Child Development in the Digital Age: Dr. Sarah Domoff (Transcript)

We know that children whose parents use parental mediation have fewer negative effects of media use. And that happens through different types of parental mediation, which I’ll briefly explain right now. Social co-viewing just means having a parent present with a child watching TV or media.

Restrictive mediation means setting limits. Parents can set limits on what their children see in terms of content and for how long they use media. And an active mediation is the really good stuff, what we want all children to experience. And that’s having a parent present, explaining the content that they’re seeing, labeling character behaviors as good or bad, explaining the motivations behind characters, and really inserting the family’s values into what they’re seeing on TV to really put that into a context for the child.

So, parental mediation can be really wonderful and is necessary. Yes.

Audience Question: Are these studies all done in correlation with schools and how schools use media?

Dr. Sarah Domoff: Not yet.

Understanding Parental Mediation in the Digital Age

So, these are a lot of the reasons, a lot of this is based on parent report of use, children’s use at home. Correct. We don’t know much about what parental mediation looks like today in our digital environment. We have some ideas of how parents manage internet exposure, but we still have a lot to learn.

And so, that’s where study one comes in. We know that research has been focused on mediation of TV use and video games. And again, this is primarily through self-report. But we don’t know what it looks like in real time in households.

And so, the aims of the study, the first study I’ll present to you, include using observational methods, actually witnessing how children use media in the home and how parents mediate or do not mediate their content. And then, identify themes of measured parent-child interactions around media use that are salient in this digital age.

So, like I said, we have research on how parental mediation works for TV exposure, but does it still occur to the same degree for other types of media? And what’s it look like right now in households in the United States?

Demographics and Tools Used in the Study

So, in this study, it was an observational study. I’ll get into the methods of how we captured household media use in a second. So, it was a smaller sample. We had toddlers and preschoolers. And approximately 50% were male. Majority were non-Hispanic white families. And most mothers in the study report having a high school degree or higher. This is what I’m really excited to share with you today.

Utilizing LENA Technology for Observation

Has anyone heard of the Language Environment Analysis, or LENA, technology? It’s really, really cool. So, it audio records the home environment to provide a deeper understanding of contextual and parent-child interaction factors, potentially salient to media use. So, children in our study wore the device.

It’s right there on the bottom of your screen. And little kids put it in a shirt that they’re designed to hold the recording device. And they wore it for a couple of days at home. And it recorded all things in their environment.

Now, what’s really cool about LENA for people like me that study technology and media use, is that it tells us when in the hour of the recording, an electronic media signal is present. So, we can isolate segments of the audio environment that have media presence. And we can transcribe or look more deeply at what’s happening when TV is on. What’s happening when there’s electronic media that’s audible.

And so, that’s exactly what we did.

Audience: Question: Could you explain the different bars? What the different colors mean?

Yeah. So, the yellow indicates the presence of electronic media. And so, that’s what I was really interested in. There’s other types of codes that they have for different types of things in the environment based on acoustic signaling. I was focused on the yellow bars.

Finding those hours when we had media present. Because I want to know how do, if at all, parents talk to their children about what they’re seeing on TV or any other type of device that provides audible electronic media. So, what we did, we had a lot of data. So, we focused on the first hour in which a media signal was present.

And we transcribed parent-child communication about media during that segment. These transcripts of parent-child verbal interactions were reviewed by cross-disciplinary experts. So, people in community, somebody from communication studies, developmental behavioral pediatrician, and clinical psychologist reviewed the transcripts and identified themes of interactions around media use. So, I want to present to you the four themes that emerged.

Findings on Parental Mediation

What did we actually see in these homes? So, as I mentioned, parental mediation is really important. And I talked to you about some different types. Active mediation being wonderful. Restrictive mediation and social co-viewing. What we heard and what we read in the transcript was that parental mediation was primarily restrictive. It was tech-focused, meaning a lot of it was focused on how to use technology, not really the content of what the child was viewing. So, to give you some examples.

So, we have a mother saying to her toddler, ‘No, no pressing buttons now, just talk to Nana,'” regarding a child talking on the phone with grandmother. “‘Come on, give me the phone. Play a game on the mother’s phone. Push next, I’m going to tell you how to play.'” So, it was really focused, the communication around media was focused on instructing the child to use the device and not so much about what the child was seeing on the devices.

Does that make sense? How to use the phones in different ways that we charge a phone, for example. So, a mother would say, “Okay, someone needs to plug the phone in. It is plugged in. You have to jiggle it a little. It vibrates, that means that it’s plugged in.” So, helping children learn about how to use mobile devices, but not so much what we’ve studied before about talking about what they’re seeing on the mobile devices.

So, in sum, parental mediation was primarily restrictive, so setting limits on use and focused on using, actually using the technology versus talking about the content.

Active Mediation and Child Elicitation

Now, when we did hear active mediation, though it was uncommon, when we did hear it, it was because the child asked for it or elicited it. Typically, when we study parental mediation, we think about the parent kind of proactively saying, “Okay, sit down with the child, and this is how, this is what you’re seeing on TV or whatnot.” In our research, we found that it was more often the child that was asking the parent to join in with them in their digital world. So, for example, a child said, “Now what happened?” in response to a scene in James and Diane Peach?

