Interview Summary

Download The Handbook of Children and Screens: https://link.springer.com/book/10.1007/978-3-031-69362-5

Kris, let’s start with you. Could you set the stage and give us some sense of how much time children spend in front of screens, children and adolescents, and what devices are being used and what kind of trends are you seeing?

Yes, I’d be happy to. I had better news for your listeners, but as you might imagine, since the advent of the smartphone and social media, the youth digital media use has been increasing each year. Especially as children get older and have increasing demands on their time to use screens. But let’s just start at the beginning of the lifespan and talk about kids under the age of two who shockingly are spending as much as two hours a day on screens. Most spend about 50 minutes, but there’s a significant chunk spending up to two hours. And that rises to three or three to five hours in childhood. And eventually in adolescence, approximately eight and a half hours a day our adolescents are spending online.

Also wanted to talk a little bit about middle childhood children, six to 12 years of age. 70% of them already have a social media account, and we all know social media wasn’t designed for children. And there are restrictions on children under 13 using them, and yet children six to 12 most have an account already. Over half of four-year-olds have a tablet and two thirds of children have their own device by the age of eight; and 90% of teens. This probably won’t be surprising, and yet we should really think about what this means; that 90% of teens are using YouTube, 60% are on TikTok and Instagram, and 55% use Snapchat. I’ll stop by ending on a really alarming statistic.

Oh my, there’s more?

There’s more. I know it! I told you. I’ll be the bearer of bad news so that we can talk about solutions later. But, children are checking their devices as often as 300 times per day.

300 times.

300 times per day, and we’re talking about screen time right now. And we know that when you’re using time to be on screens, you are not doing something else. And we know that childhood is full of challenges and skill building and mastery that requires repetition and tenacity and grit and effort. And the more children are on their screens, whether it’s social media or other entertainment, they’re not doing one of these other critical child development tasks.

That’s pretty amazing. And the fact that the older kids are spending more time on before a screen than they are in school is pretty alarming. And the younger, the really youngest kids, that’s especially alarming. So, Dimitri, why should we fret about this? And I realize that fret is kind of a mild word here. Maybe all I’ll panic would be better. But what are some of the major concerns?

Well, I don’t think panic is ever the right reaction, but the numbers Kris conveyed, you know, I think do paint a, let’s say, concerning story. You know, the simple reality is that there’s only so much time in a day. And if you think about it, teenagers in particular should sleep for eight to 10 hours a day at a minimum. They really should be in school six and a half, seven hours a day. And then when you add the numbers, Kris conveyed, you realize that something’s giving because there isn’t enough time left to spend eight and a half hours a day. The two things at a minimum that are giving are sleep. Kids are losing sleep to be on screens. And I’m sorry to say that they’re losing school while they’re on screens. We just published a paper that used passive sensing to see where and when children are on their screens. And found that the typical child in the United States spends an hour and a half during the school day on their device. And it’s not, before any of your guests ask, on Wikipedia or Encyclopedia Britannica. It’s on the usual suspects of social media, TikTok, etc. So, you know, we talk about displacement, and I think it’s pretty obvious what’s being displaced during school hours. Its time focused on learning if it’s in the classroom, and time focused on being authentically present in real time and space if it’s during recess. School hours are precious in that way, and I think it is concerning that they’re spending that much time in school. And I told you the median. Of course, some kids are above that, a significant half of them are above it. And at the high end, they’re spending 30 to 40% of school time on screens.

Now, some schools have enacted policies. They don’t typically enforce them very well. One of the things that drives me nuts, Kelly, is that as an academic, you know we love to argue amongst ourselves and hem and haw. And this issue about whether or not there’s such a phenomenon as digital addiction is still being hotly debated. Honestly, the only behavioral addiction that’s being seriously considered at this point is gaming disorder. The DSM-5 didn’t consider gaming, considered it, but didn’t include, it said it needed further study in 2013. In 2022, the WHO did include gaming disorder as an ICD-11 diagnosis. But just as further evidence how slow science is compared to technology., I mean gaming, while it’s still an entity, represents a small fraction of most people’s screen time. And the numbers that Kris conveyed, a small fraction of that for some on average was gaming. For some people, it’s their screen use of choice, but for many, it’s social media. YouTube, although I consider YouTube to be a social media, etc. And at the high end when you hear the numbers Kris conveyed in my mind that’s a behavioral addiction any way you define it.

