Dr. Pamela Hurst-Della Pietra is the President of Children and Screens: Institute of Digital Media and Child Development, an international, interdisciplinary, nonprofit organization that she founded in 2013 to support and advance the objective, high-quality scientific research, identify and nurture talent, educate and inform the public and provide policymakers with actionable information.
Using her medical degree, non-profit experience, philanthropic resources, and a long-standing interest in media and children, Dr. Hurst-Della Pietra has become one of the field’s leading conveners, curators, and grant-makers.
What are some of the negative effects of excessive screen time?
Before launching into the adverse impacts, I would be remiss not to point out that digital media has been a lifeline for many young people during the pandemic. These technologies have advanced the information highway, brought connection and entertainment to our fingertips, and most recently, of course, assisted with our children’s’ education.
However, like any good thing, digital media must be consumed in moderation, especially for kids. Excessive screen time can have negative implications for physical, psychosocial, behavioral, and cognitive development. Researchers have only begun to scratch the surface of these complex and intricate associations.
1. Physical Health:
Known physical health effects associated with digital media use include obesity and sleep disturbance. Clinicians, researchers, and parents are also concerned that digital media is contributing to diminished ocular health and orthopedic issues. Illustrating this point, a 2019 systematic review of studies examining the impacts of digital media on the health and wellbeing of children and young people by researchers at University College London Institute of Child Health found that high levels of screen time are associated with a myriad of health concerns.
One of the largest impacts of excessive screen time on physical health is the increased likelihood of obesity. A Children and Screens-curated 2017 review of the literature concluded that reducing screen time lowers weight gain in children. In addition, screen media exposure provides opportunities for junk food marketing which influences children’s preferences, which may contribute to increased weight.
Furthermore, Dr. Richard Lopez and colleagues found that media multitasking (e.g., watching television and scrolling through Facebook at the same time or doing online homework while texting) is linked with obesity risk. In order to combat concerns about obesity, the American Academy of Pediatrics recommends limiting screen time; timekeeping may be difficult due to simultaneous use of devices but should be considered as families discuss and enforce household guidelines.
It is well established that digital media use interferes with healthy sleep from infancy to middle childhood and through adolescence, which, in turn, may interfere with healthy growth, development, and everyday functioning. Children and Screens Scientific Advisory Board Member and world-renowned sleep and media researcher Dr. Lauren Hale and her team at Stony Brook University posit that digital media impacts sleep via three pathways:
- Time displacement: Children and teens are spending time they should be sleeping looking at devices
- Arousing content: Content viewed just before bed, whether it is a television show, a video game, or a message from a friend, is psychologically arousing and makes it difficult for a child to wind down and fall asleep
- Blue light exposure: The blue light that electronic devices emit fools our brains into thinking it is daytime and blocks the secretion of melatonin, which is necessary to fall asleep
Excessive screen use may also be implicated in poor ocular health. Though the association between myopia and digital media use is understudied, it is clear that the more time kids spend outside, the less likely they are to develop eye problems. Encouraging kids to play outside instead of using screens is highly important.
Children and Screens will host a special “Ask the Experts” webinar on kids and eye health on Wednesday, February 10th at noon EST. You can view all of Children and Screens popular webinars here.
2. Mental Health:
When used excessively or in unhealthy ways, digital media can also contribute adversely to mental health, including depression, anxiety, addiction, suicidality, and more.
Kira Riehm and colleagues found in a study of 6,595 US adolescents that those who spent more than three hours a day on social media are more likely to develop mental health problems, particularly internalizing problems such as depression and anxiety. Similarly, utilizing data from two nationally representative surveys of over 500,000 U.S. adolescents, Dr. Jean Twenge and colleagues found that teens, especially girls, who spend more time on digital media are more likely to have depressive symptoms and suicide-related behaviors and thoughts, while teens who spend more time on non-screen-related activities were less likely.
In a 2020 review of extensive research investigating mental health and digital media use, Dr. Twenge and colleagues conclude that heavy media users are more likely to be depressed or have lower well-being. More time on social media may also increase the risk for cyberbullying, which negatively affects mental health outcomes.
For some adolescents, digital media use is also associated with suicidality. Utilizing data from the national, longitudinal ABCD study, Dr. Delfina Janiri and colleagues reported an increased risk of child-reported suicidality with higher weekend screen use. In a study of adolescents in psychiatric care, those who were social media users were more likely to engage in self-injurious behavior. These associations are worrisome and may be related to several different mechanisms. For example, as noted above, digital media use interferes with healthy sleep, which in turn strongly predicts depression and suicidality in adolescents.