And the mother explained what happened. So, that’s kind of part of this active mediation piece. It is the child bringing it about. “Child saying, ‘I can’t watch this one.'” And the mother asking, “Is it scary?” “Uh-huh.” “Oh, I don’t like the villain.” So, these may seem like pretty simple statements, but really what it’s showing is that children are trying to get more parental interaction around their media use, what they’re seeing, and they’re eliciting it.

Now, it probably doesn’t come as a surprise to most of you, but we heard a lot of negotiation between parents and children about screen time. So, for example, we had one interaction, a mother saying, “Okay, trying to set limits. You get five minutes of TV. It’s too late already today.” And the child’s saying, “I want to watch TV for ten minutes.” “No.” “What about nine minutes?” “No.” “Can I play on my iPad?” “What do you guys think?” “Yes. You may play on the iPad.”

Isn’t that something? And the child spends time on the iPad. And it’s not watching pro-social or educational media in this example. It was actually a glorified advertisement.

So, think about that and how parents perceive, or may perceive, mobile technology and its benefits when, if you’re not seeing what the child’s actually viewing, what they could be exposed to, right? So that was the third thing. When we did hear this back and forth, it wasn’t processing content. It was, “I want to get more time,” or, “Can you give me this mobile device?”

Parallel Family Media Use

What I think is really kind of descriptive of what at least the households we observed looked like was what we’re calling parallel family media use. So, we observed children being exposed to multiple types of screen media in the home with devices being used at the same time by different family members across all the age groups. So, this is a reminder, this is including children as young as one year of age. So, examples of this type of parallel family media use include preschool-age children being exposed to other family members using their own devices while they independently viewed media.

So, we heard siblings use separate devices at the same time. So, it’s this concept of together alone. They’re together but they’re not present with the same media. What is of great concern to clinical psychologists, people that study a child’s academic functioning, and what can get in the way of success in school is what we saw around media multitasking, and I’ll define what that is.

I’ll give you some more examples of the negative impact of media multitasking in a few slides. We often heard TV on in the background while children and their parents were using mobile devices. So, children at young ages are media multitaskers. They are playing with a device and watching TV, using multiple media at the same time, media multitasking.

Implications of Media Multitasking

And this is really concerning because we know that that has negative associations with a variety of cognitive outcomes for at least adolescents and young adults. This is showing that this needs to be studied at younger ages because it’s happening today with younger children. So, this observational study gives us some evidence that there are changing practices in how families use media. Now granted, this is a small study.

We definitely hope that this encourages people to do larger-scale studies using surveys if they can, to capture some of the things that we saw here, to see how widespread it is, predictors of this type of use in the home, and what that means for the child’s development. We did hear a limited amount of parent-child engagement around media use. When it did occur, it was because the child asked for it, and the child got it to happen. We actually also heard siblings mediating the content for their younger siblings.

And so, siblings may be playing an even greater role in media management in the household today. Multiple media, mobile devices, may challenge parental mediation efforts. So, it’s really hard to mediate content that you can’t see if you’re on your phone across the room and your child’s on a tablet. So, it’s really challenging parental efforts to manage and talk about what the child is seeing.

Thinking about what the media use was like in these homes, it made me wonder if I were to call a family up and ask them how many hours they used screen media that day, I don’t know if they’d be able to tell me accurately. Because if most of the family members are using their own media, how can you report on your child’s media use if you’re using media? It was just really remarkable how much media and different types of media were being used that it’s really going to necessitate us using things like passive sensing, which automatically captures what people are doing on their phones and can give that information to researchers to capture that amount of use and what type of use. And in one of my future studies, we will be using an app to capture this on adolescents’ phones.

Questions and Answers

So that way, we won’t be as reliant on self-reports. “Yeah, quick question. When the children were advised to study the interaction between parents and child during their media use, did they take into account the context of what they’re watching? Like if it’s informational and you don’t have to interact with the kids much because it is a teaching video or something compared to watching a movie where you kind of need to explain what’s going on.”

“Did you all take that into account?” “We did not take into account the content, but I do want to emphasize that even if it’s pro-social or educational media, we do want parents present with that child one-to-one talking to them about what they’re seeing because kids retain information from positive media like that or instructional media better when they have an adult scaffolding the content and talking to them about it. So even though it’s better content, we still would highly encourage parents and teachers to be present with that child, processing the content.” “That’s a great question, though.”

“Yeah? You might have said already, what was the link for the study as far as kind of the link?” “So, it was just the first hour in which a media signal was present. Okay.”

“And then also, what level of information was given to the parents prior to the test? Just obviously like the bias in knowing that they’re being What level did they know?” “That we were going to observe and listen to whatever was in their child’s environment. So, it’s been coded for other types of how children are communicated to about different types of things besides media.”

“Parents have the option to not submit. Obviously, they could decline participating in this and not share certain segments if they didn’t want us to hear them. But yeah, I think you bring up some good points about the observer effect, like how you made a great, great point. So, there are limitations, obviously.”

