amphetamines, or cocaine): electronic screen device use puts the body into a state of high arousal and hyperfocus, followed by a “crash.” This overstimulation of the nervous system is capable of causing a variety of chemical, hormonal, and sleep disturbances in the same way other stimulants can. And just as drug use can affect a user long after all traces of the drug are out of the body, electronic media use can affect the central nervous system long after the offending device is actually used. Furthermore, also like drug use, functioning may not be impaired immediately, and in some cases it may even improve initially, but then become worse. In fact, abuse and addiction of stimulant drugs such as cocaine and methamphetamine have a very similar presentation to that of ESS, including mood swings, concentration problems, and restricted interests outside of the substance or activity of choice.
Characteristics of Electronic Screen Syndrome in Children
1. The child exhibits symptoms related to mood, anxiety, cognition, behavior, or social interaction due to hyperarousal (an overly aroused nervous system) that cause significant dysfunction in school, at home, or with peers. Typical signs and symptoms mimic chronic stress or sleep deprivation and can include irritable, depressed, or rapidly changing moods, excessive or age-inappropriate tantrums, low frustration tolerance, poor self-regulation, disorganized behavior, oppositional-defiant behaviors, poor sportsmanship, social immaturity, poor eye contact, insomnia/non-restorative sleep, learning difficulties, and poor short-term memory. Tics, stuttering, hallucinations, and subtle or overt seizure activity may also occur. Irritability and poor executive functioning* occur in most cases and are hallmarks of the disorder.
2. The symptoms of ESS may occur in the absence or the presence of other psychiatric, neurological, behavioral, or learning disorders, and they can mimic or exacerbate virtually any mental health–related disorder.
3. A child with ESS is often described by parents and teachers as “stressed out,” “revved up,” “wired,” or “out of it.” Family members often remark that they “have to walk on eggshells” around the child.
4. Symptoms markedly improve or resolve with an electronic fast; that is, the strict removal of interactive electronic screen media for several weeks. To have a lasting impact, a three-week fast is typically necessary, but it may not be sufficient in some cases.
5. Symptoms often recur with the reintroduction of electronic media following a fast, particularly if screen-time exposure returns to previous levels. After a fast, some children can tolerate small amounts of screen-time with strict moderation, while others seem to relapse immediately if reexposed.
6. Frequently, the child will be intensely drawn to screen devices and will have difficulty pulling away from them.
7. Certain factors increase risk for ESS. These include male gender; younger age; preexisting psychiatric, neurodevelopmental, learning, or behavior disorders; concurrent or past psychosocial stressors; addiction tendencies or family history of addiction; younger age when first exposed to screen-time; and higher amounts of total lifetime exposure. Possible risk factors include environmentally sensitive medical conditions like asthma, food or chemical sensitivities, and sensory dysfunction. Generally speaking, boys with ADHD and/or autism spectrum disorders are at particularly high risk.
* Executive functions include reasoning, judgment, task completion, planning, problem solving, and critical thinking; they take place primarily in the brain’s frontal lobe.
It’s the Medium, Not the Message
Now that ESS has been broadly defined, let me clarify some terms and address some questions readers may have at this point.
For instance, if mental health issues arise because of screen-time, the first question is often: Is it because of the sheer amount of screen-time, because of the type of activity, or because of the nature of what’s seen? The truth is, research suggests that all screen activities provide unnatural simulation to the nervous system and can cause adverse effects. But contrary to popular belief, content isn’t as important as amount, and interactive screen-time causes more dysfunction than passive.
Strictly speaking, the term screen-time refers to any and all time spent in front of any device with an electronic screen, such as computers, televisions, video games, smartphones, iPads, tablets, laptops, digital cameras, e-readers, and so on. It includes any screen-related activity, whether for work, school, or pleasure. This includes time spent texting, video chatting, surfing the Internet, gaming, emailing, engaging in social media, using apps, shopping online, writing and word processing, reading from a device, and even scrolling through pictures on a phone.* It includes activities like playing electronic Scrabble or solitaire, “educational” electronic games or apps, and reading from a Kindle.
Interactive vs. Passive Screen-Time
In terms of impact, perhaps the most important distinction is between interactive and passive screen-time. Interactive screen-time refers to screen activities in which the user regularly interfaces with a device, be it a touch screen, keyboard, console, motion sensor, and so on. Passive screen-time refers to watching movies or television programs on a TV set from across the room. Nowadays parents often let their children watch TV shows or movies on an iPad, laptop, or handheld device, but because viewing media this way is more stimulating and dysregulating (for reasons I’ll get into later), I consider this to be interactive screen-time.
Generally speaking, both interactive and passive screen-time are associated with health issues. Research indicates both types are involved in obesity, attention problems, slower reading development, depression, sleep problems, diminished creativity, and irritability, to name a few.1 What is somewhat counterintuitive with ESS, however, is that interactive screen-time is much worse than passive. Many families I work with already limit passive screen-time (such as television) but not interactive. This is because we associate passive viewing with inactivity, apathy, and laziness. In fact, parents are often encouraged to provide interactive screen-time (particularly in favor of passive screen-time), with the rationale that surely this type of activity engages the child’s brain. Children are forced to think and puzzle rather than just watch, so it must be better, right? But interaction is in and of itself one of the major factors that contributes to hyperarousal,2 so sooner or later, any potential benefit of interactivity is overridden by stress-related reactions. Furthermore, interactivity is what keeps the user engaged by providing a sense of control, choices, and immediate gratification, but unfortunately these attributes are the same ones that activate reward circuits and lead to prolonged, compulsive, and even addictive use.3
Burgeoning research comparing the two supports this theory that interactive screen-time is more dysregulating to the nervous system than passive. A 2012 study surveying the habits of over two thousand kindergarten, elementary, and junior high school children found that the minimum amount of screen-time associated with sleep disturbance was just thirty minutes for interactive (computer or video game use) compared to two hours for passive (television use).4 A 2007 study demonstrated that sleep and memory were significantly impaired following a single session of excessive computer game playing, while a single session of excessive television viewing produced only mild sleep impairment and had no effect on memory.5 And a large 2011 survey of American adolescents and adults demonstrated that interactive device use before bedtime was strongly associated with trouble falling asleep and staying asleep while passive media use was not.6 Notably, this study also revealed that adolescents and young adults under thirty were the age group most likely to use interactive devices before bedtime, and they also reported the most sleep disturbance. Moreover, of those experiencing sleep problems, 94 percent also reported an impact on at least one area of functioning: mood (85 percent), school/work (83 percent), home/family life (72 percent), and social life/relationships (68 percent). Not coincidentally, these are the very areas of functioning