Social media is a highly curated representation of people’s lives and the nature of social media encourages social comparison and can negatively influence body image, both of which can lead to depressive symptoms. In addition, the fear of missing out or “FOMO” might be contributing to a spike in mental health concerns among teens. When adolescents see their peers hanging out with each other or doing exciting activities on social media platforms, this often leads to the adolescent feeling bad about themselves or their own life.
This may be exacerbated as some teens are allowed to gather in the midst of the pandemic while others are not. This is concerning, considering that a 2018 study of first-year college students found that more frequent experiences of FOMO were associated with negative outcomes both daily and over the course of the school year – including negative emotion, fatigue, stress, and decreased sleep.
The specific usage of digital media may also impact mental health. Exposure to violent media increases aggression and violence, which in turn likely impacts relationships and mental states. In addition, the prevalence of sexting has increased in recent years; as of last year, one in four teens receive sexually explicit text messages. This is concerning, as higher rates of sexting are associated with risky sexual behavior and internalizing problems.
If excessive digital media use becomes addictive or problematic use, there are profound mental health impacts. Symptoms of addiction, as defined by the 11th Revision of the International Classification of Diseases (ICD), are similar to those of other mental health disorders and are highly concerning. Furthermore, videogame addiction, which is estimated to afflict between 1.96-3.05% of individuals, according to a recent metaanalysis of studies from around the world, has been implicated in other mental health concerns (see recent work in Germany and China). If parents or caregivers witness addictive behavior, they should seek professional help as soon as possible.
3. Cognitive Development:
One of the most worrisome consequences of excessive digital media use is its negative impacts on cognitive development.
Excellent research has shown a myriad of effects, but this field has a long way to go before we fully understand how digital media impacts cognition.
Strikingly, Martin Paulus at the Laureate Institute for Brain Research in Tulsa, OK and his team released early findings from the ABCD Study, a national, longitudinal, NIH study that demonstrated that nine- to ten-year-old children who spend more than two hours a day on digital media had lower scores on thinking and language tests and that those who spent 7 hours a day on smartphones, tablets, or video games experienced premature cortical thinning than those who spent less time on these media.
In younger children, a study based at Cincinnati Children’s Hospital Medical Center led by Dr. John Hutton found that screen time above the AAP recommendations was associated with the aberrant brain structural development in the areas that support language and emerging literacy skills. This team also found that higher screen time was associated with lower scores on cognitive assessments. A 2020 Meta-analysis of children’s screen time and language skills led by Dr. Sheri Madigan revealed that more screen time was associated with lower language scores. Notably, however, better quality screen time, including educational programming and co-viewing television with parents, was positively associated with language development.
Furthermore, an international longitudinal study that included researchers from NYU, Cambridge, and Leiden University in the Netherlands found that regular screen exposure at just four-months-old had a negative impact on inhibition when the children were 14-months old. Notably, regular exposure in infancy was not associated with set-shifting or working memory in toddlerhood. Corroborating earlier research, a follow-up to this study with the British sample found that digital media use at age two-years was related to lower executive function skills at age three-years. The implications of digital media use for executive function do not stop in the early years, though; a July 2019 cross-sectional study of 656 adolescents with a median age of 16.3 years old found an association between problematic use of digital media and impulsivity.
Digital media’s impacts on neurological functioning translate directly to problematic behavior. For example, a longitudinal cohort study across Canada found that children with more than two hours of screen time each day had a significantly higher risk of meeting criteria for ADHD than those with less screen time. In older children, Dr. Ra Chaelin and colleagues found that more frequent digital media use was associated with subsequent ADHD symptoms in the sample of over 2,500 15-16-year-olds followed over a two year period and.
What was the inspiration for the development of Children and Screens?
In the early 2000s, as video games were gaining popularity, and later in 2008, when the iPhone was released, I noticed an intense and unique pull that these new technologies had on children’s lives. I wondered whether the constant availability of technology and the “there’s an app for that” culture would contribute to addiction, attention problems, and other concerns.
Children of all ages and stages are immersed in digital content from every angle, no matter where they are. As a child advocate, medical professional, parent, and philanthropist, I committed myself to learn as much as I could as quickly as possible – which resulted in three key questions I started the Institute to answer:
- How is digital media enhancing or impairing children’s ability to live happy, healthy, and productive lives?
- How are years of electronically mediated interactions shaping children’s physical, cognitive, emotional, and social development?
