I was terrified that smartphones would harm my toddler, but the latest research suggests there are benefits
- Smartphones and tablets are irresistible to children, but many parents aren't sure how to responsibly manage their use.
- Plus, scientists don't really know how using interactive screens influences brain development.
- Meanwhile, screen-time guidelines have struggled to keep pace.
- The good news: Experts are beginning to discover some potential benefits for kids from interactive media.
- This is an installment of Business Insider's "Your Brain on Apps" series that investigates how addictive apps can influence behavior.
My smartphone's screen fades to black, closing a magic portal to a realm of singing and dancing beasts. "EHMAAA! EHMAAA!" screams my 21-month-old daughter, angling for her third or fourth YouTube video of Elmo, the red and cuddly high-pitched monster of "Sesame Street."
Elmo is found everywhere in our home because anything that looks like him, even my pitiful drawings of him, elicit her screams of joy. "Sesame Street" is highly rated educational content for toddlers, so my wife and I will occasionally indulge her with YouTube videos.
But I'm worried about screen time, its potential negative effects on her development, and its seemingly addictive nature. After all, many Silicon Valley parents heavily restrict screen use, including Steve Jobs and Bill Gates.
Did we start her on screens too young? How much exposure is too much? What distinguishes good versus bad content? Should we push books, Legos, and other real-world activities for her developing brain? Or is it a lost cause with the planet increasingly awash in touchscreens and interactive content?
"Smartphones are in 98% of homes across the US with children under 8 years of age," Rachel Barr, a developmental-psychology researcher at Georgetown University, told me.
To find answers, I spoke with Barr and other experts, reviewed some of the most popular guidelines and squared them against the latest scientific research, then factored in the realities of parenting.
While some studies suggest heavy smartphone use may stress the brains of teens and adults, what I learned about raising toddlers in the smartphone age dialed back my panic and gave me a lot of hope for my daughter's increasingly digital future.
The murky truth about 'digital addiction'
If you're concerned about how kids use TVs, smartphones, tablets, and other devices, you're not alone. In 2016, the nonprofit Common Sense Media surveyed 620 parents and 620 of their teenage kids in the US. About half of the teens said they "feel addicted" to their phones while 59% of the parents also felt their teens were addicted.
But how the word "addiction" is used by the public - often in a shameful, black-and-white, all-or-nothing context - and how scientists and doctors think about the problem is different.
For example, when looking at substance-use disorders, including drugs like alcohol, opioids, and cocaine, the fifth edition of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5) couches addiction as a spectrum disorder with multiple shades of severity. Some usage patterns lead to problems in some people but not others, or do so to a lesser degree.
Additionally, "digital addiction" remains a fiercely contested concept, in spite of the World Health Organization's recent move to include "gaming disorder" in its own codex of maladies, called the International Statistical Classification of Diseases and Related Health Problems.
"There's a lot of disagreement about what that thing is. There's a larger chicken-and-egg kind of argument," Chris Ferguson, a clinical psychologist who studies the effects of media on children at Stetson University, told Business Insider.
"There's no question that people overdo media, but people overdo lots of other things too - food and sex and work and exercise," he said. "So one question is, is the overuse of media different from the overuse of all these other things?"
According to some evidence, Ferguson said, overuse of technologies like smartphone apps and video games may just be one facet of larger, underlying mental-health problems.
"In other words, a person already has depression, anxiety, [attention-deficit disorder] - something of that sort - before they start having difficulty regulating their media use," Ferguson said. It isn't clear whether the tech itself shoulders any blame, other than being a good escape.
"People are drawn to fun things, and some people have difficulty regulating the use of those fun things," he added.
But such disagreements don't negate a potential for harm, especially among young kids, said Dimitri Christakis, a pediatrician at Seattle Children's Hospital.
"We think a lot about digital addiction in older children and adults, but I think the roots of it, especially nowadays, are going to increasingly be in infancy," Christakis, who directs the hospital's Center for Child Health, Behavior, and Development, told Business Insider.
Screen time and kids' brain development
From infancy through toddlerhood, kids are obsessed with exploring cause and effect, Christakis said. This exploratory phase coincides with a remarkable period of brain development.
