Obsession or Addiction? Technology Use and What Parents Can Do

02:47 Moderated by Dr. Gaya J. Dowling, the director of the Adolescent Brain Cognitive Development Study (ABCD) at the National Institute on Drug Abuse, an international, interdisciplinary panel of researchers, clinicians and parent experts reviewed the current research into the effects of digital technology on developing brains, the symptoms and impacts of technology addiction, and the ways parents can best help their children navigate these challenges.

7:08 Joining us from across the pond, Dr. Daria Kuss from Nottingham Trent University in the United Kingdom informed parents about what the science tells us about digital media use and young brains. Dr. Kuss delved into the prevalence of internet addiction and how digital media use may affect a person’s neurobiology, sharing her wealth of experience gained from working at the first and largest treatment center in Europe. As the pandemic continues, developing brains may be especially at risk of the adverse impacts of technology use.

23:20 Bringing her insight from working with teens and young adults with severe internet addiction, Dr. Hilarie Cash, a co-founder of reSTART, the first long-stay residential treatment program in the United States or Canada for screen addiction, discussed how internet addiction presents itself. Dr. Cash informed parents about how to identify signs of addiction and problematic use in their children. After explaining various treatment options and how parents can help guide their children, she answered questions about how addiction is often linked to other psychological disorders such as depression or anxiety.

44:20 Finally, Dr. Lisa Strohman, a clinical psychologist, attorney, and author, outlined steps for how to resolve issues of unhealthy technology use before they become exacerbated. Dr. Strohman emphasized the importance of open communication about digital media use and parental awareness of their own engagement with media. To conclude, she shared simple tips for reducing screen time that everyone can follow, such as turning off autoplay and choosing one day of the week to be “screen-free.”

[Dr. Pamela Hurst-Della Pietra]: Welcome everyone to another Ask the Experts workshop. I am Dr. Pamela Hurst-Della Pietra, founder of Children and Screens: Institute of Digital Media and Child Development and host of the series. As many of you know, Children and Screens is one of the nation’s leading nonprofits that advances and supports science on the topic of digital media use and children and teens’ cognitive, psychosocial, emotional, behavioral, and physical well-being and development. Among other activities, we provide research grants, convene interdisciplinary experts, and curate articles and supplements in top scientific journals. In response to the devastating pandemic, we have brought together experts in the field to provide you and your family with the tools and resources you need to manage digital media use this summer. In addition, we are funding three outstanding research projects that will investigate the short and long-term impacts of digital media use during COVID-19. Thank you for joining us today for today’s conversation focusing on technology addiction, and thank you in advance to our incredible panelists. We know that problematic technology use and addiction are not always easy to talk about with your families, and we hope that the information will empower you to continue the hard work of parenting children and teens growing up in a digital world. Our panelists have reviewed the questions you submitted and will answer as many as they can. If you have additional questions during the workshop, please type them into the Q&A box at the bottom of your screen. We will answer as many questions as time permits. We are recording today’s workshop and hope to upload a YouTube video in the coming days. You’ll receive a link to our YouTube channel tomorrow, where you’ll find videos from our past webinars as well. It is now my great pleasure to introduce our moderator, Dr. Gaya Dowling. Dr. Dowling is the director of the Adolescent Brain and Cognitive Development (ABCD) Project at the National Institute of Drug Abuse, part of the National Institute of Health (NIH), which she will speak more about in a moment. Dr. Dowling earned a PhD in neurobiology from the University of California Davis. She has since worked across the NIH to provide scientifically-based information to parents and their family members, health professionals, researchers, policymakers, and other stakeholders to inform policy and promote the prevention and treatment of a wide variety of diseases. We are so delighted to have you with us today. Welcome, Gaya.

[Dr. Gaya Dowling]: Thank you, Pam, for that kind introduction and for inviting me to moderate this session. I’m really looking forward to it. So as Pam mentioned, I am with the National Institute on Drug Abuse, and so, you know, our focus is substance abuse, so why am I here? Aside from the fact that I’m a parent of teenage children? Well, a major focus for NIDA is addiction, which is defined as a chronic, relapsing disorder that is characterized by compulsive use, despite adverse consequences. And while NIDA’s focus on this definition is with respect to substances of abuse, I think it’s a useful definition to keep in mind for the discussion we will be having today as well. Another major focus for NIDA is adolescent development because we know that substance use often begins during this period. Adolescence is a time of extraordinary physical, emotional, and intellectual growth, and while risk-taking during adolescence is healthy, parts of the brain that control judgment and decision-making are not fully developed until people are in their mid-20s, which may limit a teen’s ability to accurately assess risks, which we know that they are confronting regularly during this period. And there’s so much we don’t know about all of these experiences, good and bad, and how they affect brain, social, emotional, and academic development. So NIDA, along with many other institutes at the NIH, have launched a study called the Adolescent Brain Cognitive Development study, as Pam mentioned. This is a longitudinal, long-term study of more than 10,000 children to look at the various factors that affect brain development and other functional trajectories. So I’m not going to go into a lot of detail about what ABCD is doing, other than to mention that we began the study in 2016 when the kids were 9 and 10, and we’ll be following these kids for 10 years to look at a number of different aspects of development, and there’s a list on this slide so you can see the breadth of information that we’re collecting, including brain imaging and mental health measures. But importantly for today’s discussion, we’re also collecting information on their mobile technology use, including how much time they spend, questions related to compulsive use, questions related to sleep, and the goal is to be able to combine that information with all of the other information to be able to understand what the impact is of this use during this period on brain development, social, emotional, and academic development, as well. Also as Pam mentioned, we are also collecting information related to what the experiences and the changes in experiences that kids are going through during the pandemic, particularly with respect to family situation, schooling, etc, to be able to look at how those unique impacts, and possibly long-term impacts, may affect development. So I encourage you, if you’re interested in learning more about the study, to visit ABCDstudy.org for more information. So with that, I would love to introduce to you our first speaker. We have a very exciting panel of experts today. We are going to begin with Dr. Daria Kuss. Dr. Kuss is a chartered psychologist, chartered scientist, and associate professor in psychology at Nottingham Trent University in the UK, and the program leader of the new MSC program in cyber-psychology. She has an international reputation as an Internet addiction expert and is an award-winning author on the topic. She will provide us with a brief overview of Internet addiction, including defining what it is, its prevalence among children and teens, and how we differentiate addiction from obsession or deep interest. Dr. Kuss. 

