Transcript for
Children and technology: Screen use

Narrator [00:00:02] Welcome to the Emerging Minds podcast.

Sophie Guy [00:00:08] You’re with Sophie Guy and today I’m talking with Dr Anthea Rhodes. Anthea is a paediatrician at the Royal Children’s Hospital in Melbourne and director of the RCH National Child Health Poll. In today’s episode, Anthea talks about her experience as a pediatrician and the sorts of issues related to screen use and digital technology she encounters in her practice. We explore the impacts of screen use on children’s social and emotional wellbeing, as well as strategies that can help children and often parents, reduce the amount of time they spend in front of the screen.

Sophie Guy [00:00:40] Thank you very much for joining me today, I really appreciate your time.

Anthea Rhodes [00:00:43] Thanks, Sophie.

Sophie Guy [00:00:44] I wonder if you could just start by telling me a bit about your background and how you came to be interested in and an expert in children and digital technology and screens.

Anthea Rhodes [00:00:53] Yeah. So I’m a developmental and behavioural paediatrician. So what that means is that I’ve done quite a lot of study beyond regular pediatrics, looking at how children learn, develop and behave in different situations and environments. And obviously as part of everyday life now here in Australia and across the world, technology is increasingly a big part of a child’s environment. And so we’re starting to see in clinical practice or healthcare how that technology might be impacting on a child’s health and wellbeing. And that’s really what led to me being interested in this area. But then more recently as part of some other research work that I do, we’ve surveyed parents in Australia about the difficulties and the experiences that they’re having when it comes to managing technology in their households and families. And I guess that’s really where more interest was sparked to me in this area.

Sophie Guy [00:01:50] Okay and was that the results of the Australian Child Health Poll?

Anthea Rhodes [00:01:53] It was, yeah. So, yeah. So the results of the National Child Health poll about eighteen months ago, we looked at two-thousand households in Australia and we asked parents about what their children were doing when it comes to using screens. And we found that perhaps not surprisingly, technology is really a big part of everyday life for most Australian families now. But what was more surprising to us was just how challenging this is on a day to day basis for most families to manage.

Sophie Guy [00:02:23] Challenging in what ways?

Anthea Rhodes [00:02:25] So a number of different things that parents have told us about. About two thirds of parents said that they experienced conflict or arguments in their household most days of the week relating to technology use. In the situation that we have with screen based devices, really the parent is the main regulator. That’s the role that they’ve had to take on as this technology has rapidly kind of exploded into homes and environments. And parents are telling us they find that really hard. Then there’s other issues as well, some that relate a bit more to health and wellbeing directly. So things like an impact on sleep, impacts on mood, particularly where children might have experienced negative interactions online and bullying, impacts on their ability to regulate or sort of stay calm in certain situations, were all things that parents are observing and experiencing that they see to be related to technology in their homes.

Sophie Guy [00:03:23] Okay. You’ve talked a little bit about what are parents concerns, what do they come in raising about the use of technology and screens..

Anthea Rhodes [00:03:29] So in terms of day to day clinical experiences, so obviously I’ve just talked a bit about parents and what they’ve told us in a big survey about the troubles they’re having at home. And many of those things might be within a spectrum of what we’d call typical or normal experiences. And then you see the more extreme experiences where technology use might be really impacting on a child’s function and day to day life. And they’re the situations where sometimes we see those children coming into clinical practice and saying, you know, this is a problem for us. So.

Sophie Guy [00:04:02] What does that look like?

Anthea Rhodes [00:04:03] So there are a number of things that that can look like. So we I mentioned before sleep and certainly it can affect sleep quantity and sleep quality. It can also affect a child’s ability to actually prioritise other functions and aspects of their life. So where a child has very problematic media use, that in some ways people see as addiction, then they might be prioritizing that media use, whether it’s gaming or spending time viewing content on the Internet or communicating online through social media, spending time doing that over many hours, prioritizing other aspects of life. So sometimes even really basic day to day things like, you know, spending time engaging with other people [okay] whether that’s in the family or outside the family, spending time eating and, you know, doing day to day activities with the family. Those sorts of really important key functions are pushed aside and interaction with the media becomes a priority.

Sophie Guy [00:05:02] Okay and are you talking about teenagers or kids, younger kids?

