The debate over digital technology and young peopleBMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h3064 (Published 12 August 2015) Cite this as: BMJ 2015;351:h3064
All rapid responses
It seems clear to me that the conflicting evidence on digital technology and young people is in part due to the wide variety of effects, both positive and negative, that digital technology can have on young people.
Social networking, for example, may be beneficial in reducing isolation and increasing emotional wellbeing in young people who are isolated due to chronic diseases such as cystic fibrosis1. The internet also allows young people to access health information online and whilst this information may not always be accurate, there is evidence that it increases compliance with medications and improved attendence at appointments2. Conversely social media and use of the internet can be harmful in some young people with chronic illness, particularly mental health probelms such as anorexia. Many 'pro-anorexia' websites have appeared over the years and these often promote unhealthy ideals, dangerous weight loss tips and promotion of harmful behaviours3.
Similarly whilst there is evidence that playing video games in associated with a decline in physical activity and an increased risk of obesity,4 there have also been studies showing the positive effect of health video games on obesity. In a systematic review of health video game interventions on obesity prevention, there was a generally a positive effect found although this was only statistically significant in 3 of the 14 studies.5
I feel that more research needs to be done focusing on some of the individual effects of digital technology on young people rather than trying to classify digital technology as 'good' or 'bad' as a whole.
1. Faust, M. A.(2014). The Use of Social Media and the Impact of Support on the Well-Being of Adult Cystic Fibrosis Patients. (Master's thesis).
Retrieved from http://scholarcommons.sc.edu/etd/2758
2. Krishna S, Boren SA, Balas EA. Healthcare via cell phones: a systematic review. Telemed E Health. 2009;15(3):231–240
3. Bond E. Virtually Anorexic – Where’s the harm? A research study on the risks of pro-anorexia websites. UCS. 2012 Nov.
4. Nelson MC, Neumark-Sztainer D, Hannan PJ, Sirard JR, Story M. Longitudinal and secular trends in physical activity and sedentary behavior during adolescence. Pediatrics. 2006;118(6)
5. Shirong Lu A, Kharrazi H, Gharghabi F, Thompson D. A Systematic Review of Health Videogames on Childhood Obesity Prevention and Intervention. Games Health J. 2013 June; 2(3): 131–141
Competing interests: No competing interests
THE IMPACT OF SCREEN TECHNOLOGIES The debate should focus on determining the boundaries between harmless use and misuse
Mind Change was published in the UK in August 2014. A year on, Bell et al. have reacted with an editorial claiming that, seemingly single-handedly, I am scaremongering about internet and computer use and its potentially adverse effects on the brain, emotions and behaviour. The thrust of their editorial is that there is no evidence that “typical internet use harms the adolescent brain”. Tellingly, however, they do not define “typical use” or reflect on the escalating time spent online; these are crucial omissions in the light of reports from Ofcom[2,3] and the House of Commons Health Committee that call attention to the rising level of discretionary screen time preoccupying children. Public Health England recently warned:
“Increased screen time and exposure to media is associated with reduced feelings of social acceptance, and increased feelings of loneliness, conduct problems and aggression. Certain internet activity (social network sites, multi-player online games) have been associated with lower levels of wellbeing. Much more recent evidence suggests a ‘dose-response’ relationship, where each additional hour of viewing increases the likelihood of experiencing socio-emotional problems”.(para 3.7)
These points merit attention given recent research showing that teens are using screen technologies for an average of 10.75 aggregated hours daily. Such findings raise the all-important question – for scientists, healthcare workers and parents alike: where should we draw the boundaries between harmless, indeed beneficial, use and misuse? Change in brain structure and function in response to experience is a well-established phenomenon; it would be surprising if many hours per day of screen activity did not influence this neuroplasticity. High levels of multi-tasking, internet use or playing video games are associated with significant differences in, variously, the anterior cingulate cortex[7,8], dorsolateral prefrontal cortex, supplementary motor area, orbitofrontal cortex, cerebellum and/or ventral striatum. With internet addiction, the reductions in certain prefrontal functions and striatal dopamine receptors and transporters resemble those seen in other addictive disorders[10-13]. As discussed throughout Mind Change, the chicken-and-egg problem applies to many such findings. Nevertheless, evidence indicates that the duration of internet addiction is negatively correlated with grey matter volume at various cortical sites and that attention problems are both a consequence of and a predisposing factor for protracted video gaming, an activity associated with acute striatal dopamine release[15,16]. It is clear that large-scale longitudinal studies are needed for all these aspects of screen use.
