can engage our kids in productive conversations, without making them too anxious and without coming off as too anxious ourselves.
Here are a few questions to get the conversation started:
Recent world events are causing a lot of anxiety – particularly with children and young adults. Screenagers posted an informative article, featured below, about how to determine what action should be taken in regards to anxiety.
If you have a loved one struggling with anxiety, please contact Tamara Ancona, MA, LPC at (678) 297-0708 for an evaluation, and to discuss the best treatment options available.
Anxious feelings are understandably very high right now in youth given COVID-19. My daughter is a senior in high school and gets waves of many emotions right now–such as anxious feelings related to deciding on a college or sad feelings thinking about all the things she will miss from not being able to go back to her school. All kids have stories right now of things they are fearing, regretting, missing out on, obsessing over, and much more.
As a physician, I thought it would be helpful to give insight into the difference between anxious feelings vs. clinical anxiety, and then to provide examples of skills and resources.
I have been talking with psychiatrists and psychologists who are finding that many teens who were experiencing a lot of anxious feelings related to things at school are doing overall emotionally better with school out. Yet they do talk about how this can change for them at any time, particularly as the days like this continue.
Traditionally schools in our country do not teach about mental health challenges and skills. Fortunately, that is changing, as seen in Screenagers NEXT CHAPTER.
No matter what has been taught at school, there is still so much that can be discussed with our kids now that will help them when they face anxious feelings and will help them in helping their friends and others. In surveys, teens report that they are more likely to tell a peer about hard emotions than adults. I say this only to point out that helping our youth gain skills can be a real asset to be able to help others in their lives, be it now or be it years from now.
We often use the word “stressed” in our society, which can mean many different things to the person saying it, such as feeling that something in their life is out of control, or they feel overburdened, or irritated, or many other things.
In the same way, when a person says they are feeling “anxious”, it can mean many different things—similar to the word “stressed.” This is where the skill of stopping to think about the core emotions behind these words is a great one to hone. Understanding leads to the most effective interventions.
It can be helpful when thinking about anxious feelings to know that often the anxious feelings are actually fear. Fear of an uncertain future, fear that you did the wrong thing (regret is a type of anxiousness), fear of what will happen if you ask someone if they want to video chat, and then the fear of how that person will perceive you.
In Washington State, there is a survey of high schoolers every two years. Here are the 2018 results regarding anxious feelings for teens in King County– where the city I live, Seattle, is located:
58% reported that they at least sometimes “felt nervous or anxious in the past two weeks.”
46% reported that at least sometimes, they were “unable to stop or control worrying in the past two weeks.”
69% felt nervous at least sometimes
59% were unable to stop or control worrying at least sometimes
Unfortunately, they only started asking these questions in 2018, so I cannot provide you with any data from past years.
There is an incredible dearth of data in this country to be able to effectively compare data about anxious feelings of youth over past years. Often people cite two surveys of college students.
For example, the American College Health Association surveys students from many colleges over many years. They have been asking if students “ever felt overwhelming anxiety in the past 12 months.” In 2011, roughly 50% reported yes, and in 2016 approximately 58% reported yes.
The other study of U.S. freshmen asked if they ever “felt overwhelmed.”
The numbers here come from the main comprehensive study on youth mental health, called the National Comorbidity study-Adolescent Supplement. When any book or scientific paper references rates of adolescent clinical anxiety, this is the paper to which they are referring.
(*Of note the numbers here were rounded to the nearest tenth.)
The prevalence of the main specific types of clinical anxiety
By Age 18…
…19% of youth will have met criteria for having had a specific anxiety phobia (such as towards spiders). These were ranked from mild to severe, and the majority met criteria for “mild.”)
….9% met criteria for social anxiety (the majority met criteria for “mild.”)
….5% will have met criteria for PTSD.
….8% will have met criteria for separation anxiety.
….2% will have met criteria for generalized anxiety (the majority met criteria for “severe.”)
…2% will have met criteria for a panic disorder (the majority met criteria for “severe.”)
…2% will have met criteria for agoraphobia (the majority met criteria for “severe.”)
Unfortunately, the data collected for this study was done in the early 2000s and published in 2010, and there has not been a follow-up study. I know this is shocking. I have spoken with the researchers, and they told me it had to do a lot with a lack of funding.
Diagnosing Clinical Anxiety
Some anxious feelings are to be expected and are even helpful. For example, anxiousness in anticipation of a test in a few days can help a person to study for a test.
When anxious feelings are often out of proportion for the situation, and the feeling does not fit the fact, this may indicate the possibility of clinical anxiety.
For example, these two scenarios would be cause for concern:
1. A teen worries all the time about tests. Long before it is even going to happen the student is so consumed by the fear. The teen loses sleep and has lots of intrusive thoughts about failing.