“The goal with this type of research is just to try to describe a new phenomenon in our society and encourage other people out there to study this, to quantify it across the population. We definitely want, I’m really interested in how often this family parallel media use is happening and what impact that has on how parents and children interact with each other and their relationships and the child’s social development. That’s definitely to come. I’ll take another question before I move on to my conceptual framework.”

“So, parents weren’t told that they were observing the media use?” “Correct. Correct. Okay.”

“So, parents couldn’t monitor that, obviously. They were told that you were being monitored to make a request?” “Say that one more time?” “You said it was self-reporting.”

Parental Awareness in Observational Study

So, the parents, so the children wore the device all day in the home. So, they had, the parents knew that the child was recording what was in their environment. But it wasn’t like we told them, “We’re going to look for when you talk to them about this,” or, “We’re going to see how you talk about feeding practices.” We didn’t tell them specifically what we would be transcribing.

“Does that answer your question?” “Yes.” “Okay, awesome.” So, I want to just present this to you to give you a kind of dive into how I think about and study children’s media use.

The Changing Landscape of Media Use and Child Development

So, we know there’s a lot more screen time today than there was when we were younger, that children at younger ages are gaining access to mobile devices, and family dynamics around media use have been changing. So, what does that mean for a child’s development? There are three different mechanisms that have been studied, and that I’m interested in studying, looking at how does actual media use in children affect their development. And there are three different mechanisms or processes.

The first one is called time displacement. So, if children are spending time watching TV, they’re not spending time doing something else that could be good for their development. So, if they spend most of their time playing video games, that’s not multiplayer, just single-player video games, they’re not spending time socializing with other peers. So, it’s this idea of we take time away from something that could be beneficial to the child. What I’ve been seeing a lot more in the research, and the two mechanisms that I look at specific to how media use affects a child’s health and their well-being, are these bottom two mechanisms. And I’ll talk about those more in-depth later.

Content and Context of Media Use

So, one is that it’s not so much how much time children use media, but what they see. So, the content. Content matters. And the second is interference with other contextual behaviors.

So, with mobile devices, viewing media through your mobile device, you can take that anywhere. And when you use the mobile device, when you view media, can matter maybe more so than how much time you spend with that media. And I’ll tell you what I mean in just a second. So, in terms of content, many of you have probably heard about how viewing violent content can influence antisocial and aggressive behavior in children.

We also see negative associations between viewing violent content and school achievement. We see that viewing violent content or aggressive content can negatively influence executive function, especially the ability to focus and sustain attention. So, there’s a lot of research on how content matters. This is true for viewing sexually explicit media.

Viewing commercials can have a negative impact on children because it makes them want to desire requests of things that are advertised, like fast food. But I do want to point out, and I do focus a lot on the negatives, but I should point out that we see positive outcomes for positive content. So, content matters. Educational programming for preschoolers can have a positive impact on cognitive development, including vocabulary, literacy, social behavior, academic knowledge.

And so, programs like Sesame Street or Mr. Rogers, those are pro-social educational programs that have been developed by people that know about child development and how to promote these positive things for kids. So, content matters in both good and bad ways. What a lot of my next studies will be focusing on is how and when children and adolescents use media.

The Impact of Media Use on Sleep and Academic Performance

The context. The context of media use matters. I want to focus on bedtime because that’s going to be one of my big projects next semester in our tech and teen study. We’re going to be looking at how adolescents use mobile devices after bed and if that affects their sleep and their functioning the next day using passive sensing, so automatically tracking what they do on their mobile devices.

What we do know from prior research is that having a television in the bedroom is a major health risk. It predicts increased obesity risk beyond overall TV viewing time. So, again, the context matters. Screen media use around bedtime may stimulate children, especially if the content is fast-paced or violent, which has also been found to associate with greater sleep problems in preschoolers.

And what do sleep problems look like in kids when they go to school? What do those kids look like, kids that don’t get enough sleep? Hyper, hyperactive, impulsive. So, we have sleep is so important for everything, right?

And so, media use around bedtime, the context of when you view media, matters for a child’s development. We know that shorter sleep duration is associated with metabolic disturbances, and sleep deprivation has been associated with increased desire for high-calorie foods along with decreased activity in the frontal cortex and insular cortex regions of the brain, responsible for evaluating hunger. “So, I don’t know if you all have experienced this.”

“When you don’t get enough sleep, the next day you want to eat junk food, or you may not feel as full as you would if you had enough sleep.” So, you’re seeing media use, especially with its impact on sleep, being a big mechanism linking screen time to child health and development. And it’s not just bedtime. Think about any context that’s important for child development and child functioning.

Media Use and Its Effect on Academic Outcomes

Think about academic-related time. We see a negative effect on academic outcomes when youth use media or mobile devices when learning or studying. The majority of college students report using electronic media while in class, studying, doing homework. “That sound about right?”

And this may begin as early as five to eight years of age. And many children have to deal with background TV, background media while working on homework, which has been shown to slow them down and decrease accuracy. And then, media multitasking, which I reported to you as being common even in younger children, has been found to be negatively associated with older students’ GPA. So, again, the theme of it’s not how much necessarily, but when children are using media that may have an impact on their health and development.

