Screen time and executive function skills
Battles over screen time are a big issue in many homes, particularly following the lockdowns associated with Covid-19. Children with ADHD, autism and other difficulties often have particular difficulties with regulating screen time. Screen time and gaming are a preferred activity for many children. Screens have an almost hypnotic effect on both children and adults. We lose sense of time as we zone out and tend not to think too much past the endless scroll or game.
Children tend to get in the zone and become hyper-focused when they are on a screen, receiving both constant dopamine hits and instant gratification with minimal effort. This effect is amplified if a child has poor executive function skills. Popular games such as Roblox and Fornite are designed to keep your child fixated as long as possible (similar to social media apps used by teenagers and adults).
National guidelines for screen time in Australia state that young people aged 5-17 years should spend 2 hours or less a day on screens (not including school work). Many parents are worried that their kids spend too much time on screens (Royal Children’s Hospital National Child Health Poll, 2021). Even pre-Covid-19, 80% of Australian 16-year-olds were exceeding the recommended <2 hours of screen time per day (Houghton et al., 2015). An analysis of screen time and mental health among Australian youth reports high levels of internet use and gaming, with 3.9 % of young people reporting problem behaviour. The proportion of girls with very high levels of psychological distress and behavioural difficulties was (42%), which was twice that of boys (19%) (Rikkers et al., 2016).
Recent statistics show that only 15% of 5–12-year-olds meet recommended guidelines for screen time (Hinkley et al., 2020; Howie et al., 2020). Furthermore - only 23% of Australian families with multiple children adhere to screen time recommendations. In many cases, toddlers are having as much screen time as their siblings (Tooth et al., 2022). Time spent on screens increases in late childhood (ages 10-14). Girls tend to gravitate toward social network platforms and boys towards gaming (Thomas et al., 2020).
Excessive screen time has been associated with anxiety, behavioural problems, hyperactivity, and difficulty with attention (Stiglic & Viner, 2019). Young mice have been used to assess the effects of screen time on the developing brain. Researchers took baby mice and provided them with constant stimulation for a month by playing them music from cartoons such as “Pokémon” and showing them flashing lights designed to capture their attention. After a month of “screen time” the overstimulated mice showed marked deficits in their ability to pay attention to new objects and to remember things (Christakis et al., 2018). I do not think that screen time “causes” ADHD. While there is a correlation between screen time use and neurodevelopmental disorders, I interpret this as being due to these kids having lagging executive function skills, a propensity to hyperfocus, an inability to feel time and a high sensitivity to the constant dopamine hits provided by screens (there may also be more complex issues such as social skills and language at play).
So why are screens so addictive? The answer applies to both adults and kids. The content delivered via social media and gaming platforms is designed to keep us wanting more, and more and more … The invention of the never-ending scroll keeps us online for far longer than when we used to have to click from page to page. Much of the content we see is boring or (boring) advertising. Just often enough we see something interesting that keeps us clicking. The delivery of rewards at irregular intervals is termed “intermittent” reinforcement. The power of providing rewards on an intermittent schedule has been studied by psychologists for decades (often using rats or dogs). Sophisticated gaming and social media platforms use this technique to keep adults and kids mindlessly scrolling, gaming or viewing for longer. We also lose sense of time when we are on a device. One of the biggest dilemmas with kids who struggle with executive function skills is that they struggle to conceptualise time making it even more difficult to manage screen time. This has been termed “time blindness”. I cover this in detail in a separate blog - see Time blindness. To manage screen time, we need high-level executive function skills. The frontal lobes (in charge of high-level executive functions) do not fully develop until age 25. Many adults also battle with the pull of a screen or an alert on their phone. Some families chose to completely ban screens. However, screens are a part of life and we can use screen time management as a way to help kids develop executive function skills such as planning, organisation, impulse control, and emotional regulation.
Additionally, not all screen time is bad. I love that my kids can go to Google and find out how many rhinos are left in the world, or whether a worm is an amphibian etc. There is also some evidence (albeit contentious) that certain strategic games can be useful to help boost working memory and spatial skills. Kids do have a fair amount of insight and are very aware that screens can be addictive (although, this insight flies out the window at the time they are actually on a device or gaming).
I have previously worked with kids with visual dysfunctions. When I started in 2015, I rarely treated kids for eye strain or a condition termed “convergence excess’ (a tendency for the eyes to aim more inwardly than necessary). Roll on 2021 and it was the most common issue walking in the door. And it was hard. Kids with double vision or poor peripheral vision due to excess screen time are almost impossible to treat when they go home and spend 12 hours in a dark room gaming.