[Dr. Daria Kuss]: Well, thank you so much, Gaya, for your lovely introduction. I hope you can hear me and hope all the technology is working, so fingers crossed we’ll make it work. And hello from Nottingham, so I think I’m the only person calling in from Europe, and I’m really keen and glad that I’m here with all of you today. I’m really happy and looking forward to any kinds of questions as well, but what I’d like to start with is to provide you with some of the information that I’ve put together briefly in a few slides, so I will be sharing my screen. All right. So I’ve been researching Internet use and addiction for well over 10 years now, and I’ve always had an interest in understanding why people use technology across different age groups, and especially the kind of fascination that people have with gaming, social media, and the amount of time that they can spend. I was really interested in understanding, how is it possible that individuals can spend hours and hours on end using technology? Many, many years of research have led me to work with the first and largest research and treatment center in Europe, which is based in the beautiful city of Mainz, in Germany, where I was able to work with clients who have presented with problems, especially with their gaming. They tended to be young men in their 20s and 30s who had developed lots of problems because they were gaming a lot—really significant and negative impairment as a consequence of their gaming. And I’ve also seen other individuals who were experiencing problems as a consequence of other media use, other technology use: social media and online pornography, online shopping. But gaming in general tended to be the main problem, but I’m sure that Hilarie later on will be talking more to the clinical approaches here. Now, as part of the World Health Organization working group of addictive behaviors, what we tend to do is to come together every year in a group of us, international collaborators talking about research, as well as clinical experiences in the context of especially gaming, but also gambling and other addictive behaviors. And as you may be aware, this has led in the last few years to the World Health Organization deciding to include gaming disorder as an actual, official mental diagnosis in the International Classification of Diseases for the first time, basically meaning that this has given us the framework, as clinicians and researchers, to study the problem more effectively but also to provide treatment for those individuals who are actually suffering from that and really have a diagnosable entity that we can use in order to provide their treatment from, and this is really, really important. It has been a crucial development, and without the diagnosis, I think the field would still be developing at a much slower pace. Now, thinking about Internet addiction more generally, so Internet addiction encompassing different kinds of behaviors on the Internet, when we are having a look at the international research, what you can see here are different studies, and they would suggest that the prevalence rates vary considerably depending on the kinds of countries you’re looking at and also depending on the particular samples that you’re looking at. They vary as you can see here, ranging from 2.6 percent of adolescents in South Korea to 16 percent of adolescents in China, so really considerable differences. Here, as a comparison, you can see numbers for Europe ranging from 1% in Germany in the general population to 15.5% in Hungarian adolescents. I think that already gives us an indication that there must be some reasons for why there are indeed those prevalence estimates. Yes, on the one hand, they will be due to cross-cultural differences and differences in terms of engagement, but they will also be due to the kinds of measurements that we’re using in order to assess generalized Internet addiction and/or gaming addiction. There are so many different kinds of psychometric tools that measure different forms of Internet addiction, that it’s really difficult for us as researchers to make proper comparisons. The field is still young, a lot of work still needs to be done; we need more funding to do the research to be able to provide more accurate statistics—statistics that are comparable across studies, across different countries. That’s something that we need to bear in mind whenever we talk about prevalence: where is that prevalence estimate coming from? Now, from the UK context, and given that here in England, I can tell you that given that the WHO has now decided to include gaming disorder in the official diagnostic manual, the NHS, our national healthcare system, has decided to open up a new clinic, specialized treatment center for the first time, in the merit within the national healthcare system that offers children, especially, the opportunity to be treated for excessive gaming or their excessive Internet use and this is a monumental development for this country, for the healthcare services in this country, because those individuals who are experiencing problems can now indeed be treated by experts in the field. And this is a fantastic development, and as I say, Hilarie will be talking a little bit more about clinical implications, but for those of you interested in reading about the background information on the research on Internet addiction, gaming addiction, social media addiction, including some of the things that I’m talking about today, as well as specific approaches and tips that can be used, both for parents but also for clinicians in treating and looking after individuals who may have problems as a consequence of their Internet use, this may be problems that you yourself find you’re having with your technology use, I’d strongly recommend our book, Internet Addiction, co-written with my colleague, Holley Pontes, who is based in Australia, and I would recommend it to you because we’re giving specific tips and help for those individuals who may have problems. Another thing, the final thing that I’d like to address today, is the neurobiology of addiction. I know this has already been touched upon briefly by Gaya, so the kind of research that is being done. When we are looking at the research in the context of technology use, it is a very new field: there is little research available, but what we have in terms of research is that there is a strong relationship, in terms of the kinds of brain structures and brain functions involved in gaming addiction, Internet addiction, in comparison to substance-related addiction, so there seem to be lots of similarities, including the engagement of particular brain areas, as well as particular neurochemicals, as you can see here. The nucleus accumbens, which can be considered the pleasure center in the brain, is activated when we are engaging in online gaming or when we are receiving likes to our social media posts. What you can see here is that the addicted brain has a significantly lower function: there’s very, very little activity in comparison to a healthy brain, and that’s why the individual who may experience negative consequences because of the excessive gaming, the excessive Internet use, may have a lowered activity in a general way in comparison to an individual who doesn’t experience those kind of addiction-related problems. As a comparison, what I’ve got here are brands of individuals who engage in smoking, drinking alcohol, individuals who are obese, and individuals using cocaine—in comparison to individuals who do not engage in these kinds of activities, who do not take those kinds of substances, and what you can see here, with the warmer colors representing more activity, there is significantly less activity in those individuals who are having problems as a consequence of their behaviors. You find similarities as well, here, with individuals who are using the Internet, who are using gaming excessively as well. There is less activity in the brain. And in order to increase the levels of activity, in order to rebalance the brain, what they will do is to engage in technology use because technology use itself is experienced as particularly rewarding. And finally, I wanted to refer back to some of the research that has been done. The few studies, but a number of really important studies, in terms of the neurobiology of online gaming addiction. In this context, what we know is that the National Institute for Health Research is really, very strongly supporting the fact that mental disorders should be classified based on neuroscience and pathophysiology, so the ways in which diseases develop, rather than the typical approaches of clinical presentation or phenomenology, so how the symptoms are the experienced by the individuals. And that really gives us a very strong rationale for why we need neurobiology in order to understand these kinds of problems. We know, as I mentioned before, that there are significant similarities between substance-related addictions—the more classical, more traditional kinds of addictions—and gaming addiction, for example, on different kinds of levels. On the one hand, we’ve got the molecular level. As I’ve alluded to previously, there is a reward deficiency and decreased dopaminergic activity in the brain, meaning that individuals don’t find those things pleasurable, or individuals who are addicted to using technology don’t find the more normal activities pleasurable. Activities such as, you know, eating food, drinking water, and really engaging in sex, for example, is not as pleasurable as it would be. That’s why they’re seeking activities that are even more pleasurable, and those kinds of activities can be engaging in gaming, can be engaging in other forms of technology use. In addition to this, there are also similarities between substance-related addictions and Internet addictions in terms of the neural circuitry that is involved. So what we know from the research is that if individuals are to engage in excessive technology use over extended periods of time, over many months, over many years, we know that those brain areas that are associated with addictions become significantly more active, and they may change the function of the brain, and they may even change the structure of the brain. So the actual, physical structure of the brain can change as a consequence of Internet and gaming use. In order to illustrate this, maybe I can refer you to the study on London cab drivers, which I’m sure many of you will be familiar with, where the brains of those cab drivers have been assessed by researchers, and the researchers have found that the areas associated with memory, memory function, were significantly larger in those cab drivers, in comparison to control people—people who are not cab drivers. And it basically means that as a consequence of their job, as a consequence of navigating the complicated complex streets of London, their brains change. They’d literally, physically change, and similarly, the brains of individuals addicted either to substances or to behavior, such as Internet and technology use, can physically change as well, and there’s research evidence to support this. Finally, on a behavioral level, we also know that there are significant similarities between individuals who are addicted to using substances and individuals who are addicted to using technology. They have impaired cognitive functioning, they have impaired control over their impulses, for example. They may have impaired attention, and a range of other activities, a range of other kinds of functionalities. And, you know, I think when we’re this research, when we’re looking at this research evidence, it really goes to show that there appear to be striking similarities across any forms of addiction, even though we really need to bear in mind that it’s only a very small minority of excessive technology users who will ever develop addiction symptoms. And this is the point at which I would like to end my brief presentation, so if you’ve got any questions, I’ll be happy to take them.

