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

A growing body of literature is associating excessive and addictive use of digital media with physical, psychological, social and neurological adverse consequences. Research is focusing more on mobile devices use, and studies suggest that duration, content, after-dark-use, media type and the number of devices are key components determining screen time effects. Physical health effects: excessive screen time is associated with poor sleep and risk factors for cardiovascular diseases such as high blood pressure, obesity, low HDL cholesterol, poor stress regulation (high sympathetic arousal and cortisol dysregulation), and Insulin Resistance. Other physical health consequences include impaired vision and reduced bone density. Psychological effects: internalizing and externalizing behavior is related to poor sleep. Depressive symptoms and suicidal are associated to screen time induced poor sleep, digital device night use, and mobile phone dependency. ADHD-related behavior was linked to sleep problems, overall screen time, and violent and fast-paced content which activates dopamine and the reward pathways. Early and prolonged exposure to violent content is also linked to risk for antisocial behavior and decreased prosocial behavior. Psychoneurological effects: addictive screen time use decreases social coping and involves craving behavior which resembles substance dependence behavior. Brain structural changes related to cognitive control and emotional regulation are associated with digital media addictive behavior. A case study of a treatment of an ADHD diagnosed 9-year-old boy suggests screen time induced ADHD-related behavior could be inaccurately diagnosed as ADHD. Screen time reduction is effective in decreasing ADHD-related behavior. Components crucial for psychophysiological resilience are none-wandering mind (typical of ADHD-related behavior), good social coping and attachment, and good physical health. Excessive digital media use by children and adolescents appears as a major factor which may hamper the formation of sound psychophysiological resilience.

Lissak G 《-》

[The use of social media modifies teenagers' sleep-related behavior].

Modification of sleep behaviors in teenagers has been observed over the past 30years with a reduction in overall sleep time and an increasing number of teenagers suffering from sleep deprivation. Sleep deprivation is linked to physical problems such as obesity but also to change in performance at school and mood disorders. Changes have been associated with the use of screens, cell phones, Internet and social media. Use of screens has been shown to delay sleep onset and melatonin secretion and stimulation of wake systems by interaction with social media may exacerbate these effects. The links between the use of social media and sleep patterns have not been fully explored. Our study aimed to evaluate the effects of social media on teenagers' sleep and the impact of sleep deprivation. As part of a sleep education program conducted in middle schools, teenagers from 6th to 9th grade were invited to complete an online questionnaire on sleep habits with teacher supervision and after parental consent. Outcome measures were sleep and wake times with estimated sleep duration in school (SP) and rest periods (RP), use of screens (computers, tablets, smartphones and video game consoles), the use of social media and impact on visual analogue scales of sleep quality, mood and daytime functioning. Students were divided into those with clear sleep deprivation (sleep time<6hours in SP) and those whose sleep time was in line with the National Sleep Foundations recommended sleep needs for teenagers (9hours or more). A total of 786 questionnaires were completed and 776 were exploitable. Four schools took part with 408/786 girls (64.2 %) and a mean age of 12.4±1.24. Internet access was almost universal (98.3 %), 85.2 % had cell phones and 42.7 % had a personal computer in their bedroom. Social media was used by 64.6 %. After dinner, 52.6 % spent more than an hour and 14.7 % spent more than 2hours in front of a screen. After bedtime, 51.7 % regularly used electronic devices of which 25.6 % had a screen-based activity (e.g. texts, social media, video games or television). During the night, some teens woke up to continue screen-based activities: 6.1 % in order to play online video games, 15.3 % to send texts and 11 % to use social media. Bedtimes were later in PR compared with PS (22h06±132 vs. 23h54±02; P<0.0001) as were wake times (7h06±36 vs. 10h06±102; P<0.0001). Sleep time was clearly longer in PR (10h12±126 P<0.0001) compared to PS. For students in 6th grade compared to 9th grade in sleep duration in SP decreased (8:55±90 vs. 7:25±93; P<0.0001), whereas sleep duration during RP was stable (10h08±118 vs. 10h08±90 P<0.029). No significant difference was found between girls and boys for sleep duration, sleep quality, performance during the day or mood. Sleep deprivation during the week (6hours or less) was less common in 6th graders 5 % vs. 15 % (P<0.0001). In sleep deprived teens compared to teens sleeping, the recommended ≥9hours, difficulties falling asleep were reported with 33 % vs. 9 % taking over an hour to fall asleep (P<0.0001) and difficulties getting up in the morning were more common (7.05±3.27 vs. 5.74±2.97; P=0.0003). Sleep deprivation had an effect on daytime performance: teenagers deprived of sleep were more likely to report a need to fight sleepiness, (5.93±3.24 vs. 2.84±2.44 P<0.0001) and had reduced energy during the day (6.21±2.86 vs. 7.77±2.07 P<0.0001). A negative effect on mood was evident: in sleep, deprived teenagers irritability (5.28±3.12 vs. 3.30±2.34; P<0.0001) and feelings of sadness (3.97±2.99 vs. 2.59±2.15; P=0.003) were more common. There was a clear association between sleep deprivation and access to screens and social media: sleep deprived teens were at more risk of nocturnal disruption with a higher prevalence of computers (67 % vs. 33 %; P<0.0001), cell phones (99 % vs. 80 %; P=0.0001) and smart phones (85 % vs. 66 %; P=0.0001) in their bedrooms. Access to social media and especially a cell phone in teenagers' bedrooms is associated with a reduction in sleep time during the school week with negative effects on daily functioning and mood which increases with increasing age. Education about use of social media and sleep for teenagers needs to start early as modifications in sleep and evening use of screens was present on our population from 11years on and to involve parents as setting parent controlled bedtimes has been shown to increase teenage sleep time.