Although Bell et al. claim that social-networking “enhances” friendships, it turns out that increased time spent using social media does not correlate with a larger offline network or with feeling emotionally closer to friends in the real world. Real world intimacy and Facebook intimacy are far from the same; the editorial overlooks numerous peer-reviewed publications reporting adverse effects of social-networking on individuals and their relationships. Such studies (for example [18-31]) reveal risks of a more volatile identity, increased narcissism and reduced self-esteem, along with complex distortions of the sense of self. Bell et al. assert that “people generally portray their identity accurately” on the internet. But various studies (for example ) refute this; in a survey of 2,300 11-18 year olds 50% admitted to lying about their personal details online.
Bell et al. insist that it is “entirely implausible” that screen technologies influence the development of autistic–like traits. The response to their editorial from Dr Oestreicher, as recently published in the BMJ, challenges this view; furthermore, links between those traits and exposure to screen technologies have been reported (for example [35-39]). As for video games, Bell et al. state: “multiplayer cooperative games are increasingly common, and evidence suggests these kinds of games might lead to an increase in socially beneficial thoughts and behavior”. But the majority of popular video games reflect a narrow range of human emotions; their dominant narrative concerns a male protagonist engaged in external conflict in a fearful and aggressive way[40,41]. Repeated exposure to media violence has been shown to diminish responsiveness in an inhibitory frontolimbic network; a recent meta-analysis of 98 independent studies concluded that violent video games increase aggression. Bell et al. acknowledge that there are “valid concerns... about digital technology”; in the case of video games they focus on the “displacement” of academic activities, a concern that is beyond dispute (for example ). But it is not clear why they overlook the concomitant displacement of real world interactions with real people and thereby chances to develop socially beneficial thoughts and behaviour. Surely the crucial factors are the content of these games and the time and opportunities that they usurp.
Bell et al. also take exception to my reasoning that reliance on search engines and surfing the internet may foster superficial mental processing at the expense of deep knowledge and understanding, but they concede that “when people know they can access information through search engines they are less likely to remember the content”. They point out that this effect “is not restricted to the use of technology ... people who work in teams are less likely to remember facts when others hold the information”. There is no cause for dispute about these points; Bell et al. clearly concur that memory is vulnerable to factors that include the screen technologies in question.
A further criticism is that I have not submitted my arguments to peer-review. But Mind Change is not a specific research paper; it is a 100,000 word book written to be accessible to the general reader. It presents the results of numerous studies that have already been peer-reviewed, spanning neuroscience, psychology, sociology and epidemiology. These are complex and important topics that cannot be adequately discussed in this word-limited response. Nevertheless, peer-reviewed studies and reviews (for example [6,7,10,13,40,43,45]) published more recently than Mind Change, indicate that it is not a solitary scare-mongering book, but an increasingly validated wake-up-call.
A few years ago, the suggestion that information technology may shape the mind was widely dismissed. Now the question appears to be to what extent, rather than if. Given that the digital world offers a way of life that is unprecedented and multifaceted, we need to be alert to the opportunities and threats it offers. Bell et al. conclude: “the public deserves to participate in the debate fully informed of all the evidence”. I could not agree more. That is why I wrote Mind Change.
1. Bell V, Bishop DV, Przybylski AK. The debate over digital technology and young people. BMJ 2015; 351:h3064
2. Ofcom. Children and parents: Media use and attitudes report. October 2012. Available from: http://stakeholders.ofcom.org.uk/binaries/research/research-publications...
3. Ofcom. The communications market report: United Kingdom. August 2014. Available from: http://stakeholders.ofcom.org.uk/market-data-research/market-data/commun...
4. House of Commons Health Committee. Children's and adolescents' mental health and CAMHS. Third Report of Session 2014–15. Available from: http://www.publications.parliament.uk/pa/cm201415/cmselect/cmhealth/342/...
5. Public Health England. Impact of digital culture. Written submission to Commons Select Committee on Child and Adolescent Mental Health, CMH0085. Available from: http://data.parliament.uk/writtenevidence/committeeevidence.svc/evidence...