[Dr. Gaya Dowling]: Wonderful. Thank you, Daria, that was a really nice overview, and particularly, coming from my background, the link that you made between the neurobiology of substance use and that of gaming addiction, I’ll take a little point of honor on the moderator side to just mention that the ABCD study is also looking at some of these long-term brain changes that may be associated with technology use, and there have been a couple of papers that have recently come out, one of which did kind of classify people into different groups based on the amount of technology use, and they are seeing differences in brain structure. But it’s a very complicated scenario, and I’m sure this is something you’re seeing too because there are so many different types of technology that may have different consequences on brain development that we’re interested in seeing, so it’ll be interesting to see, going forward, you know, some of those participants showed premature maturation of certain areas of the brain but not all. Because, like you said, it’s dependent on the amount of time that they are spending and what types of technology they’re using. So it’s a very interesting area moving forward. One question for you, though, you know, right now we are all experiencing lifestyle changes due to the COVID pandemic, and you had talked about prolonged exposure to gaming or substances and that impact on the brain. What do you think we may be expecting in the coming time, and what should parents be concerned about about this prolonged exposure during this sequestered period that we’re in, in terms of addiction to gaming or other technology, or even just problematic use?

[Dr. Daria Kuss]: I think this is a really valid question, really bearing in mind that most of us will be, it’s the status quo for all of us to use technology in the context of our work, how we socialize; it has become a way of living. I am sure I’m not the only one who’s spending most of my day on the Internet nowadays because there is no other way. So working remotely, of course, will lead us to spend more time on the Internet, but I think we really need to bear in mind that at the moment, what we find is that we have a time-bound increase in Internet use. A time period where, hopefully within the next few months, we’ll be going back to more normal lives, where our lives will probably be mediated less, where we’ll be using technology less. And one of the great things that I’ve seen and I’ve noticed in my research in the context of the current pandemic is really that individuals are so happy that they have the Internet because it allows them to connect socially, to have their entertainment, to be able to be connected to the world, especially if they’re vulnerable individuals who can’t leave the house, who cannot do their shopping anymore, who cannot go and see their friends anymore. And I think this is really important. At the same time, however, there will be the very small minority of users and those often gamers, for example, or users of social media, who may experience additional problems as a consequence of their technology use. But they will certainly be in the minority. 

[Dr. Gaya Dowling]: Wonderful, thank you very much. Our next speaker is Dr. Hilarie Cash. Dr. Cash is co-founder and Chief Clinical Officer of reSTART Life, a residential program designed for adults and adolescents who are experiencing addiction to the Internet and video games. She’s been working with families struggling with Internet addiction since the mid 90s and co-authored the book Video Games and Your Kids: How Parents Stay in Control. She will be providing information about what Internet addiction looks like clinically and red flags for parents to look for. Hilarie.