Royant-Parola S ，Londe V ，Tréhout S ，Hartley S ... -  《ENCEPHALE-REVUE DE PSYCHIATRIE CLINIQUE BIOLOGIQUE ET THERAPEUTIQUE》

[Sleep and Psychological Functioning of Children and Adolescents - a Narrative Review].

Brand S ，Lemola S ，Mikoteit T ，Holsboer-Trachsler E ，Kalak N ，Bahmani DS ，Pühse U ，Ludyga S ，Gerber M ... -  《PRAXIS DER KINDERPSYCHOLOGIE UND KINDERPSYCHIATRIE》

Increased Screen Time as a Cause of Declining Physical, Psychological Health, and Sleep Patterns: A Literary Review.

Dependency on digital devices resulting in an ever-increasing daily screen time has subsequently also been the cause of several adverse effects on physical and mental or psychological health. Constant exposure to devices like smartphones, personal computers, and television can severely affect mental health- increase stress and anxiety, for example, and cause various sleep issues in both children as well as adults. Risk factors for obesity and cardiovascular disorders, including hypertension, poor regulation of stress, low HDL cholesterol, and insulin resistance are among the physical health repercussions we see. The psychological health effects comprise suicidal tendencies and symptoms of depression which are associated with digital device dependency, screen-time-induced poor sleep quality, and content-influenced negativity. Oftentimes it can cause the induction of a state of hyper-arousal, increase stress hormones, desynchronize the body clock or the circadian cycle, alter brain chemistry and create a drag on mental energy and development. With a focus on brain development in children and detrimental effects in both adults and children, this research article goes on to explore the various aspects of screen addiction and excessive screen exposure.

Nakshine VS ，Thute P ，Khatib MN ，Sarkar B ... -  《Cureus》

Short-term efficacy of reducing screen media use on physical activity, sleep, and physiological stress in families with children aged 4-14: study protocol for the SCREENS randomized controlled trial.

Rasmussen MGB ，Pedersen J ，Olesen LG ，Brage S ，Klakk H ，Kristensen PL ，Brønd JC ，Grøntved A ... -  《BMC PUBLIC HEALTH》