A response to “screen based lifestyle harms children’s health”

On Christmas Day this year, multiple clinicians and academics wrote to The Guardian newspaper to express their concern about the impact of ‘screentime’ on children’s health. In this post, we will extract key phrases from the letter, which can be seen in its entirety here, and explore whether the evidence upholds the statement. In this, I am joined by my husband, Ben Fletcher-Watson.  While my research has mainly focused on the role of technology in the lives of children on the autism spectrum, Ben has been involved in a number of research projects (some cited below) investigating the use of technologies in the home by typical pre-schoolers, and especially the ways in which parents engage in technology use with their children.

We will focus on the role of screentime specifically, which is one of the modern phenomena that is blamed for what the letter-writers call “toxic childhood“. However, we should note that the writers also cite “a hyper-competitive schooling system and the unremitting commercialisation of childhood” as negative influences – we do not address these here.

… children’s health and wellbeing [are] being undermined by the decline of outdoor play, increasingly screen-based lifestyles…

This sentence wraps up the entire position of the letter in a nutshell. The hypothesis proposed is that: a) screentime has increased; b) it has displaced outdoor play specifically; and c) this has had an impact on health and well-being. There are no studies which can directly address all of these posited links in one go.  The closest is a paper by Parkes et al. which should really be the last word on the relation between screentime and developmental outcomes thanks to its sample size of 11,000 children and robust longitudinal design. This explored thirty potential statistical relations and found just one small link between TV-watching at five-years-old and conduct problems at seven-years-old.

Sue analysed the results of this paper in more detail in a previous blog post, but there’s a key point which needs to be extracted here. The only significant relation that was found was between TV-watching (i.e. passive viewing) and outcome.  The authors did also measure the effect of video gaming and found that this had no discernible impact on outcomes two years later. This is important in relation to the letter-writers’ claim, because there is no evidence that TV-watching has increased.  In fact, this 2006 systematic review reports that time spent watching TV did not increase over the preceding 50 years.

Instead, recent increases in screentime have been driven by increased access to touchscreen devices, which invite active viewing and play (unlike TV). Not only did Parkes and colleagues find no link from active game play to outcomes, but this has since been reinforced and extended in a rare example of a good quality study on the topic. The authors – including the late and very great Annette Karmiloff-Smith – report no link between touchscreen use and early developmental milestones in toddlers.

What about reductions in outdoor play?  Is screentime really displacing this activity and making kids fat?  Once more, the evidence says not, as in this large, national survey which found no links between TV-watching, outdoor play and body-mass index in children aged three-years-old. A more recent, longitudinal study with 19,000 pre-schoolers enrolled reinforced the message that watching more TV and less physical activity are related only via a shared factor – perceived neighbourhood safety. In other words, when parents think their neighbourhood is unsafe, children get out less and watch more TV. Crucially, even these associations are weaker over time, and neither physical activity nor TV watching is actually predictive of body-mass index.

Thus the plausibility of the argument hinges on a series of correlations which do not stand up to scrutiny. Screentime probably has increased thanks to the proliferation of touchscreen devices. But TV watching (which is the only form of screentime which has been linked to poor outcome) has not increased. There’s no evidence that screentime is replacing play outdoors, and no evidence that either of these things can explain the so-called “obesity crisis”. Instead, quality evidence which controls for important confounders like socio-economic factors reveals that screentime is not linked to poor outcomes or delayed development.

Physical health problems like obesity continue to escalate, and mental health problems among children and young people are approaching crisis levels.

Childhood obesity is a concern for many parents, and for society as a whole. However, laying the blame for this issue at the feet of modern technologies is a blinkered and reactionary perspective which fails to recognise the multiple and complex factors which contribute to poor health. Throwing away your iPad, or your TV, will not make you healthy.  On the contrary, a number of studies have shown how active games can support activity and weight loss in young people.  I have written before about how technology may be a particularly valuable way to help young people get active, especially if they feel excluded from team games and individual sports by their size.