[Dr. Hilarie Cash]: Hi. I’m happy to be here, and thank you so much for inviting me to be part of this panel. So what I think is important is that Daria has sort of set the stage for understanding what addiction is, neurobiologically and so forth. What I want to talk to you about is how it is showing up in individuals who are—the way I refer to it as they’ve fallen off the cliff. I think there are a lot of teenagers who are next to the cliff and their behavior is starting to have some negative consequences. And the difference between the serious addict and the non-addict is that once parents are able to set the rules, which are going to be talked about later, once parents are able to start setting the rules, they’re able to pull their kids away from the edge of that cliff. But the kids who truly have fallen over the cliff and into a deep addiction, those are kids who are going to do absolutely everything they can to retain access to the screens because they are addicted to it, and in spite of the negative consequences that they are experiencing, they feel they absolutely need access. So, what are some of the negative consequences? And these are things that parents can be keeping their eyes out for as they’re worrying about their kids and wondering how serious the problem is. There are physical consequences. A common one with the clients we work with is sleep deprivation. They usually come to us very sleep-deprived, and the most extreme example of this was a young man who came to us who had been gaming heavily since he was 18 years old. When he came to reSTART, he was 26. In those years of heavy gaming, his sleep cycle had become so dysregulated that he had reached the point where he couldn’t sleep. And he was so severely sleep-deprived that he hallucinated during the day. He couldn’t concentrate, he couldn’t remember anything, he’d been to many sleep studies, and no one had bothered to ask him about his screen use, but that was actually at the base of it, and after six weeks away from all screens, he actually started to sleep again. And I know this young man; he decided to settle in the area, he’s doing very well, and he sleeps normally now. But it did take a long time away from screens for that to happen. Another consequence that is common with our clients is coming in either underweight or overweight. An example of underweight is an 18 year old who came to us who is 6’2” and weighed 110 lbs. His gaming had overridden his body’s urges to eat. And so, he rarely ate, and he was just very severely underweight. And his posture was also very poor: he had very hunched shoulders, he had no musculature with which to hold up his body. Poor hygiene. We have had clients who have come in with very bad teeth. There was one young man who arrived, and all of his teeth needed to be capped: they were all rotten. He hadn’t brushed them in three years. Another kind of consequence are academics and work consequences. There was a young man that I worked with some years ago who had failed out of college, which for the young adults we work with, is the almost universal scenario: they have not completed their university studies. For the adolescents we work with, they are often in school refusal or their grades are starting to go down and down and down. In this young man’s case, he had gone to a very prestigious university. Because of his gaming, he’d failed out of that university. He married his high school sweetheart, got a job in the Seattle area, and for a year, he didn’t game—he didn’t go back to gaming. He had promised his wife he wouldn’t, but eventually he started back now in secret, and eventually he lost his job. But he put on a whole charade where he got up with his wife. When she went off to work, he then turned to his gaming, and he gamed, then when his wife was about to come home, he left their home, he was wearing his work clothes, he would come back at the appointed hour, and tell her stories about how his day at work had gone, when the reality was he hadn’t even been at work. And he was paying their bills with a credit card. Eventually this house of cards was falling in on him, and he became suicidally depressed. So that is when they found some help. Academics, usually, are going down the tubes, so these are things for parents to be looking for. Obviously it’s now summertime, kids are not in school, but if you think back to how your kids were behaving academically, this is something to be keeping in mind, or going forward, looking for that. Mental health wise, everybody who comes in to reSTART is depressed, and sometimes they are suicidally depressed, not always, but they always are depressed, and they usually are highly anxious. So, for you as parents, when you’re looking at your teenagers, you really need to be looking for signs of depression, and depression is often showing up as anxiety, social withdrawal, a very negative mood, a tendency to isolate. So be looking for those signs, and try to have a conversation. Now, there are some kids who will try to manipulate their parents into giving them greater access to screens by threatening suicide, but I’m not talking about that kind of manipulation. I’m just talking about a kid who is depressed, and when you question them, hopefully, will admit it. Larry Rosen, who is host of this discussion last week, wrote a book called the iDisorder. And we can confirm that what he described as iDisorder really is something that most of our clients are experiencing. And they are showing these traits, which are part of personality disorder traits, for instance, traits of dependency. You know, the adolescent years normally are moving—healthy adolescents want to become independent. They want to be able, for instance, to drive. They want to be able to go out, move out into the world, start earning their own money, and be able to move freely out in the world with greater and greater freedom from the family. That’s not the case with our clients. Our clients tend to be very dependent; they would like to be left alone in front of the screen, they don’t want to learn to drive, they don’t want to have to work, they don’t want to be out in the world, they’re not very comfortable there. Where they are comfortable is having somebody take care of them while they are allowed to play their games or do whatever they’re doing online. So that is an example of dependency, so be looking for that, and those would be red flags for you as a parent. They tend to be avoidant. Our clients tend to be socially anxious, and rather than eager to make real-world friends, they prefer to make new friends online through whatever social media. Whatever they’re doing online, that’s where they want to be making their friends. Their areas of interest are starting to shrink as they withdraw. Perhaps they had old hobbies, they might have been interested in sports. Now they’re not. They’re withdrawing from friends, withdrawing from hobbies, not playing sports anymore. Their interests are narrowing down to that space in front of the screen. These are signs to worry about. Antisocial behaviors are going to start becoming evident. If you as parents are setting boundaries and they are reasonable boundaries, and perhaps you’ve been wise enough to include your teenager in the conversation about how to set those boundaries, but, in spite of the rules, the teen is doing everything he/she can to get around those rules, to the point of perhaps stealing, lying—threats of violence are, with a client population we work with, not unusual—teens threatening their parents, bullying their parents. Remember, teenagers are getting to be quite adult in their physical structure, and we find that many parents are very intimidated by them. They might threaten suicide, threaten physical harm. These are all things to be very concerned about and thinking about seeking help with. So, I was asked to talk a little bit about what treatment options are out there. Hopefully, this has given you some idea of what to be looking for as parents when you’re trying to determine how serious of a problem you’re dealing with. Your treatment options are still, unfortunately, fairly limited just because there are not that many people who are specializing in the treatment of Internet and video game addiction. Fortunately, the number of therapists trained in these ways is growing, and that is a great relief to me. One of the options at the lowest level is to seek out some coaching. There are really good parent coaches, and if people need a referral to those, I’m happy to give referrals. I know a few who are very knowledgeable about the problems of Internet and video game addiction, and I can help you with those names, but coaching is often most effective with parents—to help them learn better parenting skills. But also, of course, you can go to a therapist who specializes in these areas, and the teenager, the addicted person in your family, can also go for counseling. They often are going to be resistant to the idea of counseling, and one of the problems with counseling if you go to someone who isn’t knowledgeable in this area, is that you may be told, because there are always these co-occurring disorders, such as depression, which is the most common, and high anxiety, we’ve heard many stories of therapists who want to just focus on the depression or the anxiety and fail to recognize the addiction. It’s very difficult and often does not work—to focus on those co-occurring disorders without addressing the addiction. We have certainly seen at reSTART that it is after the addictive behavior stops, and they have gone through a period of withdrawal, that they are able to really focus in on the things that have been fueling the addictive behavior. So, counseling, I think, certainly can work, especially if a teenager is not too far gone into their addiction, but in spite of the best outpatient counseling or coaching, if those things don’t work because you’ve got a teen who’s running circles around all efforts that you are making, as you follow the advice of your therapist, and the teenagers is running circles around all of that, then you really need to be thinking about a more intensive level of care. There are outpatient services, which we talked about, that are more intensive than just once or twice a week, and they are called IOPs: intensive outpatient therapy, or partial hospitalization. I’m pretty sure there are some programs that are IOPs specializing in Internet addiction, and I don’t know about the partial hospitalization. What reSTART offers is residential treatment, where they come and they actually live there, and we have a program for adolescents and a program for adults, and they are there for a minimum of three months so that they have a chance to go through withdrawal and a chance to begin learning the skills that they need to be successful once they leave reSTART, and that includes learning how to use screens again in a healthy way. There are other programs now that are coming onboard, and so reSTART is not the only option. There is hospitalization for kids or young adults who actually have become psychotic or are suicidal or homicidal. Hospitalization, of course, but that’s just a short term solution; it’s not a long-term solution. And there are wilderness programs, there are therapeutic boarding schools, and other therapeutic programs that will take teenagers abroad for a long period of time. There are multiple options that parents have, but the important thing is to find options with people who are knowledgeable about Internet and video game addiction; otherwise, you may not be getting the help that you really need.  So, that’s it for me. 

[Dr. Gaya Dowling]: Thank you, Hilarie. A very interesting topic and really important to understand that extreme behavior that can occur. We received a number of questions; I’ll ask you one now, and then we can save the rest for the open discussion, but we did receive a question about, you spoke a lot about mental health consequences and other consequences from Internet addiction, and the participant wanted to know, is there research that shows that those outcomes are the result of the excessive gaming or Internet activity? Or could they be using gaming or social media or other activities to cope with depression or anxiety? And then how do you tease that apart, and what research has there been to show how that relationship might work?

[Dr. Hilarie Cash]: I think Daria can talk to the research better than I can, but what I think is that it’s a chicken or egg kind of question. Because what happens is that—I think there is research that shows a strong correlation between the amount of time spent online and increasing depression: so the more time you spend online, the more dysregulated you become, which means having more depression and anxiety. So it does appear that it actually can cause that; however, of course, if you’ve got a teenager who is depressed, and they are seeking out relief from their depression by going online and engaging in very distracting activities as a way to cope, they might experience some initial relief, but what happens is that depression is actually going to become exacerbated. And they’re not going to put those things together. They’re not going to see the connection of increasing depression being the result of increasing time spent online. But what I can say, and it’s a very fascinating outcome, is that our clients who come to reSTART, almost universally, they are depressed when they arrive. Almost universally, after a month away from screens, the vast, vast majority of them are no longer depressed. That depression simply evaporates. And if they are still depressed, well, of course, then we are exploring with them what is that all about. But for most of them, the depression is gone after they are away from the screens. 

[Dr. Gaya Dowling] Thank you. I’m supposed to limit it to one question, but I’m gonna ask you one more before we move on to our new speaker, and that is, where can families go to look for programs? Are there resources that they can go to to find programs near them?

[Dr. Hilarie Cash]: Well, what I would advise them to do is contact reSTART so that we can tell them about the programs that are out there. I don’t know of an online resource that lists all of the programs that are out there. Something like that was being developed by Cris Rowan, whose website is called zonein.ca, and so, I would advise people to go also there to see, but one of the things families can do, and I would again suggest they call us to get a good referral, but there’s a whole profession called educational consulting, and there are educational consultants who specialize in therapeutic placements, and they make it their business to travel around the country and get to know the therapeutic programs and schools that are out there, and many of them don’t know a lot about Internet addiction, but some of them have become very knowledgeable about Internet and video game addiction, and they really have been making it their business to know what programs exist in the United States and Canada and can advise families about this. So, we know those consultants who really seemed to be very clued in, and I would highly recommend that they give us a call, and we’ll give them a recommendation. 