- What should we do about it?
As I began to speak with experts and read as much literature as I could get my hands on, I realized that there was a real need for interdisciplinary conversation, information sharing, and scientific collaboration. I found many slivers of deep insight, but not enough to synthesize into authoritative, data-driven, practical guidance that parents, clinicians, researchers, policymakers, and others could all utilize to affect positive change. I then made it my mission to advance research in the field and provide a forum for interdisciplinary discussion and public education.
I believe we have made great strides in this effort through our national Congresses, research retreats, Ask the Experts webinar series, seed grants for interdisciplinary, interinstitutional research, and more — and I look forward to continuing our efforts to fully answer each of the questions the Institute originally posed.
Social media is the widest used method of information sharing and communication, do you think that this will change or only evolve if children and teenagers begin limiting their screen time?
I do not think social media is going away anytime soon. These platforms will continue to evolve and serve as an important source of communication for young people for many years to come.
What is a current challenge that you see when it comes to limiting screen time?
The biggest challenge to limiting screen time right now is COVID-19 and its concomitant social distancing and virtual learning. While allowing for safe schooling and socializing, this is a real pinch point in history for digital media use, and there is a chance that families will not be able to easily undo the screen habits that they are currency forming.
Notwithstanding the pandemic, limiting screen use has never been easy due to persuasive design, a set of sophisticated tactics used by device makers, software engineers, and social media platforms to manipulate your behavior and keep you glued to your screen. Our popular, bi-weekly Ask the Experts webinar series and Tips for Parents resources provide excellent advice for parents, researchers, and educators on how to limit screen time and encourage healthy off-screen activities.
What was one thing you did that exceeded your expectations when you began developing Children and Screens?
The impact of the Institute’s work on the field continues to exceed my expectations. Prior to its inception in early 2013, no forum existed for comprehensive interdisciplinary dialogue or advancing interdisciplinary research on this topic, so I am intensely gratified by how the research and clinical communities have jumped at the opportunity. The number of initiatives and collaborations that continue to develop every day continues to impress me.
A prime example is a response we received after our first national Congress in 2015, which we held in collaboration with the National Academy of Sciences. At the beginning of the convening, I instructed the convened researchers, clinicians, pediatricians, government representatives, and others to:
- Assess the current state of scientific knowledge regarding how digital media influence child development
- Leverage the relationships formed to initiate and sustain dialogue among medical researchers, practitioners, social scientists, educators, policymakers, and funders
- Establish a prioritized national research agenda
- Devise practical, actionable recommendations that parents and teachers can use to make digital media a more consistently constructive influence in children’s lives
Afterward, attendees reported that it was the best conference they had ever participated in; they appreciated the opportunity to discuss their work in an interdisciplinary forum and to consider how their research could be turned into action to help families. Since then, Children and Screens held another research Congress and many smaller retreats and workshops that built upon that first convening.
Would you say there are any benefits to significant screen time?
If we consider the benefits only, there are many. It goes without saying that screen use is beneficial for information gathering, socializing, communicating, and entertaining. For curious young people, the internet is a treasure trove of wisdom, ideas, news, and resources and provides a world of opportunity.
In addition, digital media offers ample opportunities for civic and community engagement and for communicating with people beyond children’s and teens’ immediate areas. In this time of social distancing, social media, texting, and video chat have been invaluable aids in interpersonal connection.
Young people may also spend time on digital engaging in creative activities such as animation, coding, video creation, and more.
Of course, each child and teen is unique; and, parents must weigh the benefits of digital media with the inherent risks and ensure that media are being used in healthy ways and important off-screen activities are not compromised in the process.
What is one way that Children and Screens are different from any other organization?
Children and Screens is unique and, as a whole entity, is unlike any other organization.
Here are a few specific ways we engage differently than others:
- Through providing seed funding, we support and advance objective interdisciplinary scientific research designed to answer pressing research questions in the field. The grant proposals are reviewed by an NIH-style review committee by top topical and other experts.
- We convene Congresses, retreats, and workshops that bridge the research, academic and clinical communities that spur scientific collaboration and share the state-of-the-science.
- We do not accept funding from media or technology companies or any group that has a particular financial interest in the outcome of the research.
- Our Ask the Experts virtual workshop (webinar) series and Tips for Parents resources have helped thousands of families throughout the pandemic, and we hope they will continue to do so in a post-COVID world. Our webinars, which as a series are unlike anything I have ever seen, convene interdisciplinary panels of experts on a variety of topics and provide free lunchtime interactive conversations on a bi-weekly basis.
