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Game Over: Screening for Problematic Screen-time

Are screenings for problematic electronics use asking the right questions?

Game over: problematic video game and internet use
Problematic Video Game & Internet Use: Are We Asking the Right Questions?

Current screening tools for problematic gaming and internet use have proven helpful in both the research and clinical realms, but have limitations.    Screenings are typically developed around behavioral addiction (especially gambling) and impulse control models, but these models may not be sufficient in explaining complicated electronic toxicity phenomenon.  Furthermore, from a clinical perspective current screenings may not be sensitive enough to pick up problematic use in an individual who may be not be “addicted” per se but who nevertheless would benefit from abstinence or a prescribed “electronic fast”.      

Examples of screenings include: Young’s Internet Addiction Test (IAT) and Parent-Child Internet Addiction Test, Jenaro’s Cell-Phone Overuse Scale, and Baer’s Computer/Gaming-station Addiction Scale.  

In practice, it is typically a child—perhaps even be an adult child—who is suffering from too much screen-time—but it’s the parent who brings (drags?) them in.  In the vast majority of cases, the child (including adult children) will not acknowledge that screens are a problem and will lie about usage, effects, and consequences.  Additionally, in the majority of cases the parent has little awareness that screens might be a contributing culprit (if not THE culprit) to their child’s woes. 

Although the questions below may not be stringent enough for a formal research study, they are designed to help parents become aware of how screens may be impacting a child’s mental health and functioning. Here are some questions parents should consider regarding their child’s interactive screen- time ("IST")[1]; they are primarily centered around the child’s affect (mood) and emotion in relation to screens. 

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  1. Does your child become listless, tearful, irritable or even aggressive when they can’t use a screen device? 
  2. Does your child exhibit symptoms of mood dysregulation, poor concentration, oppositional-defiance or disorganization that seem inappropriate for their age, or that seem to be getting worse? 
  3. Would your child identify with the feeling that a device (e.g. cell phone) is “part of my identity”, or “part of my brain” or “I can’t live without it”? 
  4. Is your child receiving mental health treatment but doesn’t seem to be getting better?  Is he or she resistant to medication, therapy, discipline, or reward systems?  Is he or she receiving extra help at school to no avail? 
  5. Do you find yourself saying your child “is just not the same as they used to be” ?
  6. Is your child losing friends because they are super-competitive, bossy, controlling, or defensive?  
  7. Does your child avoid making eye contact, but used to be able to do so? 
  8. Is your child disinterested in other types of non-electronic play or activities?  Have you said to yourself “I’d take it away but she’d have nothing to do” or “I’d remove it but he’d become suicidal/explosive/despondent” or “If I take it away he’ll just lie in bed all day”?
  9. Are you afraid of giving your child consequences that involve removing screen privileges? 
  10. Does your child become extremely argumentative or nasty when you try taking away screen-time? Do they try to rationalize why they “need it” or that “it’s the only thing that makes me happy”? 
  11. Does your child “sneak” playing electronic games?  have they ever found a device that you’ve hidden because they were desperately looking for it?  Gotten around a password or other blocking mechanism in order to get computer access? 
  12. Does your child seemed “revved up” all the time? Overstimulated or spacey?  Have tics or exhibit other abnormal movements that weren't always there or are becoming worse?  Do they have trouble falling asleep or awaken feeling exhausted? 


    Interactive screen-time can have significant negative effects on mood, attitude, organization skills, focus, memory, social interactions, and the ability to regulate oneself when stressed.  In short, IST causes a stress response and may therefore cause dysfunction in school, at home, or socially even with minimal but regular use.  Parents, clinicians, and educators need to be more aware of electronics' impact since addressing it can improve functioning dramatically. 


[1] Interactive Screen-Time (IST) refers to using electronic media devices (smartphones, computers/laptops/ipads, videogames, etc) with which one interacts.  IST may be more dysregulating than passive screentime (e.g. watching  television on a non-interactive device).

 

Victoria L. Dunckley, M.D., is a board-certified child and adolescent psychiatrist specializing in treating children with complex diagnoses and/or treatment-resistant conditions.

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