to all the factors outlined in figure 4, and most parents can readily appreciate how poor sleep can result in an irritable child. Less obvious, however, is the dopamine connection. When a child is irritable immediately after, for example, video game play, it’s likely due — at least in part — to the rapid rise (during play) and fall (upon stopping play) of dopamine. This is not the natural rise and fall you’d see associated with a healthy stimulating activity, like playing a competitive sport. Rather, it’s similar to the pattern that occurs with older dopamine-releasing medications (short-acting stimulants) that work quickly but wear off in a few hours. When dopamine rises and falls suddenly — whether from game play or short-acting stimulants — the child can become weepy, impulsive, or angry.* It’s as though the sudden fall in dopamine causes the brain to short circuit; every little demand on the child becomes stressful. Since dopamine is needed to execute tasks, when it’s suddenly low, every task becomes overwhelming, setting the stage for a meltdown. No wonder the child fights getting off the device — it’s uncomfortable!
Aside from this “relative withdrawal” of dopamine levels following screen activity, irritability may also be related to dopamine depletion and desensitization of dopamine receptors that studies show develop over time with excessive screen-time.3 Unfortunately, it is literally impossible to “taper” going from screen to no screen, from virtual world to real world, so the transition cannot be gradual and smooth. The rapid and extreme drop in stimulation levels is one reason that even occasional bouts of video game play are capable of causing dysregulation in some children and why moderation doesn’t always work. Our systems simply aren’t meant to handle such extremes.
One teen admitted to me, “You know, I do notice I’m always yelling at my parents when they say anything to me when I’m on the computer. It makes me snappy.” A friend and father of three boys quipped: “We call it ‘game-head’ when the boys are playing video games and then one of them loses it and smacks the other upside the head.” And a grandmother with custody of her two grandchildren related, “When the kids get mouthy, we know it’s the electronics. It’s like it jumbles up their brains, so we remove them when the kids get out of line.” Many parents report crying, emotional sensitivity, and irritability or anger surrounding their child’s or teen’s game play or computer usage, especially when use is prolonged.
Closely related to irritability is difficulty regulating arousal levels. As mentioned in chapter 1, this symptom is one of the hallmarks of ESS. A chronically hyperaroused child may have trouble recovering from being angry or sad, as we saw with Aiden. Instead of experiencing an outburst and then calming down, the child continues to be in a state of distress for a prolonged period. In general, the greater the stimulation — in the form of changing scenes, vivid colors, rapid or sudden movements, multitasking, or multimodal sensory input — and the more often that stimulation occurs, the harder it is to regulate arousal, and the more irritable the child becomes.
Depression
The evidence linking overall electronics use and depression is substantial,4 and virtually all types of interactive screen-time have been implicated: Internet usage is directly correlated with depressed mood, withdrawal or isolation, loneliness, and less parent-child interaction, and the highest users show the most severe symptoms.5 Use of social media such as Facebook is a risk factor for depression and dissatisfaction with one’s life.6 “Light-at-night” studies demonstrate an association between electronics use at or near bedtime and increased depressive symptoms, suicidal tendencies, self-injurious behavior, and physical complaints like headache and leg pain.7 Multitasking and smartphone use have been linked to adolescent depression.8 And excessive gaming is associated with depression, anxiety, and hostility.9 Tellingly, in a large study that followed more than three thousand children over a two-year period, researchers found that youths who became pathological gamers tended to become more depressed and anxious, while those who stopped gaming in a pathological manner became less depressed and more socially competent.10
Note that generally speaking, in children and adolescents depression can present as irritability with or without a depressed mood. In a younger child with screen-related depression, the child may cry a lot, lose interest in activities, become chronically irritable, and withdraw. The child’s parent often says things like, “My son seems to have lost his spark,” or “She’s lost her natural curiosity about life.” In teens and young adults, screen-related depression can become quite serious, as it did for Dan, whose case is described below. Regardless of age, frequently the child will have some underlying social difficulties — due to shyness, odd mannerisms, or a difficult temperament — leading the parents to become overly permissive with screen privileges, which sets the stage for a vicious cycle. Psychologically, the child becomes more and more dependent on screen-time for stimulation or a feeling of connection, or to escape from what is an otherwise boring, unfulfilling, or perhaps even painful life. Eventually, even the thought of living without screen devices may cause the child to feel highly anxious — as though in an existential crisis. Meanwhile, the child’s identity can become so fused with his or her virtual cyber life that normal development is stunted or interrupted; teens who are heavy screen users often make statements such as, “My phone is like my brain. I can’t live without it.” Or, “Being on the computer is the only thing that makes me happy…it’s my life.” In older children and teens, role-playing games may serve as an escape and a place they can control their image and actions, but this can be true for children of any age, who can become obsessed with certain video games or cartoon characters as a substitute for real relationships. As social support erodes, the depression worsens. Studies suggest that children or teens with shyness or social anxiety are at higher risk for screen-related depression.11
Alongside these psychological changes are physiological ones, including dysregulation of dopamine and other neurotransmitters (brain chemicals), compounding depression and a sense of isolation. While dopamine is the “feel good” chemical linked to positive moods, another relevant brain chemical is serotonin. Serotonin is important for socialization, stable mood, a sense of well-being, and coping with stress, and it is low in depression, anxiety, and aggression. Serotonin levels are highest in the mornings, and its production is thought to be boosted by bright morning sunlight and physical activity. Lack of morning light and sedentary daytime behavior may therefore blunt serotonin, contributing to depression, anxiety, aggression, and even suicidality.12 Light-at-night may further depress mood, both because serotonin is made from melatonin (which is suppressed by light), and because sleep disturbance itself is linked to mood issues. As dopamine and serotonin become more and more dysregulated, the child starts to seek out screen stimulation to temporarily boost mood, and screen-time literally becomes a form of self-medication.
Dan: A Curious Case of Depression
Dan was a twenty-year-old young man with mild social anxiety and ADD who — despite a genius-level IQ — was failing out of college. His social life had gone from being fairly active to nonexistent, his sleep-wake pattern was almost completely reversed, and he rarely left his room. Although not actively suicidal, Dan reported he often felt he’d be “better off dead” and didn’t “see much point to life.” What was happening?
Upon graduating from high school, Dan had continued living at home. But without the eight-hour school days and no job to go to, he suddenly found himself with a lot of extra time on his hands. His electronics’ use skyrocketed. Even when his college classes began that fall, Dan continued to spend anywhere from six to twelve hours a day on the computer, playing games, chatting, or reading articles. Dan barely scraped by the first two semesters. By the end of his third, Dan had dropped one class and was getting Fs in the other two. Despite his high IQ, he was struggling to keep up.
He’d also lost a lot of weight, even though he was thin to begin with. Dan’s mother reported that he’d stopped going to the kitchen to