2. A youth experiences significant anxious feelings when they imagine talking to other people or raising their hands in class. This has resulted in them being extremely behind in school and not have any friends. While the student desperately wants to change, they can’t move past their anxious feelings.
As a physician, I assess anxiety in teens and adults in my clinic. I ask everyone who comes into the clinic at some point in the visit, “Are you experiencing any anxiety or depression?” The incidence of anxiety and depression is significantly higher in a medical setting than in the general population, so it is important that I ask about these things. And, so often, I see how relieved they are that I asked. When I see people in my clinic, and I have identified a concern about anxiety, the number one question I then ask is, “Are you avoiding things?” Their eyes light up and often respond, “How did you guess that?
The main questionnaire used in health settings to help diagnose clinical anxiety is called the GAD 7. I really recommend going over these questions with your kids or teens.
It starts with these questions:
2. If the teen answers yes to either, then the following questions are asked if they have these symptoms:
3. Then the third part assesses how distressing and/or debilitating the symptoms are and asks:
If you checked off any problems:
How difficult have these made it for you to do your work?
Take care of things at home, or get along with other people?
(Options are from “Not difficult at all” to “Extremely difficult”)
When symptoms are ongoing, there can be real suffering and can lead to avoidance of certain situations. So, while it is common for teens to feel a bit nervous about going up to talk with a peer, a more intense nervousness, would indicate a more severe problem. This might present by them starting to avoid most social interactions and becoming more isolated.
When anxious feelings lead to a lot of suffering, via constant worrying, and a lot of negative consequences, such as avoiding situations often, these are signs that anxiety is a clinical problem and should be addressed with professional help such as counselors or therapists.
Skills to Help with Anxiety
These skills can be helpful even for youth who do not have clinical anxiety but for whom anxious feelings are getting in the way of doing things they would like doing, such as having more friends, worrying less often, and so on.
Let’s start with a skill that can help with all types of anxious feelings—not just clinical anxiety.
In Screenagers NEXT CHAPTER psychologist and author Lynn Lyons describes a skill she calls the 3 Ex’s:
Exposure therapy (also referred to as exposure response prevention)
The goal of this therapy is to work towards no longer avoiding things that a person wishes they were not avoiding. It is about eventually doing the things the person is avoiding over and over, so they get used to the uncomfortable feelings and learn how to do actions despite anxious feelings. Meanwhile, the more the action is done, over time, the anxious feelings will go down to some degree.
This technique is done in graded steps. For example, a teen is too anxious to participate in class. They might not even be able to verbalize what they are afraid of, but they might be able to verbalize reasons, such as they are afraid people will judge them poorly, laugh at them and not want to associate with them.
Graded steps that might work for the student — and perhaps working with the teacher in the class to go through this:
1. Start by making time with a supportive teacher to practice outside of class to ask questions and to offer answers.
2. Making plans with a teacher before a class to have an answer ready, so when the teacher asks the question, the student will raise their hand and propose the answer.
3. Doing the same prep work to think of, and together, think of a question the student could ask in class. Then, the student is reassured that the teacher thinks this is a “good” question that is valid, reasonable.
4. Creating a goal of how many times in the class they will raise their hand regarding answering a question or asking a question. For instance, picking four times a week and having an accountability plan with a reward/ treat when they accomplish the goal.
5. Finally, starting to raise their hand and participate more in another class where the student has not been working with the teacher.
This is challenging to do, but the good news is it has a high success rate. As the teen does these exposures, as they step into the discomfort of getting scaffolding and support, you can actually see changes in the brain scans of the amygdala. It is no longer as hyperactive as it was before to that stimuli.
In Screenagers NEXT CHAPTER, Olivia, who is 15, had clinical social anxiety, and her therapeutic exposure task was to go to a shopping mall and ask for sushi at a pizza place. She needed to practice being embarrassed. When you do something like this, it makes real-life situations that much more tolerable. I’m not saying we have to do that for everyone, but sometimes it’s just calling that friend you don’t like to call, you practice doing that. You just do baby steps.
Parents and teens need support to do this. Asking youth to face the fear and feel anxiety is so hard as a parent and, of course, for the youth to do—if it were not hard, they would have been able to stop.
For parents, finding other parents who are going through the same situation or have gone through it can be such a help–not only as a source of support but also as a way to find resources.
Getting counseling for one’s child or teen is key, and for parents to be a part of that counseling at times, it is also important when appropriate. In addition, parents usually benefit from things like their own counseling, support groups or parent coaching.
Building Brain Attention Skills with Mindfulness
In Screenagers NEXT CHAPTER, we learn that my college-age son, Chase uses the App, 10% Happier to learn mindfulness skills from George Mumford, an expert who has taught these skills to many athletes, including Michael Jordan.
