SingaporeMotherhood | Preschooler & Up
October 2024
Is Excessive Screen Time or Device Addiction affecting your Child’s Mental Health?
From the outside, 16-year-old Zack (name changed) appears to be doing fine. His grades, while not excellent, are not terrible. A student in London, he speaks clearly and confidently, and joins his family for meals and shopping when he is back home in Singapore. What you don’t see is that Zack’s day starts at 2pm. This is his usual wake-up time after spending most of the night playing computer games. When he is in London, he does not readily reply to his family’s messages or calls. Neither does he partake in other pastimes like reading or going out. Any attempt to engage him further leads to further withdrawal and disconnection. His mother worries that her son may be addicted to his games, and that his lifestyle is affecting his state of mind.
“Zack is not an isolated case. Mental health issues are impacting the everyday lives of many Singaporean children,” says Gaurang Bhatia, who is Zack’s counsellor at Promises Healthcare, a psychiatry and psychology clinic at Novena Medical Centre. On this World Mental Health Day, Gaurang tells us more about youth mental health and addiction in Singapore.
What common mental health issues do children in Singapore face these days?
According to a nationwide Youth Epidemiology and Resilience Study (YEAR) conducted by National University of Singapore from 2019 to 2022, which involved 16,000 parent-child pairs, one in eight youth in Singapore was assessed to have a current mental disorder.
The top three clinical disorders among Singapore children were:
- Anxiety disorder (7%)
- Depressive disorders (5%), and
- Attention deficit hyperactivity disorder (2%)
This corresponds with the top mental health disorders in the United States — ADHD, Anxiety, Behavioural and Depression as per the Centers for Disease Control and Prevention or CDC in the US.
Why are these mental health issues at the forefront now?
Two factors have significantly contributed to the rise in mental healthcare issues: COVID-19 and rising online presence (which accelerated with smartphones in 2008 and spiked during COVID).
In a study released by the Institute of Mental Health (IMH) in 2021, 18% of respondents met the clinical criteria for anxiety and depression, plus another 9% met the criteria for stress and another ~8% for clinical insomnia. This compared with 9% of respondents meeting clinical criteria for anxiety and depression in an unpublished study pre covid. The studies may not be fully comparable with different sample sizes, but IMH did conclude what is apparent — there has been a rise in mental health issues post-COVID.
(See also: Depression in Children: Spot the Signs and Seek Help Now)
The rise in mental health concerns, though, started a bit before COVID. In his book The Anxious Generation (published March 2024), author Jonathan Haidt quotes US data that anxiety and depression amongst college students rose by 134% and 106% respectively, from 2010 to 2019. This period coincides with the introduction of the iPhone (in 2008) followed by an explosion of the apps and games after and pre-COVID.
The issue has caught the attention of the US Surgeon General Vivek Murthy, who recently called for social media platforms to include health warnings for younger users — no different from the warnings we see on cigarette packets.
Addiction researcher Anna Lembke said since the 2010s, she has been seeing increasing cases of teenagers with digital addiction. She added that they presented similarly to those addicted to heroin and cocaine in that nothing felt good anymore when they didn’t engage in online activities (see her book Dopamine Nation for more).
Why are screens so tempting?
Before we decide to wage war on screens, it is crucial to understand the why of the child’s behaviour. Each child is different, so this calls for a holistic approach.
Screens could be a coping mechanism for anxiety or a lifeline for a child who is in depression and contemplating self-harm. Does stress cause problematic screen use or is it the other way round?
This is an evolving area, and currently, screen/social media/phone addictions are not classified as a clinical condition (though this could change in future). We don’t have hard data on screen addiction as a primary diagnosis, though there is rising evidence of this behaviour.
How does screen usage affect growing minds?
There is significant research that warns us about excessive screen usage. A study by KK Women’s and Children’s Hospital (KKH), together with National University of Singapore, found that exposure to screen devices — such as smartphones, tablets, video game consoles, and television — before 18 months of age and the presence of screen devices in a child’s bedroom, are associated with elevated sleep disruption and emotional and behavioural difficulties (EBD) in preschool children with neuro-developmental disorders (NDDs). These, in turn, lead to a higher chance of anxiety, depression, self-harm and addiction.
The brains of teens are still developing, and their temporal lobe (centre for emotions, memory, learning, and reward system) may be more developed than the frontal cortex (executive decision making). This leaves them particularly vulnerable to apps created to trigger an emotional response.
Smartphones and devices also leave little time for experiential learning, which is the most influential and most needed type of learning. Excessive screen use has been linked to a range of conditions such as childhood obesity, sleep disturbances, anxiety, depression, and social isolation.
That sounds worrying.
The above sounds concerning, and given that we can’t practically live without devices, it would be important to know what excessive usage is. It may be necessary to understand the child’s behaviour before applying a standardised metric for what constitutes excessive.
The American Psychology Association (APA) has a helpful list of criteria to indicate when the use of social media (which we can extend to screens) is excessive:
- It interferes with their daily routines and commitments, such as school, work, friendships, and extracurricular activities.
- They often choose social media over in-person social interactions.
- It prevents them from getting at least eight hours of sleep each night.
- It prevents them from engaging in regular physical activity.
