Nevertheless, many parents sense intuitively that electronic screen activity has unwanted effects on their children’s behavior and mood, but they are unsure what to do about it. They feel helpless because of the sheer prevalence of electronic devices, at home and at school. At the same time, parents are acutely aware that it has become increasingly common for families to have at least one “problem child” who is suffering from enough dysfunction that a parent or teacher seeks help. Since the child’s struggles frequently include meltdowns, falling grades, or loss of friendships, parents feel increasingly desperate to find answers now.
So, what’s really happening to our children? Like Ryan, many youngsters exhibit ill-defined but disruptive symptoms that baffle clinicians, teachers, and parents alike, leading to premature or wrong diagnoses in a misguided attempt to name the problem and take action. In a word, these children are dysregulated — that is, they have trouble modulating their emotional responses and arousal levels when stressed. In fact, in 2013, a controversial new diagnosis — Disruptive Mood Dysregulation Disorder, or DMDD — debuted in the long-awaited fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The presentation of a child with chronic irritability, poor focus, rages, meltdowns, and truly disruptive oppositional-defiant behavior has become disturbingly commonplace, and there is legitimate concern that these children are being misdiagnosed with bipolar disorder or other conditions and being prescribed antipsychotic medication.11 In the face of an increase in such diagnoses, psychiatrists felt it was necessary to define a new disorder that more accurately matches these children’s symptoms, despite a lack of definitive proof that these symptoms indeed represent a true, organic mental health disorder.
But what if this “disorder” characterized by dysregulation is not some mysterious new plague, but environmentally related? If we ask ourselves, “What has been the biggest change in our children’s environment compared to only one generation ago?” the answer is not gluten, pesticides, plastics, or food dye,* but the advent of the Internet, cell phones, and wireless communication. Might DMDD really be merely a by-product of constant bombardment from electronic screen devices, causing the brain to short-circuit?
And what if systematic removal of such screen devices provided much-needed relief, almost immediately?
A Doctor’s Journey
I first became aware of the negative effects of screen-time in the early 2000s while working with particularly sensitive patients. These were children with psychiatric disorders complicated by psychological trauma. Some of these kids lived in group homes, others were in foster care, and still others had been adopted into a new family. Regardless of their current situation, they all shared a number of symptoms due to universal changes the brain and body make when presented with repeated trauma — namely, a “hair trigger” response to perceived stress that put their little bodies into a nearly constant state of fight-or-flight. This state was marked by emotional reactivity, trouble following direction, meltdowns over small frustrations, and high physiological arousal (getting “revved up” easily).
Through regular observation of these sensitive children over months and years, I discovered that even small amounts of video game play triggered this fight-or-flight response — the same response we were trying to assuage with therapy and blunt with medication. I started advising parents and group home staff to avoid letting these children have any video game play altogether. These kids had enough strikes against them — why add fuel to the fire? Although my advice was often met with resistance, when the intervention was followed, many of the more egregious symptoms abated quite rapidly.
One especially striking intervention occurred in a residential treatment facility where I worked with the children (and their staff) on site. Every week when the treatment team met, I’d be barraged with all the unfortunate events that had taken place over the previous week and pressured to make changes in medication to alter the children’s behavior. Each “house” at this center had video game consoles that were used as incentives for good behavior, and every week I’d hear things like, “Jacob hit Robert over the head while they were playing a video game together on Saturday.” Or “Joaquin was the only kid in the house who had good behavior on Wednesday, so we rewarded him with some video game play, but he wound up becoming really agitated and threw a chair.”
I’d often get exasperated and ask things like, “Why do we even have video games in the house in the first place?” Most of the time my complaints fell on deaf ears, but one day some of the staff from one house approached me after the weekly meeting and said they also suspected that the games were a problem. The house leaders had held a meeting and decided they wanted to try removing the games to see if it helped keep the whole house calmer. Sure enough, one month later, the number of “special incident reports” (which were reserved for severe behaviors like overt aggressive acts) for that house dropped by one-third. Interestingly, staff also noticed that the children stopped asking about the games fairly quickly and turned naturally to healthier activities. Years later, one of the male staff who had initiated the removal of the games contacted me to ask if I was still working on increasing awareness about using this intervention and offered to write a testimonial. The dramatic difference it had made in the behavior of the children in his house stayed with him.
Another group of patients I discovered early on to be sensitive to video game play were those with tics or Tourette syndrome.* In these children, overactive areas of the brain were causing involuntary motor activity. The exacerbation of symptoms caused by video games in this group was even more obvious. With some of these children, gaming increased their overall tic frequency and severity, and with others the tics would ratchet up whenever the child actually played the game or used the computer. As with the trauma patients, removal of the video games often produced significant relief and sometimes helped us avoid medication altogether.
For all of these children, there was something about playing video games that seemed to exacerbate both neurological and psychological symptoms by putting the brain and body into overdrive. Although my initial observations and efforts focused specifically on video games, over time it became apparent that fight-or-flight reactions occurred with other interactive screen devices as well, such as laptops and smartphones. Eventually, I found these effects were noticeable not just in children with major psychiatric disturbances, but also in children with “plain-old” ADHD symptoms. Ultimately, I realized even “typical” children (without any diagnoses) could experience less extreme but nonetheless disruptive symptoms — which meant it wasn’t just highly sensitive children or those with psychiatric disorders who were vulnerable to adverse effects, but potentially any child.
Feeling certain I was on to a significant connection, I began prescribing video game restriction more widely and more strictly — with startling results. While perhaps only a minority of children are truly “addicted” to video games, I observed how the vast majority of children exhibited certain symptoms surrounding game play — symptoms strikingly similar to amphetamine exposure — that resolved within days or weeks of complete abstention. I watched what happened before and after the intervention, which I came to call an electronic fast, tracked objective measures (like grades or homework completion), and observed what happened when parents inevitably “reintroduced” screens. I paid attention to what it took to convince parents that the fast was worthwhile, what anxieties they had about how to do it, and what impact my delivery had. I learned by watching the children over long periods what worked and what didn’t, and I noticed how their development would grow by leaps and bounds when screens were most restricted. I also saw how screen-time had a sneaky way of reinserting itself into families’ lives, and that — much like management of diet or finances — screen-time management was an ongoing process.
Importantly, I realized that the more information the parents had and the better they understood the underlying mechanisms connecting screen-time and symptoms, the better they were at regulating exposure, and the more quickly they could get a handle on problems before they