In the film, I say:
“My son, Chase, also found an online tool that has really helped him. He’s had chronic pain from an accident years ago and lots of stress because of it. From his favorite online teacher he’s been learning mindfulness. It’s all about getting more insight into one’s patterns of thinking and learning to direct attention to more helpful thoughts.”
In the film, Chase talks about it in this way:
“There’s the sensation of pain, but then I add the stress of being in pain and the emotional baggage of the history of the pain and the uncertainty of the future of the pain. And I recognize that I actually have a lot more control over this than I thought. So in my day-to-day when I’m in physical or emotional pain, I can be mindful of the negative layers that are building up on top of it and intervene before they themselves cause unnecessary suffering.”
Here are some popular Apps that teach mindfulness
(Myself, my husband and my teens have used all of these at different times)
Dialectical Behavioral Therapy (DBT) has many useful skills for overcoming intense feelings, including anxiety. There are many websites with many skills.
The TIPP skill is one such example. If a person is suddenly overcome by anxiety or other strong emotions, doing one of these things changes a person’s physiology, which helps stop or lower the intense emotions.
T– Temperature–the person applies ice in a bag to their face for a minute or two. Many teens also talk about how useful it is to put their faces into an ice bath of water for a few seconds. I have known many teens who find this temperature skill very helpful.
I– Intense exercise–the person takes the energy of the emotions and does some quick jumping jacks or other quick exercises.
P-Paced breathing–the person slows their breathing-such as breathing in for breathing for 5 seconds in and then 7 seconds out.
P-Paired muscle relaxation-the person breaths in and tenses a body part at the same time, such as the arms–they pay attention to the feeling of the contractions and then when they breathe out they release the contraction.
Mental Health Organizations – Resources for Teens and Parents
The following are examples of mental health organizations
This organization has information on stress and many types of anxiety conditions as well as links to find help for children, teens, and adults.
The National Alliance on Mental Illness has local branches across the country and offers support groups, online resources, programs in schools, and more.
The site has many written materials and links to awareness campaigns. My Younger Self, for example, is 30 short interviews with actors, athletes, and other celebrities who discuss their past mental health challenges.
These are free day-long courses designed to help parents learn how to understand youth mental health issues better and as a parent, things to do. On the website, you can find if there are classes near you.
This organization has affiliates across the country. The website has links to information, and they also do important work in working to increase mental health access, locally and nationally. This page on their website is helpful for the nuts and bolts of finding mental health support.
The international emotional intelligence network researches and shares tools, methods, and training to create a kinder, more positive world.
Born This Way Foundation – Started by Lady Gaga and her mother, the organization works to build a “braver, kinder world” for youth by creating safe-spaces and promoting self-care skills.
Psychology Today (link to https://www.psychologytoday.com/)
This site is very well respected as a way to find a therapist, psychiatrist, or support group in one’s area. One puts in their zip code, and any indicators, such as “adolescent” and it will list many possible providers. Then the provider can be contacted, and a short call can be set up to see if there will be a good fit.
Crisis Text Line is free, 24/7 support for those in crisis. Text 741741 from anywhere in the US to text with a trained Crisis Counselor. Crisis Text Line trains volunteers to support people in crisis. This organization is a resource that many youth and adults report using and feeling helped. People who volunteer for CT receive 30 hours of training before they start, and they volunteer several hours a month.
My good friend is a volunteer, and we spent an afternoon together, where she showed me how their training works and examples of the work she does with people. It was powerful. A person can text about anything they are struggling with, and the volunteers are there and provide supportive interactions. Even though it is called Crisis Text, the texter does not have to have an imminent crisis; they get all sorts of people seeking support for things like eating issues, problems with peers, and just people dealing with hard emotions.
National Suicide Prevention Lifeline Call 1-800-273-8255
7 Cups – Connects you to caring listeners for free emotional support
Better Help – This is a fee-based service that provides online therapy via Skype and text
Boys Town National Hotline 1-800-448-3000. 24-hour, free, confidential hotline staffed by trained counselors for boys and girls to receive help with bullying, anger, abuse, depression, school issues, and more.
211.org is a free and confidential national hotline that connects callers with resources and support in their area.
