How Screen Time & Social Media Affect Children and Adolescents

Digital devices are integral to daily life in the 21st Century. Some people can barely put them down even when doing something they enjoy. In 2023, an estimated 4.9 billion people worldwide will use social media (Weir, 2023). While being connected can help people stay informed, teach new things, and help build and maintain a sense of community, it can also be detrimental to mental and physical health by interfering with sleep, creativity, and social skill development.

Children growing up with technology are referred to as “Digital Natives”(Muppalla et al., 2023), having been born into an age where technology has integrated into nearly every aspect of their lives and are particularly vulnerable to social media’s charms (Weir, 2023). Electronic devices have revolutionized our way of living, our way of learning, and our way of socializing. While the World Health Organization (WHO) (WHO, 2019) recommends only one hour of screen time per day for children ages 2 to 5 years, the global prevalence of excessive screen time among children ranges between 65 and 75 percent of any given day (McArthur et al., 2022). Adolescents, defined as children between the ages 13 and 17 (Vidal et al., 2020), use at least one of the following seven online platforms: YouTube (86% of adolescents), Instagram (72%), Snapchat (69%), Facebook (51%), Twitter (32%), Tumblr (9%) or Reddit (7%) (Anderson & Jiang, 2018).

This course will discuss screen time, which includes any content on any technology platform with a screen, and the mental, physical, and social impact on patients. The course will also provide interventions to mitigate any adverse consequences of social media use.

Emily is a 15-year-old female who lives with her biological parents and two younger siblings in a home outside of town. Her parents are both working professionals and lead busy lives. Emily is a sophomore in high school but does not participate in any school activities. She does not have a driver’s license and must rely on others for transportation. Over the past few months, Emily's grades have been dropping steadily, and she seems increasingly withdrawn and irritable. She often complains of headaches and difficulty sleeping. Emily's parents approached the school counselor with concerns about her declining academic performance and noticeable changes in her behavior. During sessions with the school counselor, Emily displays symptoms consistent with depression and anxiety. She expresses loneliness and inadequacy, comparing herself unfavorably to her peers based on the carefully curated images and posts she sees on social media. Emily's self-esteem has plummeted, and she struggles to find joy in activities she once enjoyed.

The most significant benefit of using technology for learning appears to be motivation; when lessons and learning activities are integrated into tablets or other devices, kids become excited, active learners. Technology-based apps and programs are also reported to support individualized learning. This access is due to their ability to support multiple levels and styles of learning and allow students to work at their own pace. Personalized apps can track if a child is struggling with a specific topic and provide extra support where it is needed. Alternatively, students can move to more advanced topics when they excel in a particular area. Using technology at the elementary school level helps students learn the basic skills required to operate the newest devices and latest software. It also helps them collaboratively and cooperatively with their peers with research and problem-solving.

Social media is an integral part of everyday life in the United States, and it is used for socializing, work- and business-related interactions, and even dating. This allows for global interactions that can impact not just personal lives but career opportunities. Dixon (2023) states, “As of 2022, the United States had the third-largest social media audience worldwide, after China and India. The United States is home to over 302 million social media users at a social networking penetration rate of over 91 percent.”  Despite this widespread usage, little is known about the relationship between screen time and its impact on social development (Ma, Li & Chen, 2024).

As recently as 1970, urban children spent most of their recreation time outdoors, playing anywhere they could go, on sidewalks, streets, playgrounds, parks, greenways, vacant lots, and any other available spaces. Suburban children did the same and spent time in the fields, forests, streams, and yards. Today, nature-based activities have been replaced with video games, PlayStations, and television shows, resulting in children and adults spending less time outdoors.

Action figures, puzzles, and board games are no longer considered the favorite toys of today's children; touch screens have taken over. Even though humans derive many benefits from nature, our lifestyles today are disconnected from the natural environment. Researchers estimate that today, humans spend up to 90 percent of their lives indoors, missing out on the beneficial effects of nature. Because we do not spend time outdoors, we are less connected to nature and feel less responsible for protecting or preserving our environment.

Children need nature; they need to touch it, hear it, and taste it. They need sensory experiences like playing in fresh-cut grass, walking in soft mud, or experiencing a caterpillar wiggling on its finger. These are the types of sensory experiences many occupational therapists integrate into a child's treatment plan. Could the lack of time spent in nature contribute to sensory processing and modulation difficulties? Nature brings our senses alive; scientists recently discovered that humans could track by scent—some humans rival bats in echolocation or biosonar abilities (Teng & Whitney, 2011).

Mounting evidence supports that spending time in nature protects against a startling range of diseases, including conditions such as depression, mood disorders, schizophrenia, eating disorders, and substance use disorders (Weir, 2020), as well as cardiovascular disease and cancer, to name a few.Time spent in and around tree-lined streets, gardens, parks, forests, and agricultural areas has consistently been linked to long-term health outcomes. The less green an individual's surroundings are, the higher their risk of morbidity and mortality, even when controlling for socioeconomic status and other possible confounding variables(Weir, 2020). Even the sounds of nature, including crickets, chirping, and the cadence of crashing waves, have been linked to improvements in cognitive performance (Van Hedger et al., 2019).