[Dr. Gaya Dowling]: Great, thank you. Our final panelist for today is Dr. Lisa Strohman. Dr. Strohman has become widely known for her advocacy in education around mental wellness as it relates to our digital lives. She has worked with thousands of parents, schools, and children around the globe. An attorney, clinical psychologist and author, Strohman established the Digital Citizen Academy, a nonprofit program that educates, empowers, and inspires balance and pro-social use of technology. Today, she will provide some practical tips for parents about technology addiction and how to communicate with your kids about it. Lisa. 

[Dr. Lisa Strohman]: Hey everyone, how are you? I am going to pop over and share my screen so that we can get started right away. I wanted to just say, what an incredible opportunity I feel having to be part of this panel where we have incredible researchers—Gaya, Daria—and then we have such an amazing, Hilarie, as being one of the first presidential programs. I would say that kind of my area has been right, smack-dab in the middle, as a clinical psychologist and really working with the families directly, utilizing all the incredible research that you all put out and trying to create solutions in the middle so that parents aren’t always having to go to those extreme areas of treatment. So I really always talk with parents about whether technology is actually really the issue, and I know we’ve all been talking about gaming, and I think that there are some questions in the chat that were talking a little bit about whether or not we could differentiate what addiction is or overuse. I would recommend anyone to look at my TED Talk because I talked about how I personally tend to use technology overuse when I’m talking about this issue with kids because I don’t like throwing labels on them too early, but I think Daria nailed it when she talked about the need for funding. And I think that ironically, what we tend to not see is that everything has to come back to funding, and, like, how do we get dollars behind the research so that we can actually get the scientific evidence to be able to go out there and effectively help parents and kids and figure out what they’re doing? When I talk about technology, with parents specifically, I really pull them back into understanding what role we play. Obviously I present on this a lot, so I have really extensive presentations, and I talk to parents, and I talked directly to kids, which is obviously different messaging, but I was going to play a really short video just kind of highlighting how innocently we can lay the tracks with kiddos, so let me play this.

[Video of a baby holding a phone] An adult asks, “Can I see this?” and takes it away. The baby begins to cry but stops once the phone is given back. The adult laughs.] 