Anthea Rhodes [00:05:07] More common among teenagers but also we see this among younger children too. So we found in the health poll that almost all Australian teenagers have their own mobile screen based device of some sort, either an iPhone or a tablet or often both. [Right]. So about ninety-seven per cent.

Sophie Guy [00:05:24] Wow. So it becomes very hard to manage that.

Anthea Rhodes [00:05:27] It’s a regular part of most teenagers’ life. And then among primary school aged kids, two thirds of those children also have their own device. So not something that they’re borrowing or using of someone else’s, but their own device. And even a third of pre-school aged kids have their own mobile screen based device. So when a child has a device like that that belongs to them, much like us as adults, it becomes a part of their everyday. What they’re doing, what they’re thinking about, what their habits are. But children don’t always have the same ability as adults to actually regulate those patterns of behaviour in practice. So it can be easier for them to find themselves in situations where it’s difficult to draw a boundary around when enough’s enough, or when an interaction or behaviour with that device, the time they’re spending online or the way they’re using their time online is problematic.

Sophie Guy [00:06:20] What do you mean when you say technology? What sorts of technology?

Anthea Rhodes [00:06:23] So when we asked about this in our study, we included a whole range of things that were screen based media primarily. So TVs, obviously have been around for a long time now, computers and more desktop or laptop computers, mobile screen-based devices like tablets, iPads and then digital devices like iPhones.

Sophie Guy [00:06:46] And I was curious to ask, before you mentioned impacts on sleep, is it as simple as the kids who are using their devices and screens just before bedtime, they’re the ones struggling with sleep? Or is it sort of more diffuse than that?

Anthea Rhodes [00:06:58] So there’s lots of good research that really clearly links use of devices, particularly in that last hour before bedtime with difficulty getting off to sleep [okay] and then sometimes difficulty staying asleep. So there’s a few reasons for that. One is the blue light that’s emitted from screens actually suppresses melatonin, which is the hormone that we release in the brain to bring on a sleep wave. So if that melatonin isn’t released in a normal way, you don’t feel as sleepy. So actual exposure to the light from devices will impact on that physically for young people, which is why there’s pretty clear advice in at least the last hour before bed, anyone, not just children, that anyone should put away the screen. But then we have also found in other studies, there’s research that suggests where a screen is then also kept in the bedroom overnight, so whether that’s being charged perhaps at the bedside, which is really, really common practice in adults but also in teenagers, that those people are more likely to have broken sleep. So that may be that you’re tempted to have a look in the middle of the night when you roll over [okay] at what’s happened on the phone and then young people might then be drawn into some communication or perhaps they’re gaming or something that is actually engaging with that device during the night and that obviously going to impact on their sleep.

Sophie Guy [00:08:23] You mentioned before, I think you mentioned how a lot of screen use and maybe with younger kids does start to impact them cognitively. Is that the case? Could you talk a little bit about that?

Anthea Rhodes [00:08:33] So it’s really important, I think, to note upfront that it’s very early days on any research that can be clear on just how much technology is affecting development and behaviour of young children. And that’s mainly because it’s so new and the research is only just starting to catch up. But what we do know is that certainly it is impacting on the way people engage and interact with their child. And so how significant any health concerns or effects from that are we’re yet to really understand. One area that is being explored more and more is how screen use is affecting language development for young children. And it looks like in some studies that there may be some links that are not positive, suggests a lot of screen use, not just by a child but also by a parent, in the environment raising that child could impact on the way they develop language. And the reason for that is that as adults interact with one another in an environment and communicate, then they’re speaking, they’re creating language that a child can watch and hear. If an adult instead is communicating online with someone while that adult still gets the same positive things from social engagement and interaction, they might get a lot of support from an series of text messages, the child in the environment next to that adult doesn’t see any of that communication. [Okay.] There’s no words being spoken, there’s there’s no facial expressions being exchanged. All they hear or see is silence and a parent that’s engaged with the device. And so what we do know about young children and their learning is that that role modelling, hearing words, seeing communication is a really important way for children to learn how to communicate themselves. So I’m often talking with parents about thinking about their own technology use around their children, particularly their very young children, the first couple of years of life, and making sure that they’re mindful of how they’re engaging with their child.

