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September 23, 2019

Disentangling the Association of Screen Time With Developmental Outcomes and Well-being: Problems, Challenges, and Opportunities

Author Affiliations
  • 1Bronfenbrenner Center for Translational Research, Cornell University, Ithaca, New York
  • 2Department of Communication, Johannes Gutenberg University, Mainz, Mainz, Germany
JAMA Pediatr. 2019;173(11):1021-1022. doi:10.1001/jamapediatrics.2019.3191

Concerns about the association of screen time with myriad developmental, health, and productivity outcomes in children and adolescents date back to the advent of screens themselves. The earliest of these studies was conducted in 1949 as a collaboration between the Columbia Broadcasting System (now known as CBS Corporation) and researchers from Rutgers University. Perhaps unsurprisingly, the study found that having a television increased family cohesion; did not promote viewer passivity; and did not replace other diversions, such as outdoor activities and socializing.1

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2 Comments for this article
longitudinal challenge
Michael Mundorff, MBA, MHSA | Integrated Healthcare Delivery System (retired)
Indeed, such long-term studies pose a challenge due to the constantly changing nature of the devices and software platforms over time. My first screen (besides a television) was a DOS personal computer. Now in addition to the computer, users progress to a smartphone, then a tablet, then a wearable such as an Apple Watch or VR goggles. How to adjust for technological changes (not all changes are necessarily advances) which have yet to occur, or anticipate those in the design of a study?
Do you see patients? Or just work for Instagram?
Rebecca Soskin, MD, IBCLC |
I appreciate the notion presented in this editorial that there is certainly more work to be done. That future studies need access to big data collected by social media and search engines in order to prevent reporting bias, and that researchers need to find new methods to drill down into the nuances of screen media use by individual subjects.

But I disagree with the broad strokes painted here that all of the current data we have finds only small effects of screen time on well being. The author of this editorial disproportionately cites studies that weigh heavily on one
statistic: the percentage of variance (which is always small and then followed by the conclusion that thus the concerns over screen time are unfounded).

But what about the multitude of analysis that report on measures that are more meaningful to primary care physicians (like differences in outcomes based on varying levels of media use)?

I see the author of this editorial works for Instagram. I, on the other hand, work for a community health center in a county where adolescent depression is skyrocketing and suicide among adolescents has increased 200% in the last 14 years. Over the last decade of primary care work here is what I find: face to face interactions, play time and time spent outdoors are replaced with screen time and this is what results, in ascending age order: language delay, poor executive functioning, inattention, low self esteem, anxiety and depression.

When the mother of a 13 year old comes to me and says that all her daughter wants to do is stare at a smart phone and doesn't interact with the family anymore, a 15 year old boy is failing out of school because all he wants to do is play Halo, and a 14 year old threatens self harm if her parents restrict her access to social media...if I tell these families that the percentage of variance in statistical analysis doesn't support their claims of screen time being a problem, how is that helpful? My patients have negative consequences of excessive screen time now and I can't wait for better evidence before I help them. And I can't in good conscience wait for better evidence before I incorporate significant screen time guidance into my routine anticipatory guidance for young ones.

Dr. Christakis, we need research and editorials that are helpful to primary care practice. Publishing editorials by folks who work for Instagram and preferentially cite articles that downplay the effects of screen time (which are very obvious to those of us working on the front lines of healthcare) is not helpful. Long term studies are certainly needed, but we shouldn't wait for their results prior to implementing screen time education and guidance on limits setting for our patients now. Let's not discount the significant number of large scale cross sectional analysis and handful of longitudinal studies that have found significant associations between excessive screen time and negative health outcomes, which validate what we actually see in practice and empower us to continue educating our patients.

Rebecca Soskin Hicks, MD