their individual presentations varied, each child was essentially in a state of dysregulation — that is, they lacked the ability to modulate mood, attention, and/or level of arousal in a manner appropriate to the given environment or stimulus. Something was irritating these kids’ nervous systems, making it difficult to handle everyday life. All three kids felt miserable and out of control, their families felt taken hostage by whatever had taken hold of their child, and their support teams struggled to identify what was being missed. Yet all three children responded to the same simple intervention. The fact that each child’s nervous system renormalized with an electronic fast suggests that screen-time played a role in the development of each child’s decline.
The Dawn of a New Disorder
Like many other aspects of our fast-paced but often sedentary lifestyle, screen-time is introducing new variables into the health equation. Screen-time affects our brains and bodies at multiple levels, manifesting in various mental health symptoms related to mood, anxiety, cognition, and behavior. Because the effects of screen-time are complicated and diverse, I’ve found it helpful to conceptualize the constellation of common phenomena as a syndrome — what I call Electronic Screen Syndrome (ESS). Importantly, ESS can occur in the absence of a psychiatric disorder and yet mimic one, or it can occur in the face of an underlying disorder and exacerbate it.
ESS is essentially a disorder of dysregulation. Because it’s so stimulating, interactive screen-time shifts the nervous system into fight-or-flight mode, which leads to dysregulation and disorganization of various biological systems. Sometimes this stress response is immediate and obvious, such as while playing a video game. At other times the stress response is more subtle, taking place gradually from repetitive screen interaction, such as frequent texting or social media use. Or it may be delayed, brewing under the surface but managed well enough, then erupting once years of screen-time have accumulated. Regardless, over time, repeated fight-or-flight and overstimulation of the nervous system from electronics will often eventually culminate in a dysregulated child. The sidebar “Characteristics of Electronic Screen Syndrome in Children” (page 17) provides a good idea of what ESS looks like.
One way to think about the syndrome is to view electronics as a stimulant (in essence, not unlike caffeine, amphetamines, or cocaine): electronic screen device use puts the body into a state of high arousal and hyperfocus, followed by a “crash.” This overstimulation of the nervous system is capable of causing a variety of chemical, hormonal, and sleep disturbances in the same way other stimulants can. And just as drug use can affect a user long after all traces of the drug are out of the body, electronic media use can affect the central nervous system long after the offending device is actually used. Furthermore, also like drug use, functioning may not be impaired immediately, and in some cases it may even improve initially, but then become worse. In fact, abuse and addiction of stimulant drugs such as cocaine and methamphetamine have a very similar presentation to that of ESS, including mood swings, concentration problems, and restricted interests outside of the substance or activity of choice.
Characteristics of Electronic Screen Syndrome in Children
1. The child exhibits symptoms related to mood, anxiety, cognition, behavior, or social interaction due to hyperarousal (an overly aroused nervous system) that cause significant dysfunction in school, at home, or with peers. Typical signs and symptoms mimic chronic stress or sleep deprivation and can include irritable, depressed, or rapidly changing moods, excessive or age-inappropriate tantrums, low frustration tolerance, poor self-regulation, disorganized behavior, oppositional-defiant behaviors, poor sportsmanship, social immaturity, poor eye contact, insomnia/non-restorative sleep, learning difficulties, and poor short-term memory. Tics, stuttering, hallucinations, and subtle or overt seizure activity may also occur. Irritability and poor executive functioning* occur in most cases and are hallmarks of the disorder.
2. The symptoms of ESS may occur in the absence or the presence of other psychiatric, neurological, behavioral, or learning disorders, and they can mimic or exacerbate virtually any mental health–related disorder.
3. A child with ESS is often described by parents and teachers as “stressed out,” “revved up,” “wired,” or “out of it.” Family members often remark that they “have to walk on eggshells” around the child.
4. Symptoms markedly improve or resolve with an electronic fast; that is, the strict removal of interactive electronic screen media for several weeks. To have a lasting impact, a three-week fast is typically necessary, but it may not be sufficient in some cases.
5. Symptoms often recur with the reintroduction of electronic media following a fast, particularly if screen-time exposure returns to previous levels. After a fast, some children can tolerate small amounts of screen-time with strict moderation, while others seem to relapse immediately if reexposed.
6. Frequently, the child will be intensely drawn to screen devices and will have difficulty pulling away from them.
7. Certain factors increase risk for ESS. These include male gender; younger age; preexisting psychiatric, neurodevelopmental, learning, or behavior disorders; concurrent or past psychosocial stressors; addiction tendencies or family history of addiction; younger age when first exposed to screen-time; and higher amounts of total lifetime exposure. Possible risk factors include environmentally sensitive medical conditions like asthma, food or chemical sensitivities, and sensory dysfunction. Generally speaking, boys with ADHD and/or autism spectrum disorders are at particularly high risk.
* Executive functions include reasoning, judgment, task completion, planning, problem solving, and critical thinking; they take place primarily in the brain’s frontal lobe.
It’s the Medium, Not the Message
Now that ESS has been broadly defined, let me clarify some terms and address some questions readers may have at this point.
For instance, if mental health issues arise because of screen-time, the first question is often: Is it because of the sheer amount of screen-time, because of the type of activity, or because of the nature of what’s seen? The truth is, research suggests that all screen activities provide unnatural simulation to the nervous system and can cause adverse effects. But contrary to popular belief, content isn’t as important as amount, and interactive screen-time causes more dysfunction than passive.
Strictly speaking, the term screen-time refers to any and all time spent in front of any device with an electronic screen, such as computers, televisions, video games, smartphones, iPads, tablets, laptops, digital cameras, e-readers, and so on. It includes any screen-related activity, whether for work, school, or pleasure. This includes time spent texting, video chatting, surfing the Internet, gaming, emailing, engaging in social media, using apps, shopping online, writing and word processing, reading from a device, and even scrolling through pictures on a phone.* It includes activities like playing electronic Scrabble or solitaire, “educational” electronic games or apps, and reading from a Kindle.
Interactive vs. Passive Screen-Time
In terms of impact, perhaps the most important distinction is between interactive and passive screen-time. Interactive screen-time refers to screen activities in which the user regularly interfaces with a device, be it a touch screen, keyboard, console, motion sensor, and so on. Passive screen-time refers to watching movies or television