Well, and if you think about things that we all agree are addictive, like nicotine and alcohol and heroin, people aren’t doing it 300 times a day. So it’s really pretty remarkable.

And that’s exactly right. One of the salient criteria for those addictions is that it’s interfering with activities of daily living. Well, you can’t be on a screen for nine hours a day when you’re supposed to be asleep for 10 and at school for six without interfering with activities of day. The math isn’t there.

And things like being physically active and going out and playing.

That’s right. It doesn’t add up. So, you don’t need the DSM-5. You don’t need a psychiatrist. You need a mathematician to tell you that there’s too much time on this thing.

Alright, so Kris, talk to us if you will, about the Children and Screens organization. I have a lot of respect for the organization and its work. Tell us how it got started and what its objectives are.

Well, it’s so great to be on this show with you and get to see you in your day job, Kelly. Because you’ve been an advisor, like Dimitri, to the institute almost since its inception, which is in 2013. As you know, our founder, Dr. Pamela Hurst-Della Pietra, really became concerned as a parent about the way digital media was impacting her children and sought out some answers. Well, what does this mean? Why is this happening? What should I do? And found out that this, of course, is 2013, this is a long time ago. There wasn’t that much research yet. And it was multidisciplinary. In other words, there might be a study among neuroscientists or developmental psychologists, even ophthalmologists. But there really hadn’t been, yet, a concerted effort to bring these different disciplines and the research together to try to answer some of these hard questions about the impact on kids. And lo and behold, here we are, almost 13 years since the advent of the smartphone and social media. And there is an astounding amount of research across disciplines. So, what we do at the institute is we try to translate it as fast as we can and make it actionable for parents, providers, and policy makers. And we do that through our Ask the Experts webinar series where we bring the experts themselves directly to our audience to talk about these impacts and answer questions. We also create printables, you might say, like tip sheets and Research at a Glance Digest, and newsletters and FAQs and we’ve upgraded our website to make it very navigable for parents of kids of all ages.

I even started my own podcast this year, which has been really fun. Dimitri was my first guest, so it’s great to see him here. And we have convenings. We’re having our third Digital Media Developing Mind Scientific Congress this summer where the experts come together in person to discuss issues. And we really try to focus them on advancing research and supporting it, translating it, and positioning the issue as a policy priority. We’ll be in Washington, DC where we know lawmakers are grappling with the impact of digital media on child development, how to make online, products safer for kids and protect their data. The Institute is in the middle of all of this, trying to facilitate more discussion, more results and more support for parents primarily.

Kris, a couple of things occur to me. One is that the breadth of work you do is really very impressive because you’re not only having very hands-on kind of in the real world ex advice for parents on how to navigate this world, but you have advice for and helpful resources for policy makers and for researchers and people. It’s really quite an impressive breadth of work. The other thing that occurred to me is that I don’t think you and I would have any podcast career at all if it hadn’t been for Dimitri helping us out. So thanks Dimitri. Yeah. So, let me ask you, Dimitri, so I know that both you and Kris are committed to an evidence-based approach to making policy.

Yeah.

But technology advances way more quickly than scientists can evaluate it. Much less come up with policies to deal with it. And by the time research gets funded, completed, published, you’re on to eight new levels of technology. So how does one handle this fundamental problem of pace?

It’s a really good question. I mean, I can tell you that we should at a minimum learn from the mistakes we’ve made in the past. And, you know, one of the most critical, frankly, that most people don’t really understand is that we talk about the age at which children get social media accounts in this country. Kris pointed out that actually pre-teens routinely have social media accounts. Social media companies do very little to age gate. They’re trying to do more now, but even the age at which we’ve accepted it is being normative is 13. Few people know where that comes from. That doesn’t come from talking to pediatricians, psychologists, parents about what age is the appropriate age. It comes entirely from COPPA (Children’s Online Privacy Protection Act), which basically was the original privacy act that said that before the age of 13, companies could not collect data from children. So, because these companies were interested in collecting data, they set the age at 13 so as to not have any constraints on the data they collected.