Participation in various outdoor activities can help strengthen children's social relationships, mental and physical health, creativity, and conservation orientations. An individual's outdoor time, particularly during childhood, can foster a connection to nature, yielding other benefits. Studies suggest that nature's "connectedness" or "relatedness" contributes to positive emotions, happiness, and subjective well-being. Screen time may be a key factor linked to declines in outdoor time and time connecting to nature, even in rural populations, and it has been reported that as children age, the problem intensifies(Weir, 2020).

Human beings are very social creatures that require human interaction and companionship to fully develop into healthy individuals who can contribute to society and maintain independence. Social connections allow humans to share experiences, relieve stress, connect, and bond. However, when these social connections occur over media instead of face-to-face, the outcomes are not always positive and can have dire consequences. The quality and quantity of social interactions directly impact mental health, physical health, behavior, and mortality risk.

Research has shown that excessive screen time and multi-tasking worsen executive functioning and academic performance (Muppalla et al., 2023). Although social media and technology have tremendous potential to impact education and learning, ongoing research indicates that multi-tasking notably decreases the ability to manage the capacity to switch tasks effectively, lowers inhibition, and negatively impacts working memory (Muppalla et al., 2023). Studies show increased screen time is negatively associated with language development (Sundqvist et al., 2023). If a child has early and persistent exposure to violent content, research shows that the child has an increased risk of engaging in antisocial behaviors, decreased social coping skills, and increased craving behaviors associated with substance dependence (Kerai et al., 2022).

The World Health Organization has estimated that 280 million people (or 3.8 percent of the global population) suffer from symptoms of depression (WHO, 2023). The development of the prefrontal cortex, the area of the brain responsible for executive functions such as planning, prioritizing, and making good decisions, occurs during adolescence (Azem et al., 2023; USDHHS, 2023). The adolescent brain constantly learns and adapts to new experiences (real or perceived) and situations. Because the adolescent brain is still developing, it is sensitive to various stressors that increase the risk of developing mental illness, such as anxiety and depression (WHO, 2022). Ongoing wiring of the neurons of the brain, along with physical, emotional, and social changes that occur during adolescence, increases the risk for mental health illness and may explain why many diseases such as schizophrenia, anxiety, depression, bipolar disorder, and eating disorders flower during this time(USDHHS, 2023).

The potential risks of social media are especially acute during puberty as children experience an onslaught of biological, psychological, and social changes while simultaneously experiencing social media’s impact. The developing brain is constantly building neuronal connections while trimming less-used ones away. Digital device use overwhelmingly provides “impoverished” stimulation compared to face-to-face interactions (Ruder, 2019). Seductive digital pursuits that provide immediate gratification activate the brain’s dopamine reward system, potentiating a level of addiction in developing brains. Current research on how youth float between online and offline milieus is being done in partnership with the nonprofit Sesame Workshop. The Growing Up Digital (GUD) study, studying 3000 to 5,000 youths over ten years, monitors screen time's impact on physical, mental, and social well-being (Ruder, 2019). Children older than eight and adolescents in the United States spend an average of 2 or more hours per day watching television and at least six hours per day with all media types (e.g., movies, videos, social media, etc.) (Sege, 2024).

A lack of adequate or quality sleep can contribute to chronic mental and physical conditions(Steffey et al., 2023). The body cycles through two phases of sleep: 1) Rapid eye movement (REM) and 2) non-rapid eye movement (NREM) sleep (Patel et al., 2024), which is then further divided into three other stages of sleep. The body normally cycles through all stages at least four to six times, averaging 90 minutes for each cycle (Patel et al., 2024).

According to Silvani, Werder, and Perret (2022), blue light from electronic devices suppresses the secretion of the hormone melatonin, whose primary function is to regulate circadian rhythm; thus, sleep quality and duration are negatively impacted, which, in turn, negatively affects cognitive and physical performance. Neuronal maintenance is conducted during sleep, and since sleep is the longest in developing brains, getting adequate and quality sleep is pivotal to healthy brain maturation (Fontanellaz-Castiglione, Markovic, & Tarokh, 2020). When sleep is disrupted by electronic devices, mental and physical states deteriorate. If sleep is chronically disrupted, there is a marked increased risk for mental and physical decline(Fontanellaz-Castiglione, Markovic, & Tarokh, 2020).

Depression is defined as a mood state marked by despair, feelings of emptiness, discouragement, or hopelessness (Krishnan, 2024). Research supports that early exposure to traumatic events (either witnessed or self-experienced) predisposes children to unipolar major depression by altering their sensitivity to stress and response to negative stimuli within their milieu(Krishnan, 2024). There has been a significant increase in adolescent depression and suicidal behavior over the last twenty years that coincides with the rise of social media (Azem et al., 2023; Vidal et al., 2020), with depression rising from 8.7% to 11.3% in 2014 and a 47.5 % increase in suicide rates during that same time.