What about mental health?  We’re afraid that here the Guardian letter-writers are succumbing to a basic correlation = causation error. The writers might like to check out these spurious correlations as a reminder of this basic scientific principle.  It is true that childhood disability rates are rising, with particular increases in the prevalence of diagnosed mental health and neurodevelopmental conditions in Western countries since the turn of the century. The authors point out that changing diagnostic criteria and increased awareness of childhood mental health conditions are likely to be major factors contributing to these shifts. However, a specific meta-analysis focused only on child and adolescent mental health reveals that, on the whole, the severity of these conditions has not changed in the 21st century. Importantly, there is absolutely no evidence linking any change in rates of diagnosis of mental health conditions with any technology-related factors.

If children are to develop the self-regulation and emotional resilience required to thrive in modern technological culture, they need unhurried engagement with caring adults and plenty of self-directed outdoor play, especially during their early years (0–7). 

While much of this is sensible, it seems to be predicated on an unfounded assumption that parents are using tablets and similar technology as ‘digital babysitters’. In fact, a 2015 study found that children aged from birth to five-years-old were much more likely to use tablets with their caregiver than on their own. Parents and children already enjoy time together using tablets in an unhurried and engaged way. Obviously, families also choose to use digital technology (especially streaming media such as YouTube Kids and BBC iPlayer) as a means to occupy children for short periods while they carry out domestic tasks, but this is no different to TV-watching since the 1950s, or radio before that.

A recent EU Commission study interviewed families across Europe, with a six- to seven-year-old, about their parenting strategies when it comes to tablets and smartphones. The team collected a wide spectrum of views, from tightly restricted and monitored use for a few minutes a week through to so-called ‘free-range’ use where devices are available 24 hours a day on demand. Yet in each case, parents said that they had adopted their chosen strategy in order to ensure that their child grew up with a healthy attitude to digital technology. Clearly, from a parent’s point of view, there’s no one right way to achieve a balanced diet of play.

Children thrive when parents, carers and other adults pay attention to those activities that the children themselves have chosen to do. If a child loves to paint and draw, the adults around them will hopefully take an interest in their artworks. Equally, if a child loves to play Minecraft, their caregivers have an identical opportunity to engage, ask questions, praise, offer advice and explore it together.

… [the writers call for]… National guidelines on screen-based technology for children up to the age of 12, produced by recognised authorities in child health and development.

This call is utter nonsense unless the monolithic notion of ‘screen-based technology’ is broken down in meaningful ways. One of the biggest problems we have with efforts to demonise screentime is the ignorance of those who undertake to do so. History is crowded with examples of people writing new inventions off as worthless, or damaging, due to ignorance of their potential. See one example below – Socrates’ opinion of the new technology of “writing”, as given by Plato:

I’ve said it before and I’ll say it again, THERE’S NO SUCH THING AS SCREENTIME. Right now, we are writing this blog post on Sue’s laptop. Earlier today, Ben Skyped his parents with the children, while Sue looked up the weather on a smartphone app before using the same phone to load up a family bus ticket and take the kids to the beach. At the beach, we filmed them jumping over waves in their wellies and we looked back at the footage in a cafe. Sue then browsed Twitter while the kids played in the playground, before we all came home and they settled down to play the new Lego Elves iPad app in conjunction with the new Lego toys they’ve been building since Christmas. Later, we’ll watch the final episode of Planet Earth 2 together as a family. To bracket all of those activities as ‘screentime’ is clearly nonsense. Any research on this issue needs to capture the quality, not just the quantity, of activities engaged in by children and attempt to make distinctions between more or less valuable types of engagement.

Without concerted action, our children’s physical and mental health will continue to deteriorate, with long-term results for UK society that are frankly unthinkable.

Rubbish.

In particular, this kind of call utterly ignores the huge benefits that the internet, online gaming, social media networks, active games, tangibles and robotics can deliver. In particular, the ways in which these technologies can level the playing field for people in remote communities, from disadvantaged backgrounds or those with disabilities is utterly ignored by these authors.