My daughter's brain probably weighed about 333 grams at her birth, but it will swell to 1,000 grams by the time she's 2 years old, a 300% increase in mass. Her brain will grow by only another 300 grams or so over the following 18 to 20 years.
By the time she's 3, the synapses or connections between her brain's thinking cells, called neurons, will have multiplied sixfold from birth. Those abundant connections are itching to get organized, and incessantly interacting with the world (including with electronics) is how those refinements happen. But the truth is we still don't know to what extent exposure to smartphones and other touchscreen devices has on development.
"I honestly think that this is one of the million-dollar questions," Barr said. "We know very little."
There's a dearth of data in part because it's difficult to measure the brains of rambunctious children who may be scared by big MRI machines or unable to stay perfectly still inside of them.
Barr is working to change that as the director of Georgetown's Early Learning Project, which focuses on kids' digital-media use at age 5 years and younger.
In the ELP's "media and the mind" experiments, for example, Barr's team has kids interact with custom-built apps while they wear a functional near-infrared spectroscopy (fNIRS) device. It's a stretchy cap lined with bright infrared lights and sensors. The lights illuminate the kids' brains through their skulls, and the sensors constantly measures the emissions to quantify the brain's electrical activity.
The system is quick, comfortable, and safe, so Barr's team is using it on toddlers to measure the effects of different media on young minds.
This new approach hasn't yet been used for long-term studies. But by looking at a kid's behavior, memory recall, and other observations - as scientists have done for decades with TV media - Barr's work offers insights into what is and isn't good for children when it comes to screens.
"Content is really, really critical," she said. "It's just that we don't really know how that is associated with brain development, or changes in brain development, or any of those questions, because we haven't directly measured it yet."
For instance, there's a lot of evidence that having a screen on in the background (such as TV noise) lowers the quality of kids' play, reading, and conversation. It also seems to impair or delay the development of language and executive function, which is a mental bucket that contains noticing details, committing them to memory, and then applying them to future relevant situations.
"We know that babies don't understand [background TV] and it does change their ability to play," Barr said. "That's a real problem. It interrupts their play; it interrupts parents' discussions with their children."
How early is too early?
Parents are pounded over the head with the idea that kids under 2 years shouldn't use screens at all. Actually, the American Academy of Pediatrics' latest - and popular - recommendations for media use in children, published in November 2016, has revised that age to 18 months, advising that screen exposure at 18 months and younger doesn't seem to confer any benefits.
But newer research suggests that age limit isn't so straightforward.
Take one surprising finding from a recent study of 25 families who volunteered to let researchers record short video-chat sessions with grandparents on FaceTime, Skype, and Google Hangouts. The kids were 6 months to 24 months old, yet the researchers said they were "remarkably successful" at following the focus and directions of another person (in this case, their on-screen grandparents), a property called joint attention.
Joint attention is a foundation to learning language, abstract thinking, and a raft of other abilities, including a way to forge emotional relationships with long-distance family members.
Another recent experiment with video chatting and kids 12 months to 25 months suggest they learn significantly more from interactive sessions than watching a prerecorded video of roughly the same lesson.
And supervised video-chatting may even be helpful for older kids, since studies show kids younger than 7 struggle to use telephones to communicate solely through audio.
Christakis was a lead author on those AAP recommendations, which references nearly 50 scientific studies - most of them focused on TV media, plus some newer investigations into interactive mobile devices and their content.
He said that 18-month cutoff was a big revision to the organization's previous recommendations, which advised not exposing kids younger than 2 years old. But, he explained, the previous rule viewed "all screens" equally.
"The childhood screen experience is no longer what it used to be," Christakis said. "There's video chatting, there's reading a book on an iPad, and if we sort of conflate all of these activities as 'screen time,' we're missing the reality of the experience that Skyping grandma is different than watching Baby Einstein."
One reason the recommendations don't match with the research is that the AAP traditionally reviews its guidelines just once every five years, even though technology changes far faster than that. It also takes time, effort, and money to perform and publish large, high-quality studies. "There's clearly been a recognition that's not fast enough in areas like this, where the terrain is changing so rapidly," Christakis said.
As an example, he said that the iPad, coveted by many children, came out eight years ago, in 2010, around the time the AAP published its previous guidelines. New recommendations at least every two years makes more sense, according to Christakis.
How much is too much?