Anthea Rhodes [00:10:42] I think one of the other probably important things is that just like any habit or anything, not every child or person is going to respond in the same way. And there’s starting to be some research to support the idea that some people, and including children and teenagers, might be more prone to having problematic made media use than others. [Okay]. And so if a young person has difficulties with their regulation or their attention span already, so they may not be sort of neurotypical, they’ve got some challenges, then it can be more difficult for them to actually manage and regulate their screen use. [Okay]. And then there’ll be other children who are quite capable of, you know, setting boundaries and actually managing it reasonably. Some adolescents are even more risk-taking than others. Adolescence is a period of exploration and independence seeking and risk-taking behaviour for all young people. But we know in all kinds of habits that some kids are going to do more of that than others. And then those children who are more risk-taking are going to be more at risk in their screen use as well in terms of how they engage with others online, whether they put themselves at risk of e-safety issues and whether they have difficulty actually containing the boundaries around what they view and how much of it they do.

Sophie Guy [00:12:05] Okay. And is that what you’re talking about, perhaps a vulnerability to an addiction and would, do you think of it, excessive screen use in some cases as addiction?

Anthea Rhodes [00:12:16] So the, there is now on the DSM, a diagnostic category for gaming disorder, which which really does sit within the group of addictive disorders. But most of what we see that’s problematic in young people probably doesn’t fully fit those criteria necessarily for addiction, but it’s enough to impact on regular function and behaviour and those sort of day to day activities that should be prioritized for people. So it’s a bit of a spectrum and I think it’s really about understanding with families where they’re sitting on that spectrum and how much of an issue it’s having for them and their child. And then working about working out how you can have everyone work together towards, you know, reducing some of those problems by adding some boundaries and some support.

Sophie Guy [00:13:08] And so are there other any other kind of health impacts that are maybe more physical health impacts that we see?

Anthea Rhodes [00:13:13] Yeah, there are. And there’s some probably some more research around some of that than there is around the social and emotional aspects, which is just starting to come out. So we know that what we would consider excessive, so large amounts of screen use, can be linked to short sightedness and in particularly in some Asian countries where there’s very large amounts of use, we’re seeing what has been described as epidemics of short sightedness. So it’s changing the actual way people are able to see because they’re not looking into the distance enough. Ironically, one of the ways to address this is with virtual reality [really?] goggles to look very far away. So.

Sophie Guy [00:13:53] Not just going to a place outside where you can look far away?

Anthea Rhodes [00:13:55] You could just go to a place outside. So we talk about looking every twenty minutes, looking at something 20 meters away [okay] Is a good way to kind of just make sure your eyes are still doing some of that far vision, not just short or near vision. [Okay]. And similar relationships, I guess, physically exist around posture. So some of the things that have been studied are, you know, when a young child particularly is playing with something non-digital. So perhaps they’re given a toy of some sort that might they might press buttons on, it pops up, or they roll it around. Or alternatively, they’re given a device like a tablet and they’re monitored in terms of how their body movement is during the play with those two different items. And what we do know with digital play, so they’re still engaging and learning and looking at something that’s considered appropriate, is that those children don’t move very much. So they assume a position and they tend to stay right like that for quite a long period of time. Sometimes that position can be really quite awkward and parents might, if you ask them to pay attention to it, have seen this sort of thing too, and like, does not look comfortable. But they’ve just kind of found themselves there, they become engaged visually and cognitively in something and they stay in that position versus a child who’s got a physically moving toy of some sort who is gonna move a lot during that play experience over half an hour. They’ll reposition, reposition a huge amount. So what is starting to evolve is impacts where children have really, again, excessive use where it might affect their neck or their spine because they’re not actually moving around and developing in a way that is required for all those muscles and joints to stay active and healthy. So there are some very physical impacts. And the third one, which we talked briefly about before is really around healthy weight [okay] and when children spend long periods of time sedentary. So sitting still and that’s largely in this day and age on screens and that can certainly impact on their levels of activity, which impacts on their likelihood of being of an unhealthy weight or overweight. So those sorts of very physical, direct health effects are being seen in relation to large amounts of screen use in children.

Sophie Guy [00:16:08] Okay. And could you talk a bit about how you work with families if they come in with concerns about, I imagine they’re coming in with concerns about their children’s use of technology and screens, how do you go about then working with the family, children, the parents to create some better routines around that?

