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.[1] 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[4] 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”.[5](para 3.7)
These points merit attention given recent research[6] 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[7], internet use[8] or playing video games[9] are associated with significant differences in, variously, the anterior cingulate cortex[7,8], dorsolateral prefrontal cortex[8], supplementary motor area[8], orbitofrontal cortex[8], cerebellum[8] and/or ventral striatum[9]. 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[8] and that attention problems are both a consequence of and a predisposing factor for protracted video gaming[14], 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[17]. Real world intimacy and Facebook intimacy are far from the same[18]; 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 [32]) refute this; in a survey of 2,300 11-18 year olds 50% admitted to lying about their personal details online[33].
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[31], 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[42]; a recent meta-analysis of 98 independent studies concluded that violent video games increase aggression[43]. 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 [44]). 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.
REFERENCES
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
14 September 2015
Susan Greenfield
Senior Research Fellow, Lincoln College Oxford, & CEO Neuro-Bio Ltd
Rapid Response:
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.[1] 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[4] 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”.[5](para 3.7)
These points merit attention given recent research[6] 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[7], internet use[8] or playing video games[9] are associated with significant differences in, variously, the anterior cingulate cortex[7,8], dorsolateral prefrontal cortex[8], supplementary motor area[8], orbitofrontal cortex[8], cerebellum[8] and/or ventral striatum[9]. 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[8] and that attention problems are both a consequence of and a predisposing factor for protracted video gaming[14], 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[17]. Real world intimacy and Facebook intimacy are far from the same[18]; 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 [32]) refute this; in a survey of 2,300 11-18 year olds 50% admitted to lying about their personal details online[33].
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[31], 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[42]; a recent meta-analysis of 98 independent studies concluded that violent video games increase aggression[43]. 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 [44]). 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.
REFERENCES
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