And yet, despite what you may think from this post and others, we are not uncritically in favour of technology use by children. We agree that it is important to collect evidence on the potential benefits and disadvantages of different kinds of technology use at different stages of development. In particular, parents should be aware of the potential difference between passive viewing and active engagement and should help their children balance these different kinds of ‘screentime’. Children need to be encouraged to develop self-control in the technological world, as they do in all things (i.e. when it is time to leave the playground, when they’ve eaten the last sweet). Good digital etiquette for orchestrating social relationships online, and knowledge about digital security are also important as children grow up and gain independence (online and off). This page has a useful round-up of digital skills which children should learn (and which parents and educators should be able to impart).

So, if you were writing a letter to The Guardian, what would you call for?

We call for children to be given the resources and the tools to explore and benefit from the digital world as their parents do.

We call for research to capture the nuance and detail of engagement with technology and understand HOW rather than HOW MUCH new technologies should be used.

We call for technology developers in the commercial sector to work with academics, educators and families to create digital worlds where children can play and learn in a way which meets their needs and expands their experiences.

We call for anyone making pronouncements on child development to support their arguments with quality evidence.

We call for parents not to switch off, but instead to switch on to technology, and engage with their child’s digital learning and play.

15 thoughts on “A response to “screen based lifestyle harms children’s health”

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  4. P. Samaras

    In clinical practice I see more and more non-ASD children in need of developing their social skills. They all share a common problem which is internet addictive behaviors. Obviously this is just an observation and by no mean there is intent to provoke a clinician vs researches debate. Nevertheless, research community is a bit late and should have addressed this issue much earlier in order to have created a diagnostic category in dsm-v. From a personal perspective I firmly believe that “screen time” evolves to “online time” which is just a matter of preliminary (premature if you like) acquisition. No wonder why 12 yr olds believe that their true friends live in the internet. Bottom line children should first develop their social, cognitive and motor skills rather than digital, the will have plenty of time for that in the future.

    1. Kefte

      I’d also say my greatest friendships are those formed that don’t live in my real-life. Afterall, there are 3-billion people with internet access, I meet about 100 people through work/everyday life, I reckon the probabilities are that I will meet people that I have more incommon with on the internet.

    2. Caroline Williams

      Can you explain your perspective is on the benefits of creating a diagnostic category in the DSM?

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  6. I Am A Science Lady

    This is a great and thorough article, but I worry that cold hard facts just won’t have the same reach as reassuring messages that confirm one’s prejudices. If guidelines on this sort of thing were introduced, what are the chances that the policy makers would follow the evidence rather than whatever tugs on the heartstrings of the voting public?

    I cannot think of a significant technological event that has been without a moral panic. When will we start to notice a pattern?

  7. Dr. Andy Dalziell

    For most kids “screen time” is harmless and in fact can be productive as you’ve outlined. However, where kids are sedentary with their ‘screentime’ they and their parents need to be empowered to use the digital devices available to enhance levels of physical activity where possible. In terms of social skills and relationships, I am forever baffled when I see couples of all ages sitting across a table at a lovely restaurant on their smart phones and not talking with one another!! Madness!! Again, this is not a ‘screentime’ issue but rather a faux-pas on modern living………whatever happened to holding hands across the table and gazing lovingly at one another?

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  9. Peter Bush

    Thank you for your blog. I am a special school principal in Australia and when I read the article in the ‘The Guardian’ I became increasingly frustrated. It is these type of articles that influence our parents’ thinking, often, as you have written, without any evidence.
    Well done and I will be sharing this blog with my staff to give them the facts as well.
    Kind regards,
    Peter

  10. John Fitzpatrick

    I would add to your list a recognition of the importance of play in children’s lives whether indoor or outdoor. Play being defined as what children choose themselves – controlling the content and intent themselves. To pursue their own interests in their own ways.

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