Anthea Rhodes [00:16:25] Yeah. So I think the first thing to say is that it’s really challenging [okay] and for anyone who’s trying to do this themselves, perhaps in their family or clinicians who are working with families to try and tackle screen based use, it’s really hard. And one of the reasons for that is that it’s so ubiquitous, it’s everywhere. And it’s in many ways linked to now to day to day activities. So much in the same way that an adult, I mean I came here today and found you, Sophie. I was looking on my Google Maps. I’m, you know, keeping an eye on the time, I’m using my device for regular activities. And that’s the same for most teenagers in the school environment now. They’ll be checking their timetable, their homework, their communication, their social communication, and not just social media, but perhaps information about sporting activities they’re involved in or other extracurricular activities. All of that is coming to them through digital channels. So it’s about understanding how that can be managed and kept in a healthy space. It’s not about being completely removed from social media or any other communication or digital technology because the idea of digital celibacy, so having none of it, is not effective or useful. [Okay.] That’s pretty clear now.

Sophie Guy [00:17:44] So is there some research around that?

Anthea Rhodes [00:17:46] Yes. So there’s some research that suggests where children are having negative or challenging experiences, perhaps online, they’re much more reluctant to share those concerns with adults if they think their device is going to be removed and they’ll be completely without [okay] contact because they’re worried about what that impact will have for them socially. And so then they’re more likely to conceal negative things that might have happened. For example, bullying or image-based abuse or those sorts of problems.

Sophie Guy [00:18:17] Okay. And what are what’s image-based abuse?

Anthea Rhodes [00:18:20] So image-based abuse is where photographs are taken either without consent of someone else or on-shared without consent. [Okay.] And they are negative in some way. So they may be explicit photographs. They may just be images that are then associated with negative commentary. There can also be manipulation of images. So it’s very easy now with a lot of apps for a photograph to be altered and then shared. And that is obviously a very negative experience potentially for that person who’s portrayed in that image. So it’s really using images as part of a process of bullying or abuse. [Okay.] So the e-safety office have a really well equipped direct response process to these things and anyone can register a complaint where they feel they’ve experienced this directly online and that will be addressed, generally, I think it’s within 72 hours and they can have these images removed, taken down from the Internet. So it’s important for young people to know that, for parents to know that because these things are happening more and more and it’s important to have channels that can be actioned to actually stop it.

Sophie Guy [00:19:34] What do you mean when you talk about e-safety, what are you referring to there?

Anthea Rhodes [00:19:37] Yeah. So here in Australia, we’re really very fortunate that we have the e-safety office and an e-safety commissioner. And they’re, they have a number of roles, but they really are focussed on ensuring that the type of engagement and communication people experience online, including children and teens and young people, is safe and positive. So they are addressing issues like bullying and predatory use, imaged base based abuse, which are in fact quite common online experiences for young people.

Sophie Guy [00:20:10] Yeah, okay, well that sounds really useful to know about as well.

Anthea Rhodes [00:20:14] There’s also a lot of great resources on the e-safety website for parents [okay, yeah] about how they can better understand technology and the online space. How they might have conversations with their young person or their much younger child around these topics. [Okay.] One of the challenges I think parents have is they don’t feel like they’re digitally literate, so they just don’t know how to talk about some of this stuff. Because we’re in this generation where the children coming through have grown up as digital natives and most of the parents haven’t. We’ve got a big gap that won’t be quite the same in generations to come because these, our current young people, when they have children, will have had that digital experience. It will still be changing, but it won’t be completely absent like it was for many parents that, you know, have teenagers at the moment. So often they feel like their child knows much more about this stuff than them and they may feel like they don’t have anything they can add or bring. But in fact, it’s about remembering it’s not just about the technology itself. The technology is a tool, but it’s really still about principles and ethics and feelings and emotions. And that’s what makes a difference for people. So how that tool gets used is what matters, not the actual tool itself. [Okay.].