[Dr. Lisa Strohman]: So, as you can see just in that video right there, in terms of what role we play and where the kids are, you know, the baby is obviously distressed. It has a device in its hand, the parents are laughing when the child gets it back in its hands and is soothed. So again, like there’s hundreds of thousands of those videos online, and it goes into toddler, and I think that Hilarie was talking about how teenagers aren’t quite as cute, and there’s videos online about them and people who have videotaped them having total meltdowns, but as a parent myself, we have to look at what we do with them. We have to understand where they live, where they’re operating. So I think Daria, when she’s talking about a lot of the information, in terms of gaming, I think that we have to also expand it. It’s not covered, but we have to expand it into all the areas where children live. So I know there’s a lots of information right now about TikTok, and there’s a lot of controversy about that, but TikTok, Instagram, YouTube, and Snapchat are the four top social media platforms where kids are getting information—a lot of times misinformation or a lot of times information that some of those signs and symptoms that Hilarie is talking about, where it’s causing them anxiety and depression because it’s so graphically or image-based and they may not fit the mold, or they may not feel like they’re producing content that people are really acknowledging. Obviously, the gaming: Xbox, PlayStation, and all of the gaming platforms that kids can go on today. Ironically, working with EA Sports, one of the top, leading numbers that is increasing in terms of gaming is now women 35 to 45. And I think that has a lot to do with the pandemic and moms now jumping on and trying to figure out what their kids are doing online and where they’re spending their time or trying to participate and play with them. There’s Likee, which is the heart, which used to be the Like app, and a lot of kids spend time on there posting videos, connecting with one another. YOLO, You Only Live Once, if you haven’t heard of that, it’s, to me, one of the most painfully hurtful apps that kids can participate in because it’s completely anonymous and kids put a lot of information on there. And then, of course, Houseparty, which is a little similar to what we’re doing here today, where we have a panel or a group of people, and in that kids typically get on there they can have up to eight kids. They can kind of lock that down and have a group discussion amongst themselves, or they can meet that door open and kind of get a surprise from a guest they may not know, which can lead to various problems, and my background with the FBI, I can tell you in Internet crimes units, we get a lot of issues, and cases are coming from all of the platforms here. So I think that, you know, as a parent, one of the biggest issues, I can say from a parenting standpoint, is to know where your kids are spending the time first. Because I think that to me, I think technology is not actually the problem itself but actually is kind of a gateway into social media platforms, gaming platforms, pornography. I think that when I was taking notes, like the the online gambling issue, that is very interesting to me, with adults, and you’re looking at that process addiction that happens, which means that’s not a food or a substance we’re taking into our body but a behavior or an activity that we can become addicted to, like a sex addiction, but gambling addiction in adults, I think that we talk about very often, and that’s one of the diagnosis codes that we can get funding through DSM, which is kind of the Bible of psychology. But with kids, the most recent version of Grand Theft Auto, which is on iteration six, has a casino within the game, where kids can actually use virtual money to participate with, which, again, this goes back to Daria’s comment of how we’re seeing those pathways of addiction in technology, mimicking and following that in the technology world is addiction with drugs and alcohol and nicotine. So it’s dangerous to be presenting to kids in that situation. I think that where you’re looking in with a parent, and again, I was a health law attorney before I jumped over into this world full time, I know the health world and how it funds things, and so I wanted to give parents a better view into the approach that I think that some experts are taking and why I created the program Digital Citizen Academy that I did. Because I think it was really important to get them help before they had to go into these more intensive programs because as much as what I—I mean, I’ve sent multiple people up to Hilarie’s program up north because I think it’s really helpful for those families that didn’t catch it in time—but I think that there’s a lot we can do with education and just talking with our kids. So I’m gonna go through the tips that I had put out or that I talk about often that I simplified into these five major areas. And the first one is really communicate with your kids. I think it’s really important to talk with kids at their level, and so I really kind of focus in on elementary, middle school, and high school. We do that with our program. It is absolutely—and I think that everybody on the panel has worked with kids at some time—it is absolutely the wrong approach to talk at kids when they’re teenagers. You have to talk with them, and you have to get them empowered and inspired to kind of join that conversation. So we can talk about anxiety and depression, and we can talk about, what do you do in those scenarios when you have a friend that maybe is posting on things that might make them feel uncomfortable or they’re worried about? It’s really important, in my belief, to talk about the bullying issue, you know, how do you have thoughtful, empathetic, socially intelligent kids in their digital lives? So how do you have a pro-social approach to using technology? Because ultimately, that’s where we’re identifying where kids are getting hurt and they’re lashing out at one another. And then of course, we talk about their digital reputation. One of the things that I communicate with kids all the time is I pull up live in any presentation, I’m doing my own Google. I put my name in there, and I was like, here’s what pops up, I create a pause, but I think you can do that as a family activity, and you can put your names in there, and you can see what pops up under you and see how many things are there. And what is that brand awareness of yourself that’s representing the family, that’s representing themselves? And keep in mind when you’re talking about these things that almost 90% of colleges now are doing social media reviews before admission, so it’s really important to have these conversations with your kids as they’re younger going forward so that you’re on the same page with them about what it is later, when they get a little bit older. I also think that you should not make any assumptions when it has to do with kids. I think that sometimes, I see parents, and we love our kids so much and they’re beautiful little beans, and you don’t see them every day, so you don’t see them growing like everyone else does, and we tend to look at them with their technology use, and everything seems pretty organic. If you look at the statistics that we work with at DCA, we’ve got in the U.S. specifically, the average age of first pornography viewing is eight, and chronic viewing begins at eleven. And that is highly dependent on our educational system over here, where we are now introducing in second grade the ability and the project in social studies to research historical figures, and if you look at the gateway into the Internet and looking up those historical figures, the porn industry, which is a hundred billion dollar industry, goes in and attaches content for our kids—pop-ups and things like that—so the one thing that I would say is take all the devices and have them in a family area. It won’t save you from everything. I’m gonna be totally honest and clear there; it happened to my son in second grade, where I was in the kitchen cooking dinner, and he was doing his homework. And he was like, “Mom, they’re trying to trick me like you said they would.” I came around, I tell my kids there’s a lot of things that they could be tricked on, so I wasn’t really sure what I was gonna see, and so then I came around, and I saw that there was a banner ad, even with all of the restrictions and the VPNs and all of that we had used, it had somehow attached in, and there was a woman there laying topless, and my son at eight, was like, “Mom, how do you think she got here? Do you think her family’s looking for her?” And it was a very sweet conversation at the end. We gave her, you know, a little prayer for her that she’d find her family again. And again, at eight, it wasn’t really the right time, probably, to talk about the pornography industry, but it wasn’t anything that got unusually uncomfortable because we’ve had those conversations. So don’t make assumptions you’re not gonna see these things, but you definitely have to be aware, and that’s where that communication in the previous slide comes in. For sure, people ask me all the time, “Do you monitor? Is it an invasion of privacy?” Everything is monitored today, so I think that the argument about invasion of privacy is gone. I absolutely think that you should be monitoring where your kids are going, how much time they’re spending online, and I think, like, not making assumptions that they’ll be able to restrict themselves because again—Daria touched upon it, and also Hilarie—you’ve got these unregulated brains. When they start to get them into the depths of technology, they may not make all the right choices. And of course you want to know all of their passwords so that you can access and look at what they’re looking at. Getting personal with your kids and doing things offline with your kids? I think that we forget. I think that to me, it’s like—in our house, we have Tech-Free Tuesday, so I’m glad it’s not Tuesday when we’re recording this—because it is our favorite day of the week. It is when we’re playing board games typically, inventing games, creating music. So it really does kind of define and outline a level of area that I think that is helpful for families—and it doesn’t have to be Tuesdays, it can be on Saturdays—but it, you know, what is that day where you kind of model that behavior and you actually take time and directly spend time with your kids? Volunteering with at-risk youth centers. I think a lot of kids today live in these microcosms of social media bubbles where the algorithms are keeping them within their own kind of world of interests and things like that, and so if we don’t get them into other communities and really visualizing and seeing how other kids are modeling and going through the world, it tends to cause a problem at not giving them better focus on the world as a whole. And then your schools, I cannot express enough, I’m on multiple panels to state-level governmental boards in multiple child educational systems. The system in education is about to be really, really challenged, at least in the U.S. I can’t speak, Daria, about in the U.K. or over in Europe at all, but I can say that in the U.S., we have set up a system where the programs are funded and kids are supported through that funding based on their academic performance. The higher the grades, the more money the schools get, and the more time in schools where they’re participating and sitting in the schools, the more money the school gets. So as you can imagine, the pandemic has hit them from a financial standpoint. So if there’s anything that you can do, at least in the area of programming or volunteering, I think I’ve donated—my program, we’ve touched at least 25,000 students with Digital Citizens Academy. In the school, the home-based version, I know PTOs have paid for, but it definitely is something where I think you need to talk to the school and find out how we can help in that because they’re struggling on their end as well. This is one that I find really interesting when I’m talking in front of groups: disconnecting by example. I think that children are very quick to throw their families and their parents under the bus, in terms of them being on the phone so much or on the computers. Daria mentioned it earlier: I think we’re all spending hours upon hours behind screens, and there’s a question in the chat box that was talking about the difference between use when it’s problematic and not, and I tend to look at it as what’s junk food and what sustainable healthy food in the same way as I look at my digital consumption. If you look at social media, you look at YouTube, you look at video gaming, you look at the things that are really simply for pleasure and fun, just to bide your time, then that’s really more of the less healthy digital consumption, where you, again, like the work-related, academic-related, creative-related, that would be more healthy, and that would be something you can sustain—if you’re learning how to code or you’re writing creatively, or creating music, those are the things that I think using technology can be okay. So I think it’s good to differentiate that, I know somebody asked that. And then I think just remembering that you can remove things that the tech industry creates as sticky. So those Autoplays on YouTube or on Netflix and things like that; all of that is a setting option that you can go in and change. You can turn notifications off on apps that you download. I think really showing your kids how you turn those things off. I turned my screen color off my phone so everything is monochrome, which makes it less appealing to look at, so some of those little tricks that you can show your kids that you use on your own and can be really helpful for them as well. And then finally, I think that maintaining awareness is really, really important. It’s really interesting to me, particularly now that the service providers—whichever one that you use—you know, they’ve got built-in—any of the Internet service providers, Verizon or Sprint or T-Mobile, AT&T, all of them—have some sort of program built in. They’re not always easy to find, but if you go in and you Google that, and you look at screen time, even on your own Android or iPhones, they have screen time usage, so I think maintaining that awareness, educating your kids on that, and bringing them in as part of the conversation. With teenagers, you know, oftentimes we challenge ourselves and we pull up our phones, and I’m like, “Alright, what was your screen time last week?” and I show them my screen time, and we look at that. If parents are working or they don’t have the ability all the time to be home with their kids, or somebody isn’t really aware of how much their kids are using, they can also go in and look at data usage. So there’s some really good parameters. I know Common Sense Media has one that equalizes how much a movie is and how much data use that is. So you can go into your plan and look at how much you’ve your family’s used or your kids have downloaded or used. And I think that, again, for the permission for app downloads, to me is a no-brainer. I think that, you know, Gaya said—you know, I have a teenager in my house—it seems like overnight, they just turn into these like other creatures that live in your home. And they were just so sweet, and then all of a sudden, you know they’re downloading stuff and they need stuff for educational purposes, and during the pandemic it’s been really, really challenging, I think that it’s fine, but I still think that you need to have some sort of gateway on that because there shouldn’t be so much that they’re having to do that you shouldn’t be able to have some permission on that on your end of it. And then, I think that that’s it for me in terms of the simple tips. It’s hard to take 15 years working in the field and go into a place and give you everything that I possibly can, but those are kind of the big, overarching issues that I can see. One other thing that I didn’t touch upon that I’ll just touch on—I’m gonna get back to you, Gaya—is the legal implications. You know, as an attorney, I volunteer with Internet crimes against children, so there’s kind of legal implications if your kids have their identity stolen or if they post something that is considered hate speech. If they are involved in a bullying incident, there is civil liability that is starting to be applied to families, and technically, if your child is under the age of 18, you are legally liable for the financial repercussions for that. It was a large part of why I created this program: to help families understand ownership and legalities and those things. Because I think it’s really important. We do not have the protections that we once had. And I had a family that had a $280,000 charge for their student who put a false threat against a school, which caused a threat assessment, full-scale SWAT response team, everybody came out, and that all cost money. So what they’re doing is they’re starting to hold the families personally liable, so I think that’s important also to remember as a family, and why you should actually maybe be looking at what your kids are doing a little bit more closely.