- We boast an esteemed Scientific Board of Advisors, which is composed of interdisciplinary, highly prolific, experts in the field of digital media and child development, science, and philanthropy. Through our programming, we engage a huge satellite of researchers, clinicians, practitioners, educators, public health experts, policy experts, parent educators, and others.
What are some other activities that parents can have their kids do in order to limit screen time?
There are so many great ways to engage children and teens off the screen. For school, parents can work with teachers and administrators to ensure that as much work is done off-screen as possible. For example, they can request print textbooks and encourage their students to take notes using pen and paper.
After school and during the holiday break, parents can pay careful attention to what their children enjoy doing, and then find ways to incorporate these interests into their daily routines and activities. If they enjoy listening to music, encourage them to create their own songs and dances or to tell you what story instrumental music plays in their imaginations. Find some art supplies for open-ended arts and crafts with no rights or wrongs! Take a nature walk or organize a scavenger hunt that includes their favorite toys or topics.
Involve children in cooking and baking – this is especially nice around the holidays! Set up an outdoor neighborhood soccer game or cul de sac karaoke. Many of these fun activities can easily transform into learning opportunities, too! The best way to limit screen time is to fill the day with other stimulating ideas and activities.
What tech trends are you most excited about for 2021?
Since I was a child, I have always been interested in two technological advances. I have already seen one of them become commercially available – that of video chat. My second wish is for personal flying devices and I am excited to see where advances in that arena take us this year.
On a professional level, I would like to see a better interface between virtual learning and in-person learning for students. I believe there are many new technological inventions on the horizon that will allow children and teachers to engage with one another more easily. I am hopeful for more interaction between online and in-person students and ways for virtual learning to happen that don’t involve hours of sedentary time.
If virtual learning remains as popular as we assume it will, I anticipate that the coming years will bring a number of new ideas and developments that better support children and teachers to make learning as fruitful as possible.
The Fox Magazine is all about inspiration. What/who inspires you the most?
Female scientists, clinicians, and political/government agency leaders inspire me the most.
These women use their intelligence and the opportunities and resources available to them for the betterment of society while overcoming challenges in a professional world built by, around, and for men. I admire the way these women juggle their work, families, and public engagement all while using their platforms to inform the public and inspire young women and men.
Women in the public light who are improving the world around them deserve everyone’s admiration; and, their example encourages me to continue working to serve children and families.
What is your favorite innovation-related motto, quote, or words to live by?
Two similar quotes exemplify why I created the institute: the Chinese proverb “a journey of 1,000 miles begins with a single step” and George Mallory’s response to “Why did you climb Everest?” a simple “because it’s there.”
I saw the mountain in front of me. There was a need for more research and interdisciplinary dialogue that could then be translated and disseminated to the public. I took one single step and then another single step and the rest is history.
What I would say to inspire others is not to listen to the naysayers; rather, listen to yourself and follow your dream! If you have the background, skills, passion, and resources available to you, those are qualities and tools that can help you succeed.
I know that not everyone has the resources available to them to do absolutely anything, but I firmly believe that if you are passionate about something, you can find a way to make it happen.
I hope that my story of perseverance to solve a problem I saw in the world will inspire others to do the same. I recommend analyzing the problem carefully, evaluating and then gathering all of the tools into your toolbox, and developing the resources you need. Once you’ve filled the tool belt, don’t look back or listen to the critics – I believe you can do anything you set your mind to!
Pam Hurst-Della Pietra is a Long Island-based philanthropist along with her husband Stephen, a few recent projects include endowing a chair in biomedical imaging at Stony Brook Medicine, starting the Della Pietra Lecture Series at the Simons Center for Geometry and Physics, which brings the best and brightest minds of our time in science and math to high school and college students on Long Island and developing a weekend enrichment program for gifted high school students in math and science. Pamela also developed the Mount Career Laboratory, a series of hands-on career workshops, which helped that school earn New York State’s Blue Ribbon of Excellence.
She served on the President’s task force of the Stony Brook Children’s Hospital and has also worked as the founding director of several highly successful non-profit organizations and programs. Early in her career, Dr. Hurst-Della Pietra worked in television production for children’s educational programs such as Sesame Street. In addition to being the Founder and President of Children and Screens, she is currently a Clinical Assistant Professor of Pediatric Public Health Department of Family, Population & Preventive Medicine at Stony Brook University School of Medicine.