Ideas for conversation starters with youth in your life:
Children and Screens cordially invites you, your friends and your network to join our series of three virtual workshops for parents featuring leading interdisciplinary experts on the topic of “Children and Screens During COVID-19” via Zoom. Parents can register through our website www.childrenandscreens.com. Hear from the country’s leading pediatricians, child psychiatrists, child psychologists, neuroscientists, educators, and parenting experts to learn:
The “Ask the Experts” series will focus on different developmental age groups, beginning with young children on April 28th at 12:00-1:30 EDT, moderated by Dimitri Christakis, pediatrician and editor in chief of the leading medical/science journal JAMA Pediatrics. Other panelists include:
The second workshop for school-aged children (K-8) will take place on May 6th at 12:00-1:30 EDT, moderated by pediatrician Colleen Kraft, the immediate past president of the American Academy of Pediatrics. Experts include:
The final workshop on Adolescence is scheduled for May 12 from 12:00-1:30 EDT, moderated by child and adolescent psychiatrist Paul Weigle, chairman of the media committee of the American Academy of Child and Adolescent Psychiatrists. Speakers include:
While we all learn to cope with living a digital life during this pandemic it brings up questions about the effects all the screen time will have on us and our futures. Screenagers explores the this in the article below:
Understandably most young people are on screens a ton right now. Thank goodness there are all sorts of great things made possible via screen time.
But, what are the potential costs of loads of certain screen time activities on their brain health and mood? Are there ways to do changes in tech time that might help them feel better — even while keeping the same total amount of screen time?
Clifford Sussman, MD, is a psychiatrist for children and adolescents in Washington, DC, and he is well known for his work in treating those with problematic internet and video game use. He and I have presented together at the American Academy of Child and Adolescent Psychiatry Conference and have shared ideas over the years.
Sussman and I were talking last week and I realized now would be a good time to share with you the brain model and action steps that he often teaches his clients. No matter if you put his suggestions into practice, this is a great science topic to discuss with youth in your life.
Sussman talks about “digital binging” — many hours on end, without any real breaks doing things such as video games, social media, youtube, shows, etc. This leads to what he calls the “residual effect” on the brain with prolonged use of such activities.
The residual effect of the brain is caused by changes in the physiology of the brain.
The brain has a reward center called the Nucleus Accumbens, where dopamine is the chemical released by one neuron to signal the adjacent neuron. We can call the first neuron “Neuron A” and the second one, “Neuron B.” Neuron A will secrete dopamine in the small space between itself and Neuron B. Neuron B has specific receptors for dopamine. When dopamine attaches to the receptors, it causes feelings of pleasure and reward. Dopamine is what causes chocolate to taste good, etc.
In instant gratification activities, such as social media, TV shows, and video games, dopamine is secreted non-stop. With ongoing dopamine release, the receiving neuron will eventually decrease its number of receptors for dopamine. This is because the body is always working to stay in homeostasis (balance).
If your brain gets bombarded continuously by dopamine, you start to develop a tolerance to it — meaning the intensity of good feelings decreases. The dopamine receptors have lessened, so even though there is dopamine present, the receiving neuron doesn’t fire off much of a signal because the receptors to the dopamine are less.
Sussman says that this can lead to a higher sense of boredom. Boredom is not a pleasant state.
When the person stops doing social media or playing video games after several hours, they may feel cranky or just not very happy. They may think it is only because they want to be on screens more, but part of these lower feelings can be due to having fewer dopamine receptors.
Non-screen activities may just not be that appealing because the receptors are less (downgraded) so things, like reading a book or being with family, might not be as enjoyable as could be.
The person may not be consciously aware of any lower feelings from normal daily activities, but they are experiencing this state.
Solutions Dr. Sussman Suggests:
Know this key point
With time off of screens the dopamine receptors start to regenerate themselves. This is why Sussman does a lot of work with his clients to get them to take many breaks between engaging screen time activities to let the brain receptors get back to equilibrium.
Change the conversation
Rather than parents talking about activities as “work vs. play,” consider talking about activities as high dopamine and low dopamine activities. High dopamine activities are ones where there is a constant, high flow of dopamine, such as video games, web surfing, and watching shows. Low dopamine activities are ones with delayed gratification — they can be enjoyable, or can lead to a sense of well being by eventually achieving things like completing a homework assignment. Some examples include exercising or playing board games, which are still fun but have a slower pace. Another good example is baking, which is enjoyable, and then there is a short high from the reward of eating the baked good.
Alternate high and low dopamine activities
Dr. Sussmansays that the issue is not so much the total number of hours of high dopamine activities on screens, but instead, there need to be many breaks from those high dopamine activities so that dopamine receptors can return to more normal levels.
He suggests that for teens, only about one hour at a time of a high dopamine screen activity be done before taking a break. And for younger kids, it should be more like 30 minutes. And then whatever the time spent on a high dopamine activity should be followed by that same amount of time for low dopamine activity (on or off-screens — but ideally many times off screens). So if a teen girl played an hour of Fortnite, she would do a low dopamine activity for an hour before going back to do high dopamine screen activities. If a teen spends two hours on social media, they should then be off of high dopamine screen activities for two hours.
More concrete suggestions from Sussman:
Ideas for conversation starters:
If you have a loved one struggling with the effects of screen time, please contact Tamara Ancona, MA, LPC at (678) 297-0708 for an evaluation, and to discuss the best treatment options available.