Well, that’s not even common sense-based policy, let alone evidence-based policy. And it’s never been revisited since. It’s very troubling to me. And as things move forward, I think we have to learn from those mistakes. Medicine has a maxim which is do no harm. We use that phrase a lot and I think it’s a good one in this case. I think it’s a particularly good one as we see the new technologies emerging around artificial intelligence. And you know, again, like any new technology, it has incredible upside. We made the mistake and we’re still paying for it, about not appreciating the downsides of social network sites, and frankly, the internet in general. And I would hope we put guardrails in place now. And if you will apply the same standard we apply to other non-technology based products. You can’t introduce a new pharmaceutical to anybody, let alone to children, until you show it’s safe and effective. You can’t bring toys to the world that are dangerous. Why do we have more safety precautions around toys than we do around websites for children?

You know, a lot of it involves changing defaults, doesn’t it? Because if the default is that government or somebody out there has to prove that something is harmful before it gets taken away. That changes everything then if you began at a different point where these companies have to prove that these things are safe.

Correct.

Or they’re permitted. Then the companies would find workarounds and they would play games with that too, but at least that would help some.

Well, it would help some. And at least we’d be philosophically in the right place. By the way, Kris didn’t say it, so I’ll say it. You know, the mission of Children and Screens, lest we sound like Luddites here, is not get kids away from technology. Take away their smartphones. We all recognize that technology is here to stay. I think all of us appreciate the incredible upside that it brings to children’s lives. The mission of Children and Screens is to help children lead healthy lives in a digital world. And part of the reason she and I often talk about the concerns we have is because the pros make the case for themselves. I mean, you know, no one needs to come here and tell you how amazing it is that you could Google something or that you could get somewhere with GPS. I mean, we know it’s amazing and we all rely on it. And none of us are ever talking about getting rid of that stuff.

That makes good sense. It’s like, you know, children benefit from the fact that they can get around with their parents in the automobile. But you want to have car seats in there to protect them.

Exactly. And that’s exactly right. There needs to be assurances of safety and they’re none. I mean, they’re really virtually none. The age getting is a joke. And even if we accept it as effective, the age set of 13 is too young, in my opinion. We started this conversation talking about these medias being addictive, I believe they’re addictive. There are legitimate academics that will debate me on that, and I’m happy to join that debate. But as I said before, it’s a tough argument to win when people spending upwards of 10 to 16 hours a day doing it. I don’t know what you call that besides addictive. We can argue about what percentage are doing that, but nevertheless, once you accept something as addictive, for other addictive things we immediately age gate it above 18 or 21, right?

Mm-hmm.

We don’t believe that the teenagers have the ability to regulate their alcohol or tobacco or gambling, all of which we accept are addictive. In fact, in the case of alcohol, we raised the age from 18 to 21 because we thought even 18-year-olds weren’t able to do it. And yet somehow for this behavior, we think of it as just so different that it doesn’t require greater cognitive capacity. And I don’t believe that.

Yeah, very good point. Kris, let me ask you a question about how you and your colleagues at Children and Screens set priorities because there are a lot of things that one could potentially worry about as outcomes. There’s violence that kids see on social media. There’s cognitive and brain development, social developments, social interactions, and bullying. Mental health, body image, diet, all these things are out there. How do you decide what to work on?

Well, we try to work on all of it. And in fact, we’ve built up a fair amount of expertise and resources around almost 25 different topics. And we also understand that, you know, childhood is a long period of time. Birth to 18, birth to 21, birth to 25, depending on who you talk to. So, we’re able to take those 25 topics and also provide deeper, you might say, resources that address the different stages of development. We’re really trying to do as much as we can. What’s been interesting over these last few years is trying to figure out when to be reactive, when to be proactive. And by being proactive, we go out looking for the research, translating it, digesting it, and creating materials with it that we think are really accessible and actionable. At the same time, as Dimitri points out, there are policy windows and there are opportunities that present themselves that you have to react to. If you just only talk about what you want to talk about to each other you’re missing some of these external opportunities to inform policy and policy makers. Help influence the way that parents and providers are talking about the issue. Framing it in such a way that engages youth and makes them want what we want for them. We’re really excited by increasing opportunities to partner in coalitions with others that care about kids and teachers and nurses and doctors. But we also are speaking directly to leaders in states and school districts at the federal level, at the local level. You would be, I’m sure, not surprised to hear that we are contacted every day by groups that support parents and families. Asking for resources, asking for support, because they’re seeing the impact now over many years on their children, their development. Their academic ability. Their cognitive and analytical ability. Their social emotional ability. Their ability to pay attention to tasks that we all know are critical in building that foundation for essentially, you know, future success. The Institute is being pulled in many directions. Ee try really hard to be strategic about what are people asking us for? What does the research say and how can we get that to them as quickly as possible?