Screen time has a very powerful effect on the visual system. Vision is our dominant sense and screens provide an abundance of visual stimulation. When we direct our vision onto a screen, our focus zooms in to attend to bright lights, fast movement and colour. Our body does not move at the same time as the movement we see on the screen. This means that our vestibular system is effectively put on pause. The only exception I have seen is watching kids play Mario Kart on the big screen. You can see them sway in time as they drive through the course. However, for the most part, when kids are gaming or watching a screen, their brain and visual system are processing information at high speed, while in contrast their body is still.
The visual system of young children is still developing which is why they are so prone to the negative effects of screens. Young children have a small degree of what is called “hyperopia reserve”. In kids, the eyeballs are small and the eye axis is short. As a child views an image it falls just behind the retina. As the child grows, the eye axis gradually becomes longer and the early hyperopia (far-sightedness) disappears. Myopia develops if we fail to control the length of the eye axis as a child grows. The hyperopia reserve is the first buffer against myopia. The biggest way this buffer is broken down is by excessive use of screens and decreased outdoor time. One of the best ways to prevent myopia in children is to spend two hours a day outside (more “green time”, less screen time). The term “quarantine myopia” was coined by optometrists to describe the significant increase in childhood myopia (short-sightedness, blurred-distance vision) during the pandemic.
The effects of COVID-19 lockdowns and associated home learning and increased screen time have dramatically increased the prevalence of myopia. A study that followed 123,535 children over time found that the prevalence of myopia in 2020 was at an all-time high (Wang et al., 2021). The same trend has occurred in Australia. Optometry chief clinical officer Luke Arundel has reported that more children have needed glasses at an earlier age than before the pandemic. This has been more noticeable in Victoria and NSW which experienced longer lockdowns.
If screens can change the development of the visual system, it is also likely that they can change the developing brain. Recent studies have found just that. An MRI study of 47 children aged 3-5 years found that increased screen time was associated with lower measures of microstructural organization and myelination of brain white matter tracts that underlie language development and executive functions. (Hutton et al., 2019). The most concerning results have come from an ongoing NIH study in the US. The study found that pre-teens who were spending over 7 hours a day on screens were found to have a thinning of the cortex. Cognitive skills such as executive functions were also negatively impacted by excessive screen time (Paulus et al., 2019).
Getting off a screen is not an easy task for many children. When you combine time blindness, hyperfocus, a bored kid, and the constant dopamine hits that are provided by a screen - you have the perfect storm! This is particularly true when they must get off a screen to begin a non-preferred task such as homework or a mundane chore.
Picture this
“Device down, it is time for school”
“Device down, it is time for bed” …
-> MELTDOWN!
Many kids become very emotional when required to get off screens and may fly into a rage, become completely oppositional or have a complete meltdown. Dr Kristy Goodwin has termed this “the 'techno tantrum'.
However, there are a few things that we can do to make things a little easier:
Get kids involved in deciding what times will be best for them to have screen time and how long they will be on for (kids can be surprisingly reasonable).
Negotiate screen time before your child gets online. Rules need to be clear and consistent. Difficulties arise when rules are re-negotiable once a child is already online (my 8-year-old has incredibly high-level, non-relenting negotiation skills).
Set consistent screen-free times in the home. For example, dinner and after dinner.
Balance screen time with “green time” and get outdoors as much as possible. Exercise and outdoor time provide a healthy dopamine hit.
Help your child become more aware of “time”. Do they know what half an hour of screen time feels like? Use a REAL clock to manage screen time. This may be very 1990s, however, kids are far better able to conceptualise time using an analog (large visual) clock than a digital watch.
Give a 5–10-minute reminder before your child is required to put the screen down. Where possible, try not to transition from screen time straight to a task at that your child is likely to resist (e.g., homework or bed).
Get non-preferred tasks done before time on a screen. My kids will vacuum, mop, wash windows, tidy rooms, and complete pretty much any chore before screen time. It seems that post-screen time they have lost the complete ability to perform pretty much any of these tasks.
Model appropriate screen time. There is a strong association between the time parents spend on a screen and the time a child spends online (Rhodes, 2017). As parents, we often need to manage and limit our own screen time.