Media Multitasking and Cognitive Abilities

I want to talk a little bit more about media multitasking. This is common. Of the eight hours that youth use screen media per day, 29% of the time involves media multitasking. So, heavy media multitaskers, those who watch and use multiple media at the same time a lot, show differences in their cognitive abilities.

So, this is important for people like me who do testing and assessment of what may be causing problems in academic success. Heavy media multitaskers often have poor working memory, poor interference management, they have difficulty on tasks requiring sustained attention, and they underperform on tests of relational reasoning, inhibitory control, and long-term memory. So, basically, it’s not just how much, but it’s how youth use media, when they use it. That can have an impact on different outcomes for them, right?

Clarifying Media Multitasking Research

“Yeah? Just a clarification here. You’re looking at a – so the heavy media multitaskers is identified as a population, and then you’re using that population and giving them independent assessment outside of media use and comparing them to a low media use population.” “Yep.”

“So, these results have nothing to do with the technology itself. It has to do with that relationship between that population.” “Exactly. Does that make sense to everyone?”

Media Use and Cognitive Issues

“Yeah? So, I just had a thought in my head. So, it’s important to know, especially if, like, kids who have cognitive issues, you can kind of pinpoint what’s going on in their environment that can contribute to those versus someone who is, like, has predispositions to have, like, ADHD or to have those kind of.” “Yeah.” “So, when you evaluate people, you can, like, see what’s going on in their environment, and that might be a contributing factor.”

“And when you change it, it would change the behavior, and then actually that person, you know, actually didn’t really have ADHD. It was just because of what’s going on in their environment. And that’s a hypothesis that needs to be tested. This is what the results suggest that definitely need to be tested in greater detail using intervention designs.”

Differential Susceptibility to Media Effects

“Now, I should note that there are some youth who are susceptible, more susceptible to media effects. There’s this differential susceptibility to media effects model. Basically, in a nutshell, means that youth who may be most affected may also be naturally drawn to this type of use of media. So, youth who have ADHD symptoms may be more drawn to or use initially more, play more video games that are fast-paced.”

“But we see this kind of cycle where they may be initially drawn to it, but it is associated with poor functioning over time. So, there’s definitely individual differences here that need to be studied. I do want to point that out. Thanks for the question.”

“Yeah, I’ll take one more question, then we’ll move on to the next objective. Those are young adults. So, this has not been studied in children yet, and that’s definitely something that needs to happen. Like college-age students.”

“So, we have a lot more to study in terms of what this looks like in children. Great question. So, the second objective I had for you for this presentation is we know that youth are using media a lot, and we know different ways that media may affect children. But when does it become problematic?”

Problematic Media Use

“When does it become a clinical concern, if you will? Obviously, content matters. When they use it matters. But what about those youth whose parents say they think that they may be addicted to using social media or using mobile devices?”

“What’s normal versus not? Well, in the literature, there’s been three types of problematic youth defined. One is this excessive or addictive-like youth. Youth that interferes with functioning.”

“Risky youth. So, for example, youth while driving, sexting. Youth that can harm the user themselves or others. And then antisocial youth, which cyber-victimization, cyber-bullying would fall under.”

“Youth that harms others on purpose. I should make a point to say that a lot of youth spend a good amount of time using screen media, and their youth doesn’t seem to appear and interfere, if you will, with their functioning. So, it’s not that all children show these types of problematic media use. It’s a small proportion, but it still matters.”

“We see a lot in the media that’s really blowing up of how media use is all bad and that all kids can be addicted, and that’s definitely not the message I want to give you today. I want to talk about what are the different ways and behaviors that may indicate a problem with using media, with the caveat that for most youth, it doesn’t become a problem. So, the examples I’m about to give you are really more clinical examples. Okay?”

Research on Problematic Media Use

“So, in terms of problematic media use, most of this research has been studied or done in adolescent populations. Pathological gaming or video game addiction has been the type of problematic media use that’s been studied the most. So much so that in our diagnostic manual, in Section 3, they have an internet gaming disorder listed. Now, this is not something I could diagnose right now, but it’s something that they want to have more research on and to see if this is an actual disorder that exists that we’d want to include in the DSM-6.”

“Given what I shared with you about children at younger ages using mobile media, the question comes up as to could these symptoms manifest in children, younger children, so children under age 14. So, could we apply these nine symptoms, these nine criteria, to kind of quantifying problematic media use in younger children? So, this is where my second study that I’ll be presenting today comes in. My collaborators and I developed the Problematic Media Use Measure, PMOM.”

“Now, as I mentioned, these items were generated based on the criteria of internet gaming disorder in DSM-5, and the content used to generate these items are questions drawn from the literature on problematic media use, clinical experiences, so working with families whose children had issues with gaming or other types of media that were causing problems in their lives, and interviews that we did with mothers in Michigan about their experiences in managing excessive use of media. Six of the items were generated. We sent them to experts around the country, experts from different disciplines but who studied behavioral addictions or media-related or screen media-related addictions, and they gave us feedback, and we revised it. And this is before we actually carried out the study.”