Dimitri – Can I add to that? You know, I want to emphasize that the concern around the effects of screen use on children’s lives is shared by parents on both sides of the aisle. 75% of parents are concerned about the impact of screens on their children’s lives. 35% of teenagers are concerned about their dependents on screens and that it has a negative effect on their lives. Actually by some studies, some surveys, even more than 35 to 50% of teenagers are concerned. And both sides of the political aisle agree in large part of this. And Kris and Kelly, you guys are the policy wonks, you can speak more to that. So it’s a serious indictment on us as grownups and as a society that we have not done more to deliver on this issue. Why? When there’s bipartisan agreement amongst many policymakers. This is not a political [00:22:00] issue to speak of and there is widespread concern on the part of parents and even teenagers. Why is nothing happening? Well, one has to look no further than where the money is. And that’s a problem. I mean, that’s a serious indictment on our political system when we can’t deliver something that is needed and basically wanted by everybody but the industry itself.

We’ll come back and talk in a few moments about the policy issues and where industry gets involved here. But let me take just a bit of a detour from that and talk about the book that I mentioned earlier, because I think it’s such a valuable resource. Now, when I mention the name of this book I’m urging our listeners to write this down or to remember it because you can get the book at no cost. And I’ll come back, Kris, and explain what made that possible and why the decision was to make this an open access book. But Dimitri, let’s begin with you. So you, along with Lauren Hale, edited this book that’s entitled, The Handbook of Children and Screens: Digital Media Development and Wellbeing From Birth Through Adolescence. I think it’s an extraordinary piece of work, but tell, tell us about the book.

It was an extraordinary undertaking. There’s I think 178 or 180 authors. Literally, it’s a who’s who of experts in children and media research in all disciplines. It represents pediatrics, psychiatry, psychology, communications experts, demography, lawyers, neuroscientists. I don’t know who I’m forgetting. Every single discipline is represented. Leading scientists in all of those areas. Virtually every topic that someone might be of interest to people. And we deliberately made the chapters short and easily accessible. So, it is, I think, a great resource for the constituents we serve. For teachers, for parents, for researchers, for policymakers. And it is free. The hardest part of it, to be honest, as an editor, was getting peer reviewers because unfortunately, every expert was conflicted since they all had an article in it. But it was a long time coming. And again, this was really the brainchild of Pam (Pamela Hurst-Della Pietra) and we’re grateful to have brought it along.

So, you go all the way from the neuroscience, how children’s brains are reacting to this, all the way out there into the public policy and legal arena about what can be done about it. And then kind of everything in between. It’s remarkable how much the book covers.

It’s almost a thousand pages. I mean, it is a tome to be sure. And don’t forget to mention, Dimitri, we aren’t even two months post publication, and we have 1.6 million views of the document, despite its gargantuan size. I think that is really a tribute to experts like you and others that have really studied this issue and can speak directly to its impacts. It’s been great to see the success so far.

You know, not a small number of those views is from me logging on.

And then a million from me and then we got there. So, it is free because it’s online and you can download it. You can also order a hard copy for I think, $60, but I’m not sure why you would do that if you can download it for free. But it’s up to you.

So, Kris, it’s unusual for a book like this to be made open access and free to the general public. What made that possible and why was that so important?

We want the maximum number of people to use it and treat it like the premier resource that it is. And the only way you can really do that is to fund it to be open access and find a publisher that does open access publishing, which we did with Springer. I mean, most journal articles are behind a paywall and publishers do require you to purchase either a subscription or the document itself to download it or order it. And we just really wanted maximum access. So, we funded it to be published in that way. And I think honestly, it helped us even sort of create it in the first place. People want to be a part of something that has that level of access and is available so widely. So, I think it was a kind of mutually beneficial. It gets more people to read it, but it got more people to write for it too, I think. Right, Dimitri?