Anthea Rhodes [00:21:32] So parents can still talk a lot about these topics with their kids. But what we do need to do is set boundaries around what’s healthy when it comes to amount of use and content. And these are the two things that can cause issues. Yeah. So when it comes to the amount of use, there are guidelines. [Mm hmm.] There’s national guidelines here in Australia and quite recently there’s guidelines being reduced released by WHO [okay], particularly for younger children [okay], around recommended maximum amounts of screen time per day and they’re really very low. So for children under five pre-school age children they’re suggests no more than an hour a day. And then once you get up into kind of teenagers, it’s up to two hours a day. Those guidelines really talk about the fact that screen use is sedentary, so we’re sitting around not moving. [Uh huh.] And there’s lots of research that shows the effects of that that are, can be negative when it comes to healthy weight and obesity. So keeping children active and young people active for significant periods of the day is really important for their physical and mental health and well-being. What we do know from the child health poll and also from some other research that’s been done not just in Australia but outside of Australia, is that most families aren’t able to stick to those guidelines.

Sophie Guy [00:23:02] Yeah, the poll certainly showed that, didn’t it.

Anthea Rhodes [00:23:04] So the actual use is much, much bigger than what would be recommended. So we found that the typical teenager on average is spending more than forty hours, more than a full time job’s worth of time outside of school  [right] on a screen based device.

Sophie Guy [00:23:19] I was wondering about that, whether those statistics included school use of devices and screens.

Anthea Rhodes [00:23:25] Yeah. No, so that was at home. [Wow]. So that’s a lot of time. It was slightly more than the average adult, actually, but they looked pretty similar. Teenagers and adults looked pretty similar. So what happens during that period where all those hours are spent engaging with the device is there is an opportunity cost. So if you spend lots of time doing something, it does mean that you’re not spending time doing something else. [Yeah]. And that’s where both sleep and physical activity can be really affected. And it’s important when you’re working with families to sometimes think about not just setting limits on the screen time, but scheduling in the other things. [Okay]. So at least, you know, a couple of hours doing something else and working out what that something else is going to be. Where you just say, okay, after two hours after school as you go off, no more. You don’t provide an option as to what’s going to happen instead, that’s really hard to manage and motivate someone towards. [Okay. Yeah].

Anthea Rhodes [00:24:23] So it’s helpful when working with families to start by getting a really realistic idea of what their patterns of use are, not just the young person or child, but everyone in the household. Then the next step is to try and set some goals that are realistic for that family around reducing the amount of use, scheduling in other things to help them fill time that’s not using the screen, and then finally, when there is time on the screen talking about what that looks like. So what are they actually doing. Because not all screen time is the same. Some things are more problematic than others. So some screen use has more risk in terms of the content for a child’s health and well-being than other screen use. So more and more, I’m talking with families about, well, what exactly is your child doing when they have a couple of hours on the iPad? What are they looking at? What are they engaging with. And sometimes parents are really not sure. They don’t know. Other times they have a pretty good idea. And if they’re not sure, I ask them, okay, let’s spend the next week working that out and come back and we’ll have a talk about it.

Anthea Rhodes [00:25:32] In terms of working out what exactly they do spend their time and how much they spend their time. So you can. There are a number of apps that you can download that will actually help to track screen use over the week. And some phones now have a screen tracking sort of ability built into them as well. So that will allow at its, at a fairly basic level you to get an idea of how many hours per week are being used on on a screen and also for what purpose. So that will break it down often into social media information and searching, other sorts of viewing. So you can get a bit of an idea at a high level what it’s being used for. [Okay]. And then when it comes to knowing, well, if they’re gaming, what exactly are they doing, it’s really about having that conversation with their child or teenager and trying to find out. So what is this game? Can you tell me a bit more about it? What are you doing here? What’s it called. [Mm hmm]. And then if a parent’s really not sure they can actually use, again there’s a couple of really quite helpful moderated sites where you can put in different games and apps and it will give you a lot of information about them so that you can have some idea of what your child is viewing and doing when they’re online. So one of those is called Common Sense Media and that’s the US based government affiliated site [okay] where they do a lot of really high quality reviews of digital media for the purposes of parents. So any movie app, TV program you can put into that and you get a professional review, you also get usually a parent review, and often a child or young person review about suggested age in years for appropriateness. And really detailed breakdown of what sort of sensitive or explicit content might be included [okay] on that communication, that digital information, to help parents make a decision about whether this seems right for my child. And also, okay, this is something I might want to talk about with my child. [Okay.]. So this is a game, it includes these themes. Okay well, maybe they’re things you need to discuss.

Sophie Guy [00:27:40] Right. That sounds like a useful tool.

