What to know about new research on screen time and kids’ mental health

Parents and caregivers worried about their children's screen time can gain valuable insight from two new studies on the topic, both published this week.

In one study, which appears in JAMA Pediatrics, researchers evaluated what happened when parents reported giving kids ages three to five a mobile device to calm them during a stressful moment. The strategy will sound familiar to plenty of harried parents desperate to calm their toddler's tantrum in the supermarket checkout line. The researchers found that while the tactic may work in the short-term, it can backfire for certain children who end up becoming more emotionally reactive, not less, over time.

Another study, published in the Journal of Adolescent Health, tracked several thousand children ages nine and 10 over the course of two years. They discovered that increased time spent playing video games and watching YouTube videos, separately, was associated with heightened risk of developing obsessive compulsive disorder, a condition that involves uncontrollable thoughts and/or behaviors. They found no such link with texting, TV, social media, and other forms of media use. The researchers suspect that aspects of video game playing and YouTube viewing may promote types of thinking associated with OCD, including perfectionism, overestimated fears about violence, and negative biases in how youth see themselves.

OCD is a treatable condition that affects half a million youth in the U.S. Risk factors for OCD may include genetic predisposition and childhood trauma. Research indicates some children's symptoms worsened during the pandemic, when anxiety related to avoiding COVID-19 was high.

Neither study can prove that exposure to mobile devices and screens led to negative outcomes for kids, because that would require randomly assigning the participants to different styles of media use which they may not like or be interested in. Instead, the researchers studied the children over time, which helps minimize the possibility that the studies will just show an association between kids who are most vulnerable to the negative effects of screen time as being more prone to using devices a lot in the first place. The researchers also controlled for different factors that could similarly influence their mental health, like age, sex, parental education, income, and more. Their findings persisted despite accounting for these factors.

The studies aren't cause for alarm, but instead informed caution, particularly if a child's temperament makes them prone to mood swings and explosive emotional reactions, or if they have risk factors that could predispose them to obsessive compulsive behavior. Expert tips and strategies, like strategic mobile device use and creating a family media plan, can also help caregivers navigate their concerns about both issues.

Calming kids down with mobile devices

Dr. Jenny Radesky, a developmental behavioral pediatrician and lead author of the JAMA Pediatrics study, said that when she first set out to evaluate parents' use of mobile devices to calm upset children, she wanted to know if it was an effective, benign strategy, or if it had negative consequences for kids. The study of 422 parents and their individual children suggested the latter outcome, specifically for boys, and toddlers and preschoolers whose temperament is more intense, persistent, and inflexible.

These children tend to exhibit more demanding or difficult behavior and, in turn, are given mobile devices more frequently by their parents during challenging moments. Over time, their parents told the researchers that their kids increasingly struggled to positively manage their emotions, instead experiencing worse tantrums, defiance, and impulsivity. The researchers believe the same wasn't true for girls, possibly because they are often raised to express their emotions in ways that boys aren't. Kids with a more flexible temperament weren't given devices as frequently, and their parents didn't report worse emotion-regulation for them over time.

"Not every child is going to have the same relationship with media," says Radesky, emphasizing the importance of understanding a child's individual strengths and challenges in the context of screen time.

Radesky, who authored the American Academy of Pediatrics' screen-time guidelines for children ages zero to five, says parents worried about using mobile devices to soothe their kids shouldn't abandon screen time altogether out of guilt or fear. Rather, they should use moments of difficult behavior as an opportunity to help children communicate their feelings in healthier ways, because often the presence of a screen will make it easier for them to ignore or suppress their emotions.

If a parent notices their child has "bigger behavior," like aggression or tantrums, they could develop coping strategies or tools for preventing that and for helping them to calm down, instead of reaching for their phone.

Those tactics include basic language to help young kids name their emotions; noticing, for example, that they may be sad, frustrated, or angry that a friend took their toy away. Radesky also says that young kids often need sensory strategies for dealing with feelings. That's when swinging, bouncing, dancing, and cuddles can help them channel strong emotions. A calm-down zone, outfitted with a comfortable place to sit, makes a good alternative to mobile devices. And referencing how their favorite book or TV characters would handle a situation can help, too. Knowing the words to that Daniel Tiger song about feeling angry can come in handy mid-tantrum.