The American Psychological Association issued its first-ever social media health advisory in 2023 after President Biden discussed shuttering the Chinese-owned social media platform TikTok (Weir, 2023). The advisory was an attempt to balance the use of social media instead of demonizing it altogether. Although research does show that more than 3 hours per day on social media does increase the risks for depression and anxiety (Robinson & Smith, 2024), online social interaction can promote healthy socialization among adolescents who are experiencing social isolation or stress and can be essential for marginalized groups of people such as LGBTQ+ people who are unable to or reluctant to engage during a crisis (Weir, 2023). Research shows that it is critical for people to know they are not alone in suicide prevention.

According to Sege (2024), “The average American child who spends two-thirds of his or her television time watching prime-time television programs and one-third watching cartoons views 10,000 to 12,000 violent acts per year.”This includes an average of 8,000 murders and 100,000 acts of violence by the time they finish grade school and twice that amount by the time they reach college age (Sege, 2024). Violent behaviors are normalized through exposure and become an integrated source of conflict resolution in place of patience, negotiation, or compromise. Studies support the association between viewing violence and violent behaviors through desensitization and imitation. Children learn how to behave by observation and imitation (Ybarra, Mitchell & Oppenheim, 2022).

Research supports a strong correlation between screen exposure and obesity (Muppalla et al., 2023; Skelton, 2024). “Currently, over 23% of adults and 80% of adolescents are not sufficiently physically active” (WHO, 2019). In the primary care setting, the focus is placed on educating patients on modifying behaviors that lead to excessive energy intake, such as eating while playing online, and insufficient energy expenditure, such as sitting down while on the computer, etc. (Skelton, 2024).

The post-pandemic revolution utilizing social media platforms as a form of education and the overreliance on technology have ongoing psychological effects on children. Iwamoto and Chun (2020) claim that approximately 3 billion individuals communicate via social media worldwide. Chen and Xiao emphasize that the use of social media can be both positive and negative and is, in fact, bi-directional. They state:

According to Fredrickson’s broaden-and-build theory of positive emotions (Fredrickson, 2001), the mental repertoires of learners can be built and broadened by how they feel. For instance, some external stimuli might provoke negative emotions such as anxiety and depression in learners. Having experienced these negative emotions, students might repeatedly check their messages on social media or get addicted to them. As a result, their cognitive repertoire and mental capacity might become limited, and they might lose concentration during the learning process. On the other hand, it should be noted that by feeling positive, learners might take full advantage of the affordances of social media and, thus, be able to follow their learning goals strategically. This point should be highlighted  that the link between the use of social media and affective states is bi-directional (Chen & Xiao, 2022).

Another study implemented a school-based program that included time spent outside and breaking up the duration of near-work tasks to control myopia. This study involved first-grade children in Taiwan. Students were encouraged to participate in 11 hours or more of outdoor time every seven days. Before the study, teachers, children, and parents received eye health education from ophthalmologists about myopia prevention using evidence-based medicine and were informed about the possible complications of myopia. During weekends, holidays, and summer, teachers were encouraged to assign homework that included outdoor activities. Parents were invited to bring their children to outdoor activities during out-of-school time. In class, after participating in near-work activities consisting of tasks such as reading, painting, writing, and screen time for 30 minutes, children were encouraged to take 10-minute breaks outside. The study went on for one year and was effective in retarding both myopia shift in non-myopic children and myopia progression in myopic children. Researchers announced that this was the first report revealing that outdoor activities could significantly inhibit progression in myopic children, with approximately a 30 percent reduction within one year (Wu et al., 2018).

The problem of media exposure and adverse consequences can be addressed at three levels: Family, Community Education, and Legislative and Regulatory approaches (Ybarra, Mitchell, & Oppenheim, 2022).

Under the guidance of the school counselor, Emily's parents take her to her family nurse practitioner for a full physical exam. Emily has been gaining weight and not exercising, but otherwise is physically healthy. The nurse practitioner provides Emily and her parents with information about the potential negative impacts of excessive social media use on mental health. They discuss strategies for setting healthy boundaries and reducing screen time. The nurse practitioner also recommends cognitive behavioral therapy (CBT) to address her depression and anxiety. Emily participates in CBT sessions aimed at challenging negative thought patterns and developing coping mechanisms for managing stress and anxiety. Based on social media comparisons, she learns to identify and challenge distorted perceptions of herself and her worth. Family therapy sessions are initiated to improve communication and strengthen familial support networks. Emily's parents learn to provide a supportive environment where she feels comfortable expressing her emotions and seeking help when needed. The school implements accommodations to support Emily academically, including extra time on assignments and access to tutoring services. The counselor collaborates with Emily's teachers to monitor her progress and provide additional support.

Over time, Emily begins to show signs of improvement. With the support of her family, school, and counselor, she gradually reduces her social media usage and develops healthier coping mechanisms for managing stress and anxiety. Her academic performance has improved, and she expresses greater self-confidence and well-being. Although challenges may arise, Emily and her support network have the tools and strategies to navigate them effectively.

In conclusion, caregivers, educators, and healthcare professionals need to grasp the potential risks of excessive screen time and work together to create strategies that promote healthy and safe use of technology while balancing alternative activities that encourage physical, social, and emotional skills.

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