Dimitri – I agree. I mean, you know, the numbers 1.6 million are extraordinary. I mean, Kelly, you’ve been internal editor. I mean, as a editor of JAMA Pediatrics, if an article gets 70,000 views, it’s in our top 1%, you know, 200,000 views is 0.01%. 1.6 million in growing is really extraordinary.

And that’s about the number of people that read my articles. 1.6.

And of course, they’re not all scientists. I mean, many of them are parents and maybe are policy makers, but that’s Kris’s point, you know. The moment anyone hits a paywall, even if it’s a dollar or two, they’re going to walk away. It’s great to see it get so much traction.

Alright, so again, for our listeners, the title of the book is The Handbook of Children and Screens. And it’s really a terrific resource. Alright, so let’s turn our attention to a really important matter. And we’ve sort of touched on this, but who’s in charge of protecting our children? You know, Dimitri at the end of the day help survey this landscape for us. I mean, is it congress, is it the administrative branch of government? What role do the courts play? Are there legal actors taking meaningful action? What’s being done does it come anywhere near, meeting the need. Tell us about what that landscape is like?

Well, there isn’t adequate protections for children. And we talked a little bit about that earlier. There’s been an enormous loophole, unfortunately, created by Congress when they added the Section 230 to the Communications Decency Act in 1996. And that was put in place essentially to provide protections for internet companies. And it basically said that they should be treated like bookstores and not publishers. That they weren’t responsible for content they were just conveying it. And what that means, in effect, was that the companies had sort of carte blanche to do whatever they want. And they’ve used that very effectively, legally, to argue that any restriction, any culpability on their part, is protected by that Act. That they’re exonified for any ill that occurs as a result of their product.

The only exception that’s been made of it, to date, was around sex trafficking on back page, if anyone remembers that. But other than that, social media sites and internet sites in general have been able to say that they’re not liable for anything that’s done. And I think that was a huge mistake that was made. It needs to be rectified. It’s being challenged in the courts presently. My own belief is that, and I’m not speaking as a lawyer, is that when that law was passed, it was under the assumption as I said, that they were just conveying information. No one at the time foresaw the development of algorithms that would feed the information. It’s really not a bookstore when you are making recommendations. Once you start recommending things, I think you’re no longer merely a purveyor of product. You’re actually pushing it.

So, Kris, tell us about the Children and Screens and the role the organization plays in this space. And how do you deal with policy and is it possible to be bipartisan?

Yeah, I mean, it’s essential. There’s no way to get anything done, anywhere on these policy matters at a population level without working in a bipartisan or non-partisan manner, which is what we’ve always done. And it’s easy to do that when you’re following the science, not ideology. And you’re putting the science first and you’re creating resources and tools and support for those mostly staffers, honestly, that are trying to help their bosses get smarter and better at talking about these issues as they evolve and become more complicated over time. It takes more effort to staff a lawmaker on this front. And they’re very anxious to learn and understand because they’re meeting with parents of children who have been harmed. Or frankly didn’t even survive their childhood because of the social media platform. There’s great urgency on the part of policymakers. We’ve heard everything from school phone bans to outright social media bans proposed as policies. And one thing I like to come back to is it’s one thing to want to take action and make your best guess at what would have the best impact. But it’s another thing to study whether or not that policy actually achieved its result. And it’s a part of this that by staying bipartisan, nonpartisan allows us to say, ‘Hey lawmaker, if you’re able to get that to happen, we’d really like to come in and help study whether or not your idea actually achieves the results that you wanted, or if it needs to be adjusted or amended over time.’

Fantastic. That’s so important to be doing that work, and I’m delighted the organization is doing it. Let me ask a question here. If you think about some of the areas of public health that I’ve been following, like tobacco, for example. Opioids more recently. Vaping products. And in the case of my own particular work food policy. The administrative legislative branches of government have been almost completely ineffective. If I think about food policy over the years, relatively little has been accomplished. Even though lots of people have worked really hard on it. Same thing happened with tobacco for many years. Opioids, same thing.  And it’s until you get the third branch of government involved, the judiciary, and you start suing the actors who were causing the harm do you get much action. Not only do the lawsuits seem to have an effect, but they soften the ground for legislative things that then can occur because public opinion has changed. And then those things help make a difference as well. What do you think about that kind of issue in this space?