“To give you some background, this is the measure instructions. Now, we wanted to keep it broad enough so that it could be used as a screener, that clinicians, pediatricians could use this as a way to see what symptoms were being endorsed by parents if they needed to talk to them about it in more depth in the office. So, this is a parent report form, and we asked them to think of any type of screen media or devices that their child uses, and we asked them a variety of questions that tap into those nine criteria. So, this is what the PMOM short form looks like, nine items, one item per symptom.”

“And so, the types of questions are not, ‘

How many hours does your child use media?’ It’s, ‘What are the behaviors around media use that may cause problems in the child’s life?’ So, ‘My child’s screen media use interferes with family activities. It causes problems for the family.'”

Understanding Problematic Media Use

The child becomes frustrated when he or she cannot use screen media. We heard parents talk about how the child won’t go to sleep at night in order to keep gaming, refuses to go to school in order to keep playing video games or use a tablet. “When my child has had a bad day, media is the only thing that seems to make him or her feel better.” So really, symptoms of problematic use.

You see how this is different and more clinical than the typical questions we may ask just about overall media time? So in terms of the method, and this was just recently published in the Psychology of Popular Media Culture, we recruited parents, mothers, for the first part of the study, ages 4 through 11 years old on Amazon, MTurk. They completed the PMOM, the full measure, and additional measures to test validity. So they answered questions specifically about the child’s screen time, about if they had concerns about the child’s media use, and then psychosocial functioning difficulties with the Strengths and Difficulties Questionnaire, basically capturing those subscales of potential problems in the child’s life, so peer relationship problems, hyperactivity, impulsivity, emotional symptoms, and so forth.

Study Sample and Findings

We had 291 mothers who reported on their youngest child in the home. Most commonly used media in this sample was tablets, not different from television. More recently, television was still the most popular used media, but now it seems that tablets are reaching the same level. Sixty-nine percent of children in this sample owned their own mobile device, again, showing how common this is, and at younger ages, children are owning their own devices.

And on average, children received their first mobile device at age 7. Average daily screen time was 5.47 hours in this sample. So, we did a variety of data reduction analyses to select the items that were most consistent with this concept of problematic media use as an overall factor. We found, to test convergent validity, we looked at correlations between the PMOM score, so how parents reported on that measure about children’s problematic media use, and screen time.

Validity and Reliability of the PMOM

And mother reported worry about child media use. To determine incremental validity, we did multiple regression analyses to determine whether that measure we developed accounted for significant variance in these child’s functioning over and above screen time. Exploratory factor analyses indicated that this was capturing a unidimensional factor structure, just meaning that these symptoms capture this overall construct of problematic media use. We selected the three highest loading items for symptoms to create a final scale of the 27 items for the full scale and a nine-item version for the short form.

We saw great internal reliability and evidence for convergent validity that higher scores on the problematic media use measure associated with more screen time, which makes sense. If parents report problematic media use, more likely than not the child has a lot of screen time. And mothers only reported worry about their child’s media use. What’s really important is this table here in terms of incremental validity.

The PMOM’s Predictive Ability

More often than not, pediatricians or even researchers like myself measure or quantify children’s media use by how many hours they use screen media. For a while, it was just the number of hours that was defined as the problem. There have been guidelines that pediatricians had about how many hours was too much. And so, typically we ask parents, “How many hours does your child use screen media?” as a proxy for what could be a problem or what could interfere with a child’s functioning.

What we found with the PMOM is that it did a better job in predicting total dysfunction in a child’s life than total amount of screen time. So, even when we controlled for screen time, we had a PMOM score associated with overall indices of child functioning, indicating that this may be more valuable or predictive than just asking parents about how many hours their child uses screen media. We confirmed the factor structure of this scale in an additional sample of 600 parents and confirmed the factor structure in the nine-item version. And we found that it works equally well for boys and for girls and also supported additional analysis of convergent validity.

Potential Research Directions and Limitations

And so, there are a lot of strengths to this measure and that it’s suitable for children aged 4 to 13. And up to this point, we didn’t have a measure out there that would capture this addictive-like or problematic use of media. This is specific to adolescents, so it’s looking like, based on this study, this measure could do a good job at that. Now, we see here that how children use media may be more predictive than how long they use media, but there are several limitations of the study that I want to point out, that I hope that having this measure will encourage researchers to study this further.

We don’t know if there are certain children who are at more or greater risk for excessive or addictive-like use of media. Some people have posited that maybe kids with poor self-regulation have more problematic media use or does more problematic media use associate with poor self-regulation, or do we find support for both, like with the model I mentioned earlier, the differential susceptibility to media effects model, maybe some children with poor emotion regulation are more likely to use media excessively or mobile devices excessively, and that, in turn, takes time away from those opportunities to learn how to self-regulate and then associates with poor self-regulation. We don’t know yet. We also don’t know if these behaviors reflect a distinct syndrome.

My initial impetus for studying this was as a result of some of my clinical experiences. Could these behaviors reflect something, a separate disorder, or is this just a manifestation of symptoms related to screen media that is part of a different disorder, like ADHD or autism spectrum disorder? We don’t know that yet, but we do know that parents are really concerned about this, and they want to know if their children are using media in problematic ways, and up to this point, we weren’t really sure what behaviors best corresponded to problems in functioning. But now we have something, and I really do hope that researchers take this and validate it in other samples and see if it does, in a longitudinal study, associate with longer-term outcomes.