Play with your kids from time to time. Be aware of what they are doing online and who they talking to. Watch the occasional YouTube video with them.
Age restrictions are there for a reason. Avoid apps and games aimed at 13 or 18-year-olds if you have a 10-year-old. If you have a neurodivergent child, remember that they may be lagging in their executive function skills by 3-5 years. This should be taken into account when choosing age-appropriate games.
To protect vision, prioritise gaming on the big screen (TV). Platforms such as Nintendo Switch and Sony PlayStation can be played on the big screen meaning your child can keep an appropriate distance from the screen (better for vision).
Have safety discussions about the online world with your child. Be aware of whom they are communicating with.
Avoid giving a phone, which provides constant access to a screen for as long as possible.
Send your kids outside to jump on the trampoline (or do 20-star jumps) after they game.
Avoid the stimulating effects of screens an hour before bed if you want a good night's sleep.
Involving your children in screen time management and limits is a great way to practice executive function skills. Planning, prioritisation, time management, impulse control, cognitive flexibility, problem-solving, emotional regulation …
Good luck!!
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References
Christakis, D.A., Benedikt Ramirez, J.S., Ferguson, S.M., et al. (2018). How early media exposure may affect cognitive function: A review of results from observations in humans and experiments in mice. PNAS, 115(40), 9851-9858.
Hutton, J.S., Dudley, J., & Horowitz-Kraus, T. et al. (2019). Associations Between Screen-Based Media Use and Brain White Matter Integrity in Preschool-Aged Children. JAMA Paediatrics, 174(1), 1-10. doi:10.1001/jamapediatrics.2019.3869.
Goodwin, K. (2016), Raising Your Child in a Digital World: Finding a Healthy Balance of Time Online Without Techno Tantrums and Conflict. Griffin Press NS.
Hinkley, T., Timperio, A., Watson, A., et al. (2020). Prospective associations with physiological, psychosocial and educational outcomes of meeting Australian 24-Hour Movement Guidelines for the Early Years. International Journal of Behavioral Nutrition and Physical Activity, 17(1), 17-36.
Howie, E. K., Joosten, J., Harris, C. J. et al. (2020). Associations between meeting sleep, physical activity or screen time behaviour guidelines and academic performance in Australian school children. BMC Public Health, 20(1), 1-10.
Houghton, S., Hunter, S.C., Rosenberg, M., et al. (2015). Virtually impossible: limiting Australian children and adolescents daily screen-based media use. BMC Public Health, 15(5), 1-11.
Paulus, M.P., Squeglia, L.M., Bagot, K. et al. (2019). Screen Media Activity and Brain Structure in Youth: Evidence for Diverse Structural Correlation Networks from the ABCD Study. Neuroimage, 15(185), 140-143.
Rhodes, A. (2017). Screen time and kids: What’s happening in our homes. Detailed report. Melbourne: The Royal Children’s Hospital Melbourne. Retrieved from rchpoll.org.au/wp-content/uploads/2017/06/ACHP-Poll7_Detailed-Report-June21.pdf.
Rikkers, W., Lawrence, D., Hafekost, J. et al. (2016). Internet use and electronic gaming by children and adolescents with emotional and behavioural problems in Australia – results from the second Child and Adolescent Survey of Mental Health and Wellbeing, 16(399), DOI 10.1186/s12889-016-3058-1.
Stiglic, N., & Viner, R. M. (2019). Effects of screentime on the health and well-being of children and adolescents: A systematic review of reviews. BMJ Open, 9(1), e023191. doi: 10.1136/bmjopen-2018-023191.
The Royal Children's Hospital National Child Health Poll. (2021). Top 10 child health problems: What Australian parents think. Poll Number 20. Melbourne: The Royal Children's Hospital.
Thomas, G., Bennie, J. A., De Cocker, K., et al. (2020). Screen-based behaviors in Australian adolescents: Longitudinal trends from a 4-year follow-up study. Preventive Medicine, 141, 106258. doi:10.1016/j.ypmed.2020.106258.
Tooth, L.R., Moss, K.M., & Mishra, G.D. (2022). Adherence to screen time guidelines among families in Australia with children of different ages. JAMA Pediatrics;176(5):517-519. doi:10.1001/jamapediatrics.2021.6382.
Wang, J., Li, Y., Musch, D.C., et al., (2021). Progression of Myopia in School-Aged Children After COVID-19 Home Confinement. JAMA Ophthalmology, 1;139(3):293-300.