- They keep using social media even when they express a desire to stop.
- They experience intense cravings to check social media.
- They lie or use deceptive behaviour to spend time online.
Children now grow up with devices and these have become part of their lives. Is it even fair for us parents — who also use these — to restrict our child’s usage?
Despite growing evidence on the harmful potential effects of excessive screen usage, there are various doubts about managing this behaviour. The trickiest amongst these is the parent’s use of devices.
Using devices as pacifiers may sound reasonable at a dentist appointment or on a flight. But not if used all the time — for example, when no meal is possible without a device, it is time to review screen time.
Guiding children to manage their screen time will require parents to be mindful of their screen habits and communicate the harms of not doing so with their children.
(See also: How to Talk to Your Child about Online Safety because your child WILL encounter Inappropriate Content Online)
Both parents and children are facing higher stress today than previous generations did and sometimes it is a choice between exhaustion and breakdown versus pushing a device to the child for 30 minutes of a well-deserved meal for the parent.
It is also important for the parents to practise self-compassion and self-care in the moment and over time. While we are focusing on children here, adults are no less impacted by screen addiction and face similar concerns — lack of attention and focus. If unchecked it may also lead to clinical conditions in the areas of anxiety, depression or addiction amongst others.
What steps can I take if I am concerned that my child has difficulty regulating his or her screen use?
If adults can role model device usage, children are more likely to listen to their guidance. The American Academy of Paediatrics recommends that kids aged 2 to 5 years only use screens for one hour a day, and kids 18 to 24 months only use digital media to video chat.
For older children up to age 12, the recommendation is to make a collaborative screen use plan to ensure a healthy balance between screen exposure and other age-appropriate activities.
KKH also made several valuable suggestions for parents to help regulate screen time for kids. These include:
- Having consequences for excess screen time usage (e.g. no screen time the following day).
- Discouraging repetitive viewings of the same show by switching off the device.
- Using screen time selectively to soothe a child (e.g. during medical procedures or during a flight) and not regularly.
- Stopping all screen time an hour before sleeping time.
- Protecting screen devices with passwords to prevent unauthorised use by children beyond the allocated time limit.
On top of this, there are times when phone usage is completely discouraged. Daily, we find news about banning mobile phones in schools. On 16 August this year, the Virginia (US) Department of Education was the latest to recommend that schools ban cell phone use.
Family and mealtimes are other times when phone usage is discouraged. Finally, it’s not just how long children spend on devices but what they miss out on. Playtime, real-life interaction with other kids, sports, hobbies, and picnics are all important activities growing up. With excessive time spent on devices, children may miss these entirely.
How do I choose between letting my child learn more, and managing their device use?
Is there such a thing as “excessive time spent online learning”? Technology certainly brings about a lot of good. In a 2016 study of 2,850 7th grade students in Maine who used an online tool for math homework, authors found improved math scores by 0.18 standard deviations.
Music is now listened to on devices and can positively influence. Even social media can enhance networking. Gaming can enhance cognitive skills such as perception and attentional control, and decision-making improves when subjects train with video games. Research indicates that serious simulation games help professionals such as doctors and nurses make better decisions and assess risks better.
On the flip side, UNESCO research found student learning outcomes stalled or “declined dramatically” when schools deployed ed tech (during COVID) as a replacement for in-person instruction.
Children focussed less on discovery and exploration and more on routine tasks like checking for updates or passively moving through automated learning content.
Additionally, what about time for emotional learning — interacting with others, learning to manage conflicts, playing physical sports rather than pressing some buttons on a game, having hobbies, learning skills or developing an art? Research suggests that emotional intelligence (EQ) better predicts success than IQ. Thus, STEM is important, but it is also important to make time for other things.
Technology isn’t all bad, but like anything else, moderation and supervision are needed for the advantages to outweigh the disadvantages.
Furthermore, some children could be more positively (or negatively) impacted, so we can’t have one-size-fits-all guidance on device usage.
Schoolchildren now have their own PLDs (Personal Learning Devices) and use them for schoolwork, and in class. What is your take on this?
When used wisely, devices can improve learning and increase productivity. As such, they are welcome, but with many safeguards:
- Not too early
- Limits on the amount of time spent on devices
- Supervision for what content the child has access to
- Devices complementing, not replacing, teaching
What can I do if I think that my child has device addiction?
If you suspect that your child has an addiction to his or her screen, you can seek a professional assessment. In the example earlier, Zack was not assessed to be so despite his relatively low mood and engagement.
At Promises, our psychiatrists and counsellors do see children addicted to gaming or, at times, with clinical anxiety, depression and other presentations of addiction in relation to devices and social media.
Seeing a mental health specialist is recommended. It is no different from bringing your child to an orthopaedic doctor if he sustains a sports injury.
While it may take some effort (both from the child and his parents), there can be substantial progress made in managing the addiction. Early action may limit the longer-term impact of the addiction.
Gaurang Bhatia is a counsellor at Promises Healthcare. He specialises in trauma, addictions, and related conditions including post-traumatic stress disorder (PTSD), depression, and anxiety in adolescents and adults. He also counsels couples and partners who are working through infidelity.
Featured image: Ron Lach on Pexels
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