Research Questions and Future Directions

“So, thinking about this as a predictor of poor mobility, morbid mobility, or looking at… Have you looked at the data of the known percentage of disorders present in a population? So, we know roughly how much ADHD is reported in the autism spectrum disorders. Have you then tried to overlap these data with that to see do they overlap, or are they identifying a distinctly new population?”

“And that’s what we definitely want to do. This, again, was in two samples that do not represent the population at hand. That would be a great research question for certain. We will be testing this in our…”

“for children who are getting treatment at our ASD assessment clinic to see if we see differences in problematic media use in children who have diagnoses of different types of… of different clinical diagnoses. But, yeah, definitely there’s more to come. This was just the first tiny step.”

“It’s a great question. Any other questions about this measure? Okay. So, we are also looking at…”

“do those nine symptoms… also exist for not just gaming, but addictive-like use of phones in

teens? Again, similar symptoms. Adolescent report.”

Understanding Problematic Media Use in Adolescents

And in a future study, we’re going to be looking at how do these teens… what are some predictors of addictive phone use in adolescents? Do we see differences in adolescents’ brains for those who report being addicted to phones versus not? And so, we have just completed an fMRI study looking at this, and I’m happy to share those results as they emerge.

Again, it’s this question of, is this behavioral addiction something that’s distinct? Do the measures that we have capture this phenomenon? And so, there’s a lot of work to be done, but I’m really excited about it. So, in addition to addictive-like use of media, I was trying to get at what makes it problematic.

Risky and Antisocial Media Use

In addition to the behaviors that I listed before and use that interferes with a child’s functioning, there’s also risky and antisocial use. Risky use, as I mentioned before, is use that can harm the youth doing the posting. We have sexting, for example, or excessive disclosure or inappropriate sharing based on norms of peers. Whereas with antisocial use, it’s use that can harm others, so cyberbullying, cybervictimization, trolling or harassing others online.

We recently developed an intervention to help teens who have been hospitalized for suicide attempts use social media in healthy ways and to decrease maladaptive use that may have or may not have been related to some of the depressed mood and suicidal ideation that they endorsed. Some high-risk adolescents may use social media to post content that includes threats to commit suicide, saying goodbye or announcing plans to commit suicide, and disclosing sensitive or private content. So, in these examples, I want to know as a clinician what my teens are using in terms of their apps, but also what they share, what they post, how they make decisions about what to post. Because some of these examples of risky use, obviously these are really high-risk examples, but we also have teens sharing that they post things that they regret that may not reach this level of severity, but that they regret later on and they feel embarrassed about.

Intervention Development for Healthy Social Media Use

And so, what we’re really trying to do is help teens use social media in ways that are healthy and protective. And so, we’ve just developed an intervention to do that. And if I have time at the end, I’ll definitely show you the components of that intervention. I want to briefly get into what clinicians can do, because I know we have some clinicians out here in the audience.

Before I jump into that, I would love to answer any questions that you have about how children use screen media, their development, when it becomes problematic. “Are there any examples that I didn’t share that you’ve seen in your lives about problematic media use? Use that can get in the way.” “Yeah.”

Addressing Unmonitored Media Use in Children

“I guess for, like, the children that don’t have, you know, parents that monitor their media use or, like, have, you know, parental controls on what they’re doing, the Internet is, like, a lot of information to absorb, and there’s some things that kids shouldn’t be looking at.” “I think kids are exposed to those kinds of things that can affect their brain development. They’re being exposed to adult things that, you know, a teenager or an adolescent may be exposed to.” “Exactly.”

“And we’re seeing kids at younger ages exposed to, like, online pornography inadvertently because there aren’t controls put in place on their devices. And I have resources for those of you who work with parents or are parents on how to do that. I’ll put them up at the end.” “Yeah.”

Media Use and Child Development

“I have a question. When it comes to digital media and digital film, when they’re playing on stage, being digital and electronic, is that keeping your kids away from the media and anything like that? Would that set them behind since other kids are using it a lot and everything’s going to computers and stuff?” “Mm-hmm.”

“Kind of like you teach your grandpa how to text on a computer. Do you think that would put those kids a little bit behind the kids that are always using the media and digital stuff?” “I think it depends on the age, but I have some thoughts I have about this. For one, really young children quickly learn.”

“They learn how to use technology very, very quickly. I’m not so concerned about them not being able to know how to use a laptop when they’re in kindergarten if they haven’t been exposed to it right out of the womb. I’m not concerned about that. For teens, though, most of their social interactions and their social world is online.”

“And so, I would hesitate to say no media for kids because that could take away an opportunity for them to interact with others because a lot of kids use it in healthy ways. I think it should be seen as more like how we teach kids on how to eat healthy foods in moderation. It should be seen as something that’s part of our lives that we can’t necessarily get away from, but children can learn how to use it in adaptive ways in moderation. But we also have to get buy-in from parents because it’s also tough for us to put away our mobile devices and to not always be on it.”