Anthea Rhodes [00:27:42] Very useful. So I’ll often spent time with parents, in the room, bring it up and explain it to them, they’ll download it then and there and have a look. The Australian Council for Children and Media also do some reviews of a similar sort of nature [okay] just to give parents a bit more of an idea about what these things are. Because frequently parents will be like, I don’t know what he’s doing, it’s roadblocks or fortnight or something, but I don’t know what it is. So rather than being kind of afraid of that, it’s really empowering for them to actually up-skill themselves a bit more. Have a read about it. No reason you can’t get on there and have a go if you want to really learn what this is like [yeah] and then you’ve got some information to have a conversation about it.

Sophie Guy [00:28:23] Okay. Okay. One final thing I did want to ask you. For practitioners listening to this who maybe didn’t feel like they knew a lot about the issue and, you know, perhaps some of the statistics on it, what are sort of one or two key messages that you think is important to know if they want to sort of start having these conversations with families?

Anthea Rhodes [00:28:46] When a clinician sees a family, I think it’s really important for screen use to just become part of the history. So just like we ask about a whole bunch of things routinely that might include with it, a child’s had any other problems with their health before, whether or not they’ve been immunized, we should also ask what their screen habits are like at home. It needs to become part of every consult because rarely they’ll come and say, I think the problem I have is to do with the screen. More likely they might come because they’ve got issues related to weight. They’ve got issues related to social and emotional wellbeing or mental health. They’ve got issues related to sleep. They might have issues relating to bullying, which often frequently turns out to be through a digital source. They might have issues related to behaviour and emotional regulation. So they’re more likely to be the presenting complaint, as we call it, or issue. And part of the history always needs to include, and tell me about your digital media or screen use. What sort of things? How many hours a day? What sort of content? Because often it’s not until you go asking about those things that you find that’s a big part of the challenges for some children.

Sophie Guy [00:29:59] Okay. That’s a good thing to know and it might not necessarily come out naturally in the parents when they come to see you, but it might actually be quite an important part of what’s going on.

Anthea Rhodes [00:30:09] Definitely. And parents may not always have identified it as being a contributor to the problems they’re having. They might say it is quite separate and sometimes they even see it as a solution. So if they’ve got a child who’s behaviourally really challenging, oh just give them the iPad, oh thank goodness, you know, I get a break. And they may not be aware that that may in turn facilitate to more or contribute to more problems with regulation and behaviour. I think helping parents to understand that it has to be a whole of family approach if you’re going to make a difference and that’s really the same for many lifestyle health issues and screen use is no different. So the parent who is constantly looking at their own screen at the same time telling the child to put theirs away is not going to win that battle. And as a practitioner, you’ve got to get the whole family on board, or at least, you know, one parent, ideally the whole family, if you’re going to actually move forward with the plan. And then the third thing is thinking, as we talked about before, if you’re going to take away screen use or limit it, what are you going to do instead? So really, it’s like breaking any habit. It gets back to things like, you know, even perhaps a smoker trying to break a habit, they’re going to have at risk periods. It’s easier to think perhaps in terms of smoking where people might think, okay, well, it’ll be when I’m at the pub and I’ve had two beers or it’s after work or it’s when I’m stressed or that’ll be my weak moment and giving them a plan. Okay, here’s what you’re going to do instead. It’s like that with screen use, too. So there’ll be the go to times when, you know, you’re kind of ending up with lots of screen use, if you’re trying to stop that habit, you’ve gotta think, well, what else are we going to do with that time as a family? Or what else am I going to suggest that my child can do instead? And sometimes that’s a bit of work and you got to stick at it for at least a couple of weeks till that you get some new habits forming around how they might occupy themselves and spend their time. It can be done. For many, many decades we didn’t have any digital based entertainment like we do today that’s mobile and everywhere. But it takes some planning if you want to be able to do it well.

Sophie Guy [00:32:11] Okay. I think that’s a good place to finish up. So thank you so much for your time today Anthea.

Anthea Rhodes [00:32:16] Pleasure. Thank you, Sophie. Thanks for the chat.

Narrator [00:32:20] Visit our website at www.emergingminds.com.au to access a range of resources to assist your practice. Brought to you by the National Workforce Centre for Child Mental Health, led by Emerging Minds. The National Workforce Centre for Child Mental Health is funded by the Australian Government Department of Health under the National Support for Child and Youth Mental Health Program.