[Dr. Gaya Dowling]: That’s wonderful, Lisa. Thank you very much, and I’m sure we’ve gotten quite a few questions for you in the chat. I’m gonna start with a couple of specific ones before I open it up. And one thing that you mentioned that I think is important to emphasize, which is about not making assumptions about what your children are doing and how they can control their own behavior. We got a question about, on the other side of that, though, how do you teach your children, particularly as they’re going through these years and they’re developing, how to develop strategies for self-regulation so that—yes, you don’t want to assume that they can, but are there tips you can give parents for how to help their kids start to be more aware and self-regulate their Internet or other technology use?

[Dr. Lisa Strohman]: I think that’s a great question. I think that developmentally, you have to remember there’s the timeout chair if you think about that. You know a child who’s two can maybe spend two minutes on a timeout chair, if you’re gonna use that strategy. With kids at kind of an elementary school age, one of the biggest signs I can say is, put a clock, a digital clock near where they’re using technology so that they have that reference point. And again, I can’t talk about all the tips, but the physical reminders of straightening up, stretching, taking your eyes away from the screen… All of those things that you want to talk to your kids, one of those tips that I put in there is check the clock and check your time. So I think that if you have something that’s right by the technology that they’re using so that they can remind themselves, or even setting alarms on the device that they’re using itself every thirty minutes, which can remind them to get up and stretch and walk and disconnect for a minute. And that’ll give them blocks of time, and I would say probably by fourth grade—third and fourth grade—that can be pretty simply ingrained in them if you start at a young age.

[Dr. Gaya Dowling]: Great, thank you. So I think we’re gonna open it up now for questions for all of the panelists, so again, if you haven’t had a chance yet, the Q&A is open for you to post some questions. So, with respect to treatments, wondering—maybe Daria could speak to this and Hilarie as well—about the value of cognitive behavioral therapy in the treatment of Internet or gaming addiction? Daria, could you speak to that a little bit? And then Hilarie, if you want to talk about your experiences, that would be great too.

[Dr. Daria Kuss]: Yeah, yeah, absolutely. so what I can tell you is both from my clinical experience, as well as from the research experience, as I’ve been working with individuals who have had problems as a consequence of the technology use, we tended to use cognitive behavioral therapy formats, both in a group setting, as well as an individual setting, all of which appear to be very effective and quite efficient as well of a shorter period of time.

[Dr. Gaya Dowling]: Daria, I’m sorry to interrupt you, but for people who don’t know, can you just explain what cognitive behavioral therapy is?

[Dr. Daria Kuss]: Of course, yes. So cognitive behavioral therapy focuses on changing your thinking, changing your emotions, and changing your behaviors because these kinds of things are intimately interlinked. And in cognitive behavioral therapy, it’s a very problem-focused approach where behaviors—actual behaviors—are being changed, so you don’t necessarily go very deep in the sense of psychoanalysis, for example, where you may want to discuss a number of issues in more depth. However, what we also know is, from the research on cognitive behavioral therapy in the context of Internet and gaming addiction, appears to be the most efficient and most efficacious kind of treatment approach. So when you have a look at the research evidence across the world, CBT is indeed very, very useful for individuals to reduce a number of symptoms that they experience but also to reduce any kind of comorbid symptoms or symptoms of disorders that may co-occur with the Internet addiction or the gaming addiction, and I’m sure that Hilarie can talk to this as well, given that she’s got the most clinical experience of all of us.

[Dr. Hilarie Cash]: What I would say is that of course, CBT is something that is very well studied, and we certainly use it here at reSTART. However, what we found is that in addition to that, we’ve found that it’s very effective to teach a number of skills—that if besides what is called cognitive restructuring, which is really helping people think in new and different ways that are more constructive than the ways they were thinking before, which is what CBT is kind of all about—in addition to that, we teach things like meditation and mindfulness so that they can begin to have new skills for self-regulating their emotional states. We get them out into nature because nature itself, just in and of itself, has a very therapeutic effect. We focus on their physical health because if they don’t have their physical health, it can be very difficult for them to have mental health. So we take a very holistic approach, but in terms of the actual therapy itself, if you’re looking for a therapist in an outpatient setting, certainly CBT is a great way to go.

[Dr. Gaya Dowling]: Thank you. Lisa, I have a question for you. You illustrate many really excellent tips for parents, but one of the things that we have seen is that socioeconomic status or, you know, the resources that parents have available can really impact their ability to implement some of those, and we’re seeing that there’s greater digital media usage among those that come from poorer backgrounds. So for parents who have two or three jobs and are just trying to keep everything afloat, what can they do to help their kids? When it’s not as easy to volunteer or even be around all of the time? Do you have some tips for those families?

[Dr. Lisa Strohman]: That’s an excellent point. I presented at a school that had 29 different languages, 100% under the poverty line—every single kid—and there were only six kids out of 800 that did not have a smartphone. So I think that it doesn’t follow that they may not have access. I think it’s definitely an incredibly good point. I really approach the situation, and the whole vision and my passion behind DCA was to empower, educate, and inspire kids to be future leaders. It is absolutely what I believe. It is the difference that—if you’re handing the keys of a car to a 16 year old and you trust them to make all the right decisions, it’s because they’ve gone through an educational process, and they understand if they’re driving down the road at 65 mph, and the only thing between them and oncoming traffic is two yellow lines, that we’re supposed to stay on those yellow lines. You absolutely have to trust and empower children to make those right decisions. It’s not going to happen any other way, and it’s so frustrating to me, having been in this field with this programming for about nine years now, that the schools are so willing to pay for the restorative justice or the diversion or the ‘what do we do when they make the mistake,’ and not put any funding or any approach or time into educating kids on the choices that they make when they start using the technology. So it’s not expensive—you know, it’s five dollars to put a child through an online program such as mine—I don’t know what other people pay. I do it for the cost of my program because I’m a non-profit, but I think that you have to really focus in on getting them educated, developmentally appropriate to whatever their age is and get them part of that solution because kids ultimately want to make good decisions. It doesn’t matter if they have money and resources or they don’t. They don’t want to make the mistakes that—again, I think that having been in all these different communities—they want to make the right choice if we give them the right direction. But I think that what’s happened is that technology has advanced so quickly, and they have access to new apps and opportunities every day, that we haven’t had the opportunity to catch up to them, and that’s really unfortunate. Because once you talk to them and once you educate them, it is so incredible, and I’d love to have, like Daria look at the program, but we did a pilot, and we took kids 1000 kids in one school alone, and we did a pre and a post, and 72% of their technology-related infractions were their office referrals, and once we educated them on what harassment is or stalking or technology and reputation issues, like researching teachers, that went down to 32%. So it literally is about teaching the kids, ‘here’s your yellow line, and you can’t cross it,’ and they will make the right choice. And that, really what we’re finding is across SES levels. It really is getting to the kids because we cannot be correctional officers, and we cannot be the people that mandate our kids on every option because they’re just on technology far too much nowadays to think that we can do that.