Guidelines for Age-Appropriate Media Use

“So, I think there’s a lot more that can be done by the adults in this world to shape children’s use of media in ways that are healthy. Kind of similar to that, but has your research or anyone else’s research showed what would be kind of sort of the appropriate age for a child to have a phone? I see some 6-year-olds, and I think that’s ridiculous, but is there kind of an appropriate age?” “Well, the American Academy of Pediatrics has some guidelines on this.”

“Again, you know, 0 to 1 1⁄2, to having access to mobile technology if it facilitates social interactions with a loved one is okay. So if a child wants to Skype with grandma, that’s one thing, and just in terms of exposure to any screen. There’s a move away from giving exact age limits or age recommendations because it’s not so much the device, it’s what they see, how they use it, versus it just being present. So, it depends on a lot, and it’s kind of going to be something that we as clinicians and educators need to be able to talk to parents about over time and as a child grows to determine what would be best for that child.”

Understanding Problematic Media Use in Adolescents

Like we found with that measure I developed, there may just be a propensity for some individuals to be really, really engaged to a problematic level with certain types of media. You know, I really want to know what happens to those kids in school when there are screens all around and what that means for their functioning, and so it also depends on a child’s individual characteristics. There are some children that are just not really that interested in playing outside, and so the answer is, it depends, and it takes a lot of thinking to determine what would be appropriate for your own child. “Yeah?”

“Can you explain that one more time?” “Right. It is… Again, the policy is to move away from giving exact time limits.”

Balancing Screen Time and Developmental Activities

It should be a balance, a moderation throughout the child’s day. The child should be engaged in a variety of activities that promote their development, and that may be some screen time, but it’s important that they have opportunities to play and to get exercise and to interact with people in their environment. “What the American Academy of Pediatrics has right now, I can show you real quick, is a family media use plan, and that’s a great way to start figuring out what would be best for your own family. So if you guys want to take a picture of this with your phone, the first website right there is…”

“I don’t know if I can get Internet access, but basically what it does is it allows you to create goals for your family. It could be… And it may not be specific to time. It may be not having devices at dinner time for three of the nights this week.”

Family Media Plan and Individualization

“And it has you select the different age ranges of your children. And so, you can set up different plans for your family or for families that you work with. It’s great. It’s more about what’s, like, the amount of time that beyond which is problematic.”

“I mean, it’s too simplistic because for some kids it could be less amount of time. For other kids, it could be more amount of time. It’s more about how they use it and what they see. The content is what really matters.”

Online Resources and Upcoming Presentations

“For those who can take a picture here, this entire presentation will be online early next week. Awesome. I’ll also put this up on my website as well.” “Oh, yeah. Yeah.”

“Yeah. Yeah. So, that… There are some projects that are being funded by the NIH right now to look at.”

The Impact of Risky Online Content

“And I didn’t speak about that in terms of content. But content related to seeing risky behaviors, whether it’s consuming alcohol, using drugs, promoting or normalizing alcohol or drugs or other substances. It’s really powerful through social media. And so, what researchers who are experts in that domain are looking at, how does viewing these types of content on social media affect youth?”

“We do see some evidence that it does associate with earlier initiation and use. But that’s also… It could be any type of content you wouldn’t want your adolescent to see that can influence their behaviors in those different health domains.” “Yeah.”

Children’s Elicitation of Active Mediation

“Mm-hmm. Mm-hmm. Yeah. Yeah.”

“Yeah. So, we actually don’t know a whole lot about differences when children elicit the act of mediation versus parents eliciting it. This is something, to our knowledge, hasn’t been studied. And that’s why it was one of our themes in our research was like, wow, this is really interesting.”

“Children are asking for it or trying to get it from their parents. So, we don’t know about those differences. But parents who are more verbal or have better communication with their children may be doing this, and so they may already have some protective factors related to media use. So, it’d be really interesting to see what child factors may be at play in children who are getting more of that active mediation.”

Clinicians’ Approach to Understanding Media Use

“You know, from a clinician’s standpoint, I want to know what the child’s favorite shows are, what their favorite apps are. If the parents don’t know that, then that’s a moment of intervention where I can do some psychoeducation on that and talk to them about some of this research. With teens, I love asking them about what types of apps they like to use, what’s their favorite social media, who do they follow on social media. A lot of them follow celebrities, so that can kind of give me some insight into what their interests are.”

“So, I’m really interested in the clinical arena to help understand where these adolescents are at and what they may be seeing that could be risky for them. We know that kids who have active mediation, even if the content is prosocial or educational, have better effects of seeing that type of content. So, it’s a good thing. We definitely want parents to be more engaged in talking about prosocial and educational content as well because we do see positive outcomes for those kids.”

Encouraging Reading and Moderation in Media Use

“There are some… I definitely think kids should be read to every day. But there are some great programs that do teach children some things. If that’s a possibility, if you can read a book, great.”

“But I think for a lot of families, children have to be with their screens, and so we have to do harm reduction approaches in today’s age. One other question. Oh, yeah, I’m sorry, I see you back there. Mm-hmm.”