I think you’re exactly right. I mean, I think the failure of our legislative branch to enact policy leaves us with very few options at this point anyway, except to try to pursue it through the judiciary. There are challenges there. First and foremost, it’s a big and well-funded industry, not unlike tobacco or big food, as you mentioned and there’s this Section 230 that’s given them kind of blanket immunity to date. But there are many, many very large pending cases in several jurisdictions brought by individuals, brought by school districts, brought by states. And those, at least provisionally have gotten further than prior cases have with which have been thrown out based on Section 230. So, we’ll see what happens with that litigation. But right now, my guess is it’s the best chance we have to set some guardrails. And I think there are plenty of guardrails that could be set. Everything that these companies have done to make their products addictive can be undone. Can be made protective. The tobacco company deliberately designed their products to be addictive. While they tried to make the claims that they were less addictive, you know. They made light cigarettes that had holes in the filter so that it would diffuse the carbon and nicotine, but people quickly learned they could cover those up with their fingers and think they were smoking light cigarettes, and smoke more of them. There’s a lot of things that can be done in this space to undesign the problematic nature of the products. And quite apart from the financial settlements, which will get companies attention, I hope that that’s part of any settlement if it gets that far.

It’ll be interesting to see where those go. And, also historically, one important part of these lawsuits is what gets turned up in discovery. And what sort of intent the companies have and how much do they know about harms. And how much do they know about addiction and things like that. And how they might have proceeded in the face of that information that then doesn’t get disclosed to the public. In any event, we’ll see where that goes. Dimitri, what about the argument that responsibility resides with parents. It’s up to parents to protect their kids from this, and government doesn’t need to be involved.

I’ve never understood that argument. I mean parents obviously are children’s most important safeguard, but as a society, we enact policies and laws to assist parents in that. I mean to me, if I made the argument, well, why, why do we have minimum ages of drinking. It’s parents’ job to make sure their kids don’t drink. How would that possibly play out? Look, it’s hard enough as a parent anyway, because kids do get around these laws. But we still have them and it’s a lot easier as a parent. I think most parents would agree their life’s made easier by minimum age restrictions on certain things. We have seatbelt laws. I mean, why do we have seatbelt laws? Why don’t we just tell its parents’ job to make sure their kids buckle up? The truth is its society and parents working hand in hand to try and keep children safe. And I think it also helps parents to be able to say that there are laws around this, and I expect you to follow the laws. So, I don’t think it’s an either or.

Okay, well, I think that’s a very good way to frame it. There are many, many precedents where we protect children. And why not do it here too? So let me end with a question I’d like to ask both of you. So, in this sea of concerns that we’ve discussed, is there a reason for optimism? And Kris, let me start, start with you. What do you think?

Absolutely. I think the young people I’ve met that are leading among their peers are incredibly impressive and are armed with the research and their energy and their own lived experience in ways that are very compelling. At the same time, I think the vast amount of research that has now been compiled and translated and acted upon, whether in courtrooms or in state houses, it’s becoming more, and we’re all getting more steeped and aware of more nuanced information. And finally, I would just say, there is a tipping point. We are reaching as a society, adults and kids alike, we are reaching a tipping point where we can’t withstand the pressure of technology in every aspect, every corner of our day, our life. And we want relief. We deserve relief. And I think that’s what’s going to take us over the finish line.

Good. Well, I’m glad to hear those optimistic notes. Dimitri, what about you?

I can find reasons to be optimistic. I mean, look, the reality is that technologies have enriched our lives in many ways. And I think if we put guardrails in place, we can make sure that future ones do even better. I have a piece coming out in JAMA Pediatrics around the use of AI, which people are very concerned about, I think rightly. But specifically, about the use of AI and people with intellectual developmental disabilities, making the use case, that there are ways in which it could be extremely beneficial to that population. A population I care deeply about in my role as the Chief Health Officer at Special Olympics International. And in particular, let’s say in terms of the doctor patient interaction where it could facilitate their communication with their provider, and it could also help the provider better communicate with them. Look, that use case isn’t going to be a priority for the purveyors of artificial intelligence. It’s a small, non-lucrative use of a technology. But it’s a good one. And if we created the right incentives and put in the right guardrails, we could find many other ways that technology can serve the needs of all of us going forward.

I think the problem is that we’ve tended to be reactive rather than proactive. And to not start with the do no harm first premise, particularly when it comes to children. AI is another example of that where I hope we don’t make the same mistake we made with social media.