6. Rosen LD, Lim AF, Felt J et al. Media and technology use predicts ill-being among children, preteens and teenagers independent of the negative health impacts of exercise and eating habits. Comput Hum Behav 2014;35:364-75
7. Loh KK, Kanai R. Higher media multi-tasking activity is associated with smaller gray-matter density in the anterior cingulate cortex. PLoS ONE 2014;9:e106698
8. Yuan K, Qin W, Wang G, et al. Microstructure abnormalities in adolescents with internet addiction disorder. PloS ONE 2011;6:e20708
9. Kühn S, Romanowski A, Schilling C, et al. The neural basis of video gaming. Translational Psychiatry 2011;53:1-5
10. Weinstein A, Lejoyeux M. New developments on the neurobiological and pharmaco-genetic mechanisms underlying internet and videogame addiction. Am J Addictions. 2015; 24:117-25
11. Kim SH, Baik SH, Park CS, Kim SJ, Choi SW, Kim SE. Reduced striatal dopamine D2 receptors in people with Internet addiction. Neuroreport 2011;22:407-11.
12. Hou H, Jia S, Hu S, et al. Reduced striatal dopamine transporters in people with internet addiction disorder. J Biomed Biotechnol 2012;854524
13. Brand M, Young KS, Laier C. Prefrontal control and Internet addiction: A theoretical model and review of neuropsychological and neuroimaging findings. Front Hum Neurosci 2014;8:375
14. Gentile DA, Swing EL, Lim CG, Khoo A. Video game playing, attention problems, and impulsiveness: Evidence of bidirectional causality. Psychology of Popular Media Culture 2012;1:62-70
15. Koepp MJ, Gunn RN, Lawrence AD, et al. Evidence for striatal dopamine release during a video game. Nature 1998;393:266-8
16. Weinstein AM. Computer and video game addiction - a comparison between game users and non-game users. Am J Drug Alcohol Abuse 2010;36:268-76
17. Pollet TV, Roberts SG, Dunbar RI. Use of social network sites and instant messaging does not lead to increased offline social network size, or to emotionally closer relationships with offline network members. Cyberpsychol Behav Soc Netw 2011;14:253-8
18. Grieve R, Indian M, Witteveen K, Tolan GA, Marrington J. Face-to-face on Facebook: Can social connectedness be derived online? Comp Hum Behav 2013;29:604-609
19. Mehdizadeh S. Self-presentation 2.0: Narcissism and self-esteem on Facebook. Cyberpsychol Behav Soc Netw 2010;13:357-64
20. Clayton RB, Osborne RE, Miller BK, Oberle CD. Loneliness, anxiousness, and substance use as predictors of Facebook use. Comput Hum Behav 2013;29:687-93
21. Skues JL, Williams B, Wise L. The effects of personality traits, self-esteem, loneliness, and narcissism on Facebook use amongst university students. Comput Hum Behav 2012;28:2414-19
22. Buffardi LE, Campbell WK. Narcissism and social networking web sites. Pers Soc Psychol B 2008;34:1303-14
23. McKinney BC, Kelly L, Duran RL. Narcissism or openness?: College students’ use of Facebook and Twitter. Communication Research Reports 2012;29:108-18
24. Bergman M, Fearrington ME, Davenport SW, Bergman JZ. Millennials, narcissism, and social networking: What narcissists do on social networking sites and why. Pers Indiv Differ 2011;50:706-11
25. Carpenter CJ. Narcissism on Facebook: Self-promotional and anti-social behavior. Pers Indiv Differ 2012;52:482-86
26. Panek ET, Nardis Y, Konrath S. Defining social networking sites and measuring their use: How narcissists differ in their use of Facebook and Twitter. Comput Hum Behav 2013;29:2004-12
27. Gonzales AL, Hancock JT. Mirror, mirror on my Facebook wall: Effects of exposure to Facebook on self-esteem. Cyberpsychol Behav Soc Netw 2011;14:79-83
28. Gentile B, Twenge JM, Freeman EC, Campbell WK. The effect of social networking websites on positive self-views: An experimental investigation. Comput Hum Behav 2012; 28:1929-33
29. Valkenburg PM, Peter J, Schouten MA. Friend networking sites and their relationship to adolescents’ well-being and social self-esteem. CyberPsychol Behav 2006;9:584-90
30. Van Dijck J. ‘You have one identity’: Performing the self on Facebook and Linkedin. Med Cult Soc 2013;235:199-215
31. The Government Office for Science, London. Foresight future identities: Final project report. [Internet] 2013. Available from: http://www.bis.gov.uk/foresight/our-work/policy-futures/identity
32. Qiu L, Lin H, Leung AK, Tov W. Putting their best foot forward: Emotional disclosure on facebook. Cyberpsychol Behav Soc Netw 2012;15:569-72
33. KidScape. Young people’s cyber life survey. [Internet] 2011. Available from: http://www.kidscape.org.uk/media/79349/kidscape_cyber_life_survey_result...