Guiding Parents and Children in Media Use

“Yeah, I would, you know, I would work with the parents around other outlets for the child that they enjoy as well that would involve peers and things that are… aspects of where they’re at in their development that I want them to be on target with. Mm-hmm. One more.”

Addressing Excessive Media Use

“So, let’s say maybe someone in the audience sees this information and says, okay, my kid is on media too much. If they’ve been doing it for a while, could it be harmful, kind of like an addiction, to just go home and say, okay, you know what, could that lead to bad behavior or is it something you might want to slowly wean down?” “So, like, in terms of too much use, and so that’s actually one of the symptoms that was on that measure, remember, was about how it was really hard to get their child away from screen media use. So, parents may have tried this and it just did not go well.”

Clinical Approaches to Media Use in Adolescents

So, as a clinician, what I would do is come up with some sort of treatment plan that would reduce the amount of screen time and increase other types of enjoyable activities or set limits on when a child can get screen time, only after these things are completed. It’s really tough, especially with adolescents and social media. When things go wrong on social media for adolescents, they really don’t want to share that with adults because they don’t want to lose access to social media, as that is their social world. So, that’s, I think, even more challenging, is to figure out how we can manage the social media of adolescents who may have done harmful things on social media but yet still allow them to have some sort of social outlet.

The Challenge for Clinicians

And it’s really tricky. And I think clinicians are going to be more tasked with working with families on these issues. And we need training in this because this is not something that we’re trained on in our doctoral programs. “Any other questions about the studies?”

The Future of Media Use Research

“I really just wanted to show you some studies that kind of showcase where my research is going. Observational methods, passive sensing is going to be so critical for studying media use over the next decade because, as you saw in those households, it’s really hard to quantify what children are seeing. So, I’m excited to do that and see how adolescents use their mobile devices, what apps they’re using, what types of apps may be more problematic for sleep and bedtime, and if that, in turn, has an impact on their health and their academic functioning over time.”

“So, we’ll be starting up that longitudinal study next semester and then seeing more… learning more about that problematic media use, trying to understand what problematic media use looks like in clients coming through my door or children with different diagnoses. I can definitely talk more about what I recommend to clinicians because I know we have some clinicians in the audience, or if you guys have more questions, I’m happy to answer more.” “Yeah?”

Clinician Recommendations and Parental Controls

“And the clinicians, based on some of the research, our recommendation that we usually give is no more than two hours of screen time, not including homework. Is that kind of where most clinicians are leaning, or do you see a spectrum of… And again, I know it’s not an exact time, an exact number, like you said, but to start to set some boundaries on your kids, is that kind of a reasonable…” “I wouldn’t even talk about hours.”

“I think, at least with the mothers that we interviewed, they hear that and they’re like, ‘eh, it doesn’t matter how much time because my child’s watching positive content.’ I don’t know if families, at least the families that I may come in contact with, have the schedule all planned out for when the child can view screen time. A lot of it’s dependent on different factors in their lives. So, I would rather talk to them about the content and the Internet controls they have in place when the child uses screens.”

“Do they watch TV during mealtime? Do they have TV in the bedroom? Those are the questions that I think are most important. I don’t know if telling parents two hours a day is meaningful to some families anymore because I don’t know if they could even tell you how many hours a day their child uses media.”

Technological Solutions and Parental Monitoring

“Yeah? It seems to me that it’s not going to make much difference for parents to try and monitor on the controls in their screen time.” “That’s another point. Exactly, and that’s the other thing, especially with the observational study that I told you all about.”

“A lot of parents are spending many hours with becoming an issue of reporting and monitoring. And I think we’re going to rely more on technology itself to help us manage technology. And there are some initiatives out there from social media giants to act more quickly when bad things are being broadcasted live. Still a long way to go, but I do think that we’ll have to partner more with technologists to create interventions that parents can use automatically to reduce some of the negative effects.”

Closing Remarks and Upcoming Speaker Series

“Well, thank you. Thank you. Dr. Domoff will be here for a little while, so if you want to speak with her in the next 10, 15 minutes, feel free.”

“Thank you all for coming. Let’s give her a hand for sharing her research. As I stand up here with a media device, mostly because I just don’t have that good of memory anymore, suggesting that I ever did. But for those of you from the community, those of you who are going to be around next semester, just to let you know what we’re going to have coming up in the speaker series then, Dr. Jeff Nevitt is going to be here. Those of you who might be in General Psych right now, Dr. Nevitt does research around unconscious decision-making, and so his presentation is ‘Unmasking the Automatic Mind: Toward a New Understanding of Unconscious Cognition.’ So, when you make decisions and you don’t even know what cognitions are influencing your decision.”

“And then the second one actually is complementary to the one that we just saw. It’s Dr. Brian Gibson. Dr. Gibson is going to be talking about more the cognitive effects of media. His presentation is ‘Media Effects: Can Watching TV or Playing Video Games Really Change How You Think and What You Do?’ So, Dr. Nevitt’s presentation is on Wednesday, February 14th, and Dr. Gibson is on Thursday, March 22nd. They’re always from 1 to 2:30. Thank you for coming. And again, if you wish to ask questions, feel free to come up and talk to Dr. Domoff. Thank you.”

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