Still, Radesky is realistic about how difficult it can be to forgo the phone at times.

"Occasionally you're going to have to pull out that mobile device waiting in line at a store," says Radesky, noting that it may feel like a mobile device is the only way to calm down a child in certain circumstances. The key is "not making it the primary way for managing those emotional moments."

Video games, YouTube, and OCD

Like Radesky, Dr. Jason Nagata is a pediatrician who studies the effects of screen time on children. Nagata draws on data from the Adolescent Brain Cognitive Development (ABCD) study, an ambitious government-funded effort to follow children over a number of years to better understand the links between childhood experiences and well-being. His past research found associations between screen use and binge-eating and disruptive behavior disorders in youth and teens.

Nagata is the lead author of the study that suggests playing video games and viewing YouTube can increase the risk of developing OCD. The study analyzed self-reported media use habits of 9,208 children between the ages of nine and 10, asked their parents to provide information about their children's obsessive and compulsive behaviors over time, and looked for changes suggesting they'd developed OCD during the two-year study period. (Parents filled out a diagnostic screening about observed mental health symptoms, which the researchers used to make conclusions about new onset OCD.)

Importantly, the risk of developing OCD was a modest 15 percent for video games and 11 percent for YouTube viewing, but it increased for each additional hour of usage beyond the average of 3.9 hours per day, which amounts to more than 27 hours of use each week. The researchers also evaluated TV viewing, texting, video chatting, and social networking and found no association between those forms of media and the development of OCD. 

Nagata and his fellow researchers accounted for a number of factors, including race and ethnicity, household income, and parental education and history of mental illness. They also excluded participants who already had OCD at the study's outset.

While the researchers didn't look specifically at how video games and YouTube viewing could potentially lead to OCD, they argue that the addictive nature of both forms of media could be problematic for some children. 

Video games, which have become social in nature thanks to multiplayer platforms and voice and video chat functions, may be hard to stop playing. They can become similarly absorbing when kids are eager to achieve or maintain a perfect score, which could lead to repetitive or ritualistic behaviors. Certain video games may also expose children to violence, perhaps increasing their vulnerability to imagery and scenes that make them overestimate the possibility of scary scenarios coming true. 

Nagata and his fellow researchers didn't know what YouTube videos participants watched, but they suspect that the immersiveness of the platform's algorithm makes it possible for children to develop obsessive viewing habits. At the same time, if a child is watching an influencer and develops an intense fascination or admiration for that person, they could develop negative thinking patterns about their own abilities or worth in comparison, which may drive more obsessive, compulsive thoughts. 

Though Nagata is concerned by the findings, he's not encouraging parents to entirely restrict video games and YouTube for kids. 

"Screens are not something that are going to go away," says Nagata, who is also an assistant professor of pediatrics in the division of adolescent and young adult medicine at the University of California at San Francisco. "Part of it is really helping our kids, and especially teens as they transition to becoming older teens or young adults, to be able to navigate this complex world on their own." 

Nagata recommends that parents and their children develop a family media plan. The American Academy of Pediatrics offers a template that can be customized for each family. It includes sections on adopting healthy screen-use strategies, choosing good content, and creating screen-free zones. Nagata also says that if youth develop repetitive and intrusive thoughts that affect their ability to function every day, it's time to seek professional help. 

Nagata notes that not every child who excessively plays video games or watches YouTube is going to develop OCD. "There's maybe a slightly elevated risk, and parents and pediatricians should be aware of it," he says. 

If you're a parent struggling with your mental health, or you're concerned about your child's mental health, Crisis Text Line provides free, confidential support 24/7. Text CRISIS to 741741 to be connected to a crisis counselor. Contact the NAMI HelpLine at 1-800-950-NAMI, Monday through Friday from 10:00 a.m. – 10:00 p.m. ET, or email info@nami.org. You can also call the National Suicide Prevention Lifeline at 1-800-273-8255. Here is a list of international resources.