Another often spread recommendation is that kids have their screen time limited to no more than two hours a day.
The AAP's newest recommendations actually halve the "two hours a day" to "no more than 1 hour per day" for kids age 2 to 5 years, and emphasizes a focus on "high-quality programming," including PBS's "Sesame Street" and "Mister Rogers' Neighborhood."
The guidelines also advise shutting off screens at meals, to encourage conversation, and at least an hour before bed, since screen use can delay sleep and lower sleep quality in kids. This is in part because blue-light exposure is known to affect the body's circadian rhythm. (The same recommendations apply to adults.)
The core rationale to limiting screen time, though, is based on many studies of sedentary TV-watching: the more of it kids get, the greater their risk for obesity seems to be, along with delays in language, cognitive, and social-emotional development. But the AAP itself says the research on mobile screens is thin at best, because traditional TV is neither interactive, nor portable, nor as overrun with fast-food advertisements.
To Christakis, it's really a question of how far "good" content can go when kids have only so much time in a day.
"The upside for very young children is being exaggerated when people talk about the educational value," Christakis went on. "If two-thirds of their home time is being spent with an iPad or watching a television program - even if they're educational programs, even if they're high-quality programs - what are they not doing?"
The answer: They are not doing a lot of things "that are really important to young children' cognitive and emotional and social development," he said.
Ferguson, who's know for contrarian views in his field, also takes issue with some the AAP's recommendations, especially with the imperative that content always be educational, all the time.
"Obviously there are certain activities that are going to most likely result in learning for [kids]," he said. "But babies can't do that every hour they're awake. They're going to get frustrated and crazy, and the parents will too. I think that's where sometimes the advice gets pernicious: Advising the parent that the baby always has to be on, and the parent always has to be on, and neither can take a break."
The same holds true for preschool kids. A December 2017 study on screen use by the UK's National Survey of Children's Health is one of the largest and most recent. It questioned 19,957 parents around 2012 about their 2- to 5-year-old kids. It found "little or no support for harmful links between digital screen use and young children's psychological well-being," the study's authors wrote.
In other words, the two-hour-per-day limit is meant to be a guideline for most families on most days, not an ironclad rule of law.
"Each parent makes decisions - rightly - based on how their own child is affected," Christakis said, adding that "some children may not be at risk at all" for extended screen time.
Ferguson also feels that parents should mostly trust their gut on what's appropriate for their kids, and that it's OK to bend the rules now and then and just for fun.
"You're allowed to take a break, and you're allowed to let your toddler take a break and do something goofy for awhile," Ferguson said. "Be strategic, but mellow out a little bit too. Half an hour, an hour spent with a screen isn't going to break your kid."
The benefits of tech
With so much focus on the risks that smartphones may bring to families, it's easy to forget about the potential benefits, including video-chatting.
Touchscreens provide what Christakis calls "contingent responses." When kids touch the screen they make something predictably and reliably happen. That's not only a fun experience for kids, he says, but "has a potential big upside" - used correctly - for learning information and concepts that static media like books, TV, and toys can't offer.
Barr echoed this optimism, especially as smartphones become more affordable. Used thoughtfully, she says, smartphones can help parents build vast electronic educational libraries through apps, e-books, and streaming video. And they can use the devices themselves to get parenting advice and help.
"Smartphones can be really big resources for families who haven't got a lot of other resources," Barr said.
Researchers consistently find that one key to beneficial screen time, especially for young children, is caretaker involvement, particularly a concept called scaffolding, wherein caretakers help a child map what's on the screen to the real world.
The younger the kid, the less her brain will understand abstract ideas, and this seems pointedly so for digital content. So Barr studied screen-based learning in kids with and without a caretaker's involvement - for example, a caregiver saying, "See the cat on the screen? That looks like our cat at home."
Barr found a remarkable difference.
"The baby was 19 times more likely to make the connection and to learn that this thing on the screen had something else that was related out in the real world," she said.
Ultimately, screen time can be perfectly fun and healthy for young kids, especially if it's a way for parents and kids to play together, the experts conclude.
"Consider what is meaningful to your child: What maps onto the real world and the digital world? And consider how you might help them navigate between those two worlds," Barr said. "It's just like any other type of play: You need to be paying attention to what they're learning and what they're figuring out."