[Dr. Gaya Dowling]: Thank you. So there was a question earlier, and maybe Daria can speak to this, about some of the consequences—for example, the video that we saw where the baby cried because the device was taken away or children becoming angry when things aren’t—do those have impacts on brain development as well? And if so, is there a balance between those impacts from taking things away and the impacts of having them on the brain?

[Dr. Daria Kuss]: It’s a very complex question that you’ve posed there. So when we’re thinking about addiction, I think we really need to understand that—first of all, it is an actual mental disorder, so we can’t really speak about it very lightly. If the individual was really to experience addiction, meaning that they have a significant impairment in their daily lives, within different areas in their daily life over an extended period of time, normally over 12 months (this is the minimum period that the WHO specifies), then we would assume that individuals who are having these kinds of problems will potentially, especially if they’re very young individuals where the brain development hasn’t completed, will potentially also experience consequences in terms of the actual brain development. And what we know from the research is, as I’ve mentioned previously, that the brain really reacts directly, in terms of how you’re using technology, how you’re engaging with activities, that can potentially be problematic. So I think we really need to understand all those kinds of relationships. There is some research there with regards to neurobiology and how the excessive engagement in the activities can impact brain function and brain structure over time, but I think so far, we’ve really only ever focused on the problems that can emerge as a consequence of technology use. But you already alluded to the fact that actually, we need to always bear in mind that there is a second side to the coin as well, and for the significant majority of technology users, young and old, the technology, the Internet will be very beneficial. It is convenient, it gives us entertainment, it allows us to socialize. Nowadays, it allows us to work, it allows us to connect, and I think it’s so important not to disregard all of these benefits. So personally, I always come from an ‘I like technology; I use a lot technology,’ which is why I’ve developed a master’s program in cyberpsychology at Nottingham Trent University, where I work with young students who are really keen on technology use. And we really need to understand the benefits, but at the same time, for a small minority of excessive users, there will be negative consequences, and they may experience symptoms of addiction, of depression, and of anxiety as a consequence of their technology use.

[Dr. Gaya Dowling]: Daria, just as a follow-up, I know the literature in substance use, but I’m wondering if there’s also been research done with Internet addiction, in terms of brain recovery from the addictions. So, if there are these brain changes associated with the compulsive use, if they stop that compulsive use, have they looked to see if the brain recovers from that? Those changes?

[Dr. Daria Kuss]: Very good question as well. So research in this area is really in its infancy, and what you would be looking for, by the sounds of it, is research on actual clinical populations of individuals who have undergone some form of professional treatment, looking at their brains before and after treatment over a long term period, ideally years, rather than months. And I’m personally not aware of such research having been done, so maybe this is really a great opportunity for us to think about doing that kind of research. 

[Dr. Gaya Dowling]: Absolutely. 

[Dr. Hilarie Cash]: And I’d like to jump in to say we have a great population with which, potentially, we could work to do exactly that research.

[Dr. Daria Kuss]: Excellent.

[Dr. Gaya Dowling]: Great. So we had some questions about tips for kids. So let me see if I can find it. There was a question about a child who’s getting pressure from his peers to socialize through mature video games that he’s not allowed to use. So do you have strategies for the children, for teens, and how to navigate those types of circumstances? Lisa. 

[Dr. Lisa Strohman]: Yeah, this is really challenging. I think that a lot of times, what I see happening is the kids are utilizing the gaming platforms for social purposes. I think Daria’s point of how the younger generation, particularly Gen Z, is coming out and really depending on that to connect with one another. We’ve got the same issue in our house with our family—I’ve got an eleven and thirteen-year-old, so—I’m in it with everybody else in looking at what those challenges are. I think when our kids are younger and they’re not able to travel or do things on their own and they’re reliant on parents, it’s really leaning on the other parents in the community in identifying, what are those times or those opportunities where you can get your kids social time together? So we set up a band program where the kids are using FaceTime, with each of them bringing different instruments into the room and they’re all playing together. You know, there’s art therapy and music therapy involved in that. So I think that there’s other ways that you can use technology that maybe aren’t so negative. Again, it goes back to, you know that you have an excessive use when they can’t turn it off without having negative consequences. So when you’re starting to see screaming or holes through the wall, but if they’re using it and they’re like, “I’m just gonna do 30 minutes with my friend. We’re gonna play one game and I’m gonna turn it off,” that’s really balanced use, and that’s really the goal of being able to use technology for its benefits. But have it balanced with academic, creative, and social uses. So that’s what I talk to kids about and give them kind of empowerment to really have conversations with their friends and say, “Alright. What are the other activities that you can do with them? What are some other things that they want to do?” And then behind the scenes, as a parent, really facilitating that with the other parents so that you know that you’ve got some support on the back end with that other child’s family. 

[Dr. Gaya Dowling]: Thank you, that’s helpful. Two points that you both mentioned, Daria and Lisa, that I think are important have to do with the positive uses of technology. And we’re seeing that kids are being creative online now—are creating content. And have you seen a shift in that—not only being consumers of content but also being producers of content and that that might have positive effects on children growing up? Any of the speakers are welcome to chime in. But maybe Lisa, you could start? 

[Dr. Lisa Strohman]: Sure! I think that yes, what we’re seeing in this new generation is that Gen X is really more kind of passive viewers of technology more often. In many ways, again, taking away the academic or the work-related content that’s being produced, but the younger generation is really using kind of micro transmissions of platforms and creating tons of content. You think about TikTok, and you think about Instagram and things like that that they’re putting out there. So they definitely are becoming more creative; they’re using those platforms in ways of self-expression and identifying who they are, and I think that you just have to be really conscientious of, what is the content? Is it appropriate or not appropriate, and what is the reaction to that content that they’re presenting? And I don’t really trust an adolescent brain to make those choices wisely all the time, particularly if you haven’t had training on the bigger picture on that.

[Dr. Gaya Dowling]: So this has been a great discussion. I almost lost track of time, and I just wanted to say, before I hand it back over to Pam, that one of the take-home messages that I’ve heard today is, it’s not about how much; it’s about how. So we can’t get rid of technology altogether, and as we’ve heard there, are good uses of technology—productive, developmentally-appropriate uses of technology. So it’s more about how, as parents and as scientists, do we understand that and understand what those benefits can be and promote that side of it for our kids? So with that, Pam, I will turn it back over to you. 

[Dr. Pamela Hurst-Della Pietra]: Thank you, Gaya, Hilarie, Daria, and Lisa, for sharing such wonderful insights and thoughtful guidance. And thank you all for coming and asking the panel such fantastic questions. For those who are looking for help with your children’s technology use, Hilarie mentioned a few resources, and you can also feel free to email me at info@childrenandscreens.com. Please share the video that you’ll receive of today’s workshop with fellow parents, health providers, teachers, clinicians, researchers, and friends. Our discussions about digital media use and children’s well-being will continue throughout the summer with weekly Wednesday workshops. Next week, on Wednesday, July 15th, our experts will share insights into screens and mental health and provide tips on how to help your children and teens thrive. When you leave the workshop, you’ll see a link to a short survey. Please click on the link and let us know what you thought of the workshop. You’ll also be invited to sign up for our next workshops at the end of the survey, and you can find more information about those on our website, childrenandscreens.com. Thanks again, and stay safe and well.