34. Oestreicher LM. Re: The debate over digital technology and young people. BMJ 2015;351:h3064
35. He JB, Liu CJ, Guo YY, Zhao L. Deficits in early-stage face perception in excessive Internet users. Cyberpsychol Behav Soc Netw 2011;14:303-8
36. Waldman M, Nicholson S, Adilov N. Does television cause autism? (Working Paper No. 12632). 2006. Cambridge, MA: National Bureau of Economic Research
37. Finkenauer C, Pollman MMH, Begeer S, Kerkhof P. Examining the link between autistic traits and compulsive Internet use in a non-clinical sample. J Autism Devl Disord 2012;42:2252-6
38. Mazurek MO, Engelhardt CR. Video game use in boys with autism spectrum disorder, ADHD, or typical development. Pediatrics 2013;132:260-6
39. Heffler KF, Oestreicher LM. Causation model of autism: Audiovisual brain specialization in infancy competes with social brain networks. Med Hypotheses 2015; pii: S0306-9877(15)00238-8. Epub 2015 Jun 27
40. Sauer JD, Drummond A, Nova N. Violent video games: The effects of narrative context and reward structure on in-game and postgame aggression. J Exp Psychol- Appl 2015. Epub 2015 Jun 29
41. Ip B. Narrative structures in computer and video games. Part 2: Emotions, structures, and archetypes. Games and Culture 2011;6:203-44
42. Kelly CR, Grinband J, Hirsch J. Repeated exposure to media violence is associated with diminished response in an inhibitory frontolimbic network. PLoS ONE 2007;2:e1268
43. Greitemeyer T, Mügge DO. Video games do affect social outcomes: A meta-analytic review of the effects of violent and prosocial video game play. Pers Soc Psychol B. 2014;40:578-89
44. Corder K, Atkin AJ, Bamber DJ, et al. Revising on the run or studying on the sofa: Prospective associations between physical activity, sedentary behaviour, and exam results in British adolescents. Int J Behav Nutr Phy 2015;12:106
45. Loh KK, Kanai R. How has the Internet reshaped human cognition? The Neuroscientist 2015; pii: 1073858415595005. Epub 2015 Jul 13
Competing interests: No competing interests
It is by now well known that infants and children respond and wire their brains in ways that are adaptive to the environment in which they sit. Even as young infants, they are attracted to electronic screen media (ESM) by the glowing, colorful, ever changing, moving lights these devices project. Likewise they are attracted to the music, voices and other sounds coming from the devices’ speakers. These sensory experiences are quite distinct from those of the real world. While watching ESM, the child’s brain has entered a sensory world where the visual and auditory experiences are disconnected from touch, motion, movement, time and position.
There is no social activity possible while an infant or a young child is attending to ESM. There is no eye contact, turn taking, true voices, or opportunities for joint attention. Since ESM can only project images and sounds, the time spent attending to EMS is time away from people and other biological activity. The images seen on ESM can never react or interact with a growing child the way living beings do. These Images can not react to the child’s social bids such as baby smiles, laughs, or babbling.
While we may not yet know the implications of these experiences in terms of overt behavior, it seems likely that EMS modifies something in the exposed child’s brain for good or bad. Certainly there is cause of concern that these experiences are a contributing cause to ASD in the very young and to ADHD and other mental health problems in older children (Rowan, 2010) (Heffler MD & Oestreicher MD, 2015) (Dunckley MD, 2015) (Oestreicher MD, 2012)
Susan Greenfield does all of us favor by calling for attention to the possible dangers of EMS, internet, and computer games. Do we really know enough to say the benefits come close to outweighing the dangers? It seems to me the early 21st century world, a world in awe of technology, is conducting a huge uncontrolled experiment with hundreds of millions of children as the subjects, with great dreams but little knowledge.
Already in the minds of many serious sober students of this issue including Susan Greenfield, the dreams are transforming into a nightmare.
Dunckley MD, V. (2015). Reset Your Child's Brain. Navato, California: New World Library.
Heffler MD, K. F., & Oestreicher MD, L. M. (2015). Causation Model of autism: Audiovisual brain specialization in infancy competes with social brain networks. Medical Hypothesis.
Oestreicher MD, L. (2012). The Pied Pipers of Autism: How Television, Video, and Toys in Infancy Cause ASD. Merced: Self-Published.
Rowan, C. (2010, November 1). Unplug-Don't Drug: A Critical Look at the Influence of Technology on Child Behavior With an Alternative Way of Responding Other Than Evaluation and Drugging. Ethical Human Psychology and Psychiatry, 60-68.
Competing interests: No competing interests
As a clinician working with children and adolescents, I wish to share some of my observations concerning an unregulated use of technology during development.
Many teens that I have directly examined, or about whom I have heard from parents, stay late at night exchanging messages that are often useless from the point of view of fostering friendships or more in general of communicating something useful. The behavioural profile of some of them appears very similar to that of addicted individuals, in that they seem unable to put off their devices, get angry when parents try to convince them to resume more reasonable day/night schedules, and become agitated and irritable when their mobile phone is unavailable. Their attitude is not different from that demonstrated by children and teenagers interrupted by caregivers after hours and hours of video playing.
Speaking with teachers, I have drawn the impression that those pupils who overuse video games, or start the school day after watching TV cartoons in the early morning, do not adapt later on to the slower pace and usually more complex contents of the classroom lessons.
Moreover, keeping the mobile phone on, or the PC internet connection active when studying, expose youngsters to constant interruptions, in a way that instead to go deep into concepts and reaching a whole picture of the topic that they are supposed to examine, they move continuously and superficially from their study, to an incoming mobile message, to a VoIP call, to an e-mail message and so on.
I can see the above - mentioned practices interfering with the work and social life of adults, too, and it is difficult for me to find a correspondence between the research results quoted in the article of Dr. Bell and colleagues and what I am observing in my everyday practice.
Dr. Greenfield statements about technology and the risk of developmental disorders may have been excessive, especially in reference to the insurgence of autism. And we probably need more studies to affirm that “social networking could negatively affect social interaction, interpersonal empathy, and personal identity”, but to believe that our younger generations are ready to withstand the impact of digital technology - induced changes in lifestyle and life hygiene can be misleading. There is not only a risk of physical obesity, but also one of impoverishment of mental and motor abilities.
I am not the first to suggest a link between the use of technology and the reduction of the opportunities for free open air play with the shrinking of creativity and of wide-range motivation that this may entail.
Dr. Greenfield could have restricted her assertions to more substantiated data, but in my opinion she has had the merit to raise a certain degree of alarm, particularly in those parents who seem completely unaware of the risks related to recent changes in digital technology.
Competing interests: No competing interests
The stated aim the article by Bell et al, is to move the debate from the media into the peer reviewed scientific literature. Therefore, it is unfortunate that an online search shows that the article has been headlined as a war between academics.
Focusing on one of the issues raised, the socio-emotional consequences of online social interaction, a survey of 1060 American teenagers aged 13-17 for the Pew Research Centre (an influential source of information for social scientists) http://www.pewresearch.org/fact-tank/2015/08/06/6-key-takeaways-about-te...
show that for the teens themselves, there are both positive and negative consequences of online social interaction. While a majority report that social media platforms have made them more attuned to the feelings of their friends 68% have experienced drama and conflict.
The social reality is that much interpersonal interaction now takes place at distance i.e. the individuals concerned are not co-present in either time or place when interacting with each other and the socio-emotional outcome is sometimes good and sometimes not. From a psychological perspective it is significant that facial expression, tone of voice, bodily movement may be expressed but is not available to the other partner in a dialogue. Over the previous 30 years these factors have been studied extensively in related disciplines; Distance Education, Human Computer Interaction, Communications. Embracing this research agenda could be a useful way forward for psychologists and neuroscientists.
Competing interests: No competing interests