Interview with Megan Skelding, APRN, PMHNP
Note: David Parker interviewed CRG’s psychiatric mental health nurse practitioner, Megan Skelding, about a growing trend she sees in her practice.
DP: What led to your interest in this topic?
MS: In this day and age, technology cannot be escaped. As a medical provider, I frequently encounter teens who have difficulty turning off social media whether it is in my office, at school, or home. In turn, this can and does create conflict amongst them and their parents. In fact, one-third of parents and teenagers say they argue daily about screen time (PBS Newshour). Not surprisingly, 92% of teenagers report going online daily, including 24% who report being online “constantly” with the accessibility and convenience of digital media (Lenhart, 2015). With this new wave of digital accessibility, what are the symptoms of excessive use? Determining what is happening at a neurophysiological level can provide a better understanding of the repercussions of excessive screen time. A common theme that presents in my office is sleep, or lack thereof, amongst teens. How much of insomnia or fatigue can we blame on our electronics? It’s a difficult question to measure but an important one to consider. Besides insomnia, I tend to notice other symptoms in many teens that seems related, at least in part, to excessive use of digital media.
DP: Teenagers’ use of digital devices is enmeshed in their daily lives and school experiences now. Given this, what are some current statistics or observations about “healthy” use of screen time? Conversely, what are some problems you’ve noticed or read about in the literature that can arise from too much or the wrong kind of screen time for teenagers?
MS: Adolescence marks the beginning of puberty, which has shown to produce a shift in the circadian cycle. Meaning, adolescents naturally do not become tired until much later in the evening. The blue light emitted from computers, TV’s, cellphone devices, and other electronic devices can exacerbate this trend. That light can delay the production of melatonin in a teen’s brain, which is the natural hormone our bodies produce to help us become tired and fall asleep. So, extended use of screen time late at night makes it even harder for teens to “power down” once they do try to go to sleep, creating disruptions in their circadian rhythm. According to Carskadon (2011), an estimated 30% of teenagers are chronically sleep deprived. This deprivation causes irritability, impacts social relationships, and negatively affects academic performance. There have also been neuroimaging studies that identify physiological damage within the brain’s structure and function due to extensive screen time. The ill effects are displayed as difficulty organizing, difficulty planning, difficulty prioritizing, less efficient information processing, poor impulse control, increased sensitivity to rewards, difficulty developing empathy, and difficulty developing personal relationships (Lin, 2012; Yuan, 2011; Hong, 2013; & Weng, 2013). Additionally, excessive and prolonged screen time has been associated with lower academic performance, obesity, behavior problems, increased aggression, lower self-esteem, risky behavior, and depression according to a study published in the American College of Pediatrics (2016). Furthermore, physical symptoms can include headaches, obesity, eyestrain, poor posture, sore neck and back, and cramping in the fingers (Bratskler, 2015). It is important to remember that digital media is not all rooted in evil. There have been studies that identify benefits, too. These include earlier learning, more opportunities for social contact and support, increased access to health information, and awareness of current events (Chassiakos, Y.R., Radesky, J., Christakis, D., Moreno, M. A., & Cross, C., 2016). Social media can also be used advantageously to enhance social networks, particularly amongst those who do not feel comfortable speaking about personal issues in the home or at school.
DP: Is any of this unique or specific to gender? In other words, do we need to be aware of any issues that are unique to girls’ use of digital devices/social media?
MS: The general ill effects and structural changes within the brain show no preference among genders. However, it is important to be aware of social media differences between female and male adolescents. This can provide some insight into how each gender utilizes digital platforms. According to the Huffington Post (2015), girls prefer more visually oriented social media. These platforms include Facebook, Instagram, Snapchat, and online pin boards like Pinterest and Tumblr. Boys are more likely to play video games. New social networking apps continue to come onto the market frequently. Their safety is not yet well understood. Nearly 41% of adolescent girls will experience cyberbullying in their lifetime, compared to 28% of boys. Cyberbullying is defined as “when someone repeatedly harasses, mistreats, or makes fun of another person online or while using cell phones or other electronic devices” (Hinduja & Patchin, 2015). This can lower self-esteem during a period of adolescence when maintaining a positive view of oneself is challenging enough. Thirty-five percent of teenage girls have had to block or unfriend someone as their flirting led to feelings of discomfort (Pew Research Center, 2015). The rising trend of teenage girls having major depressive episodes compared to their male counterparts is distressing. A recent study (“National Survey on Drug Use and Health”) showed an increase of major depressive episodes within a twelve-month period from 13% in 2005 to 17% in 2014, while boys increased from 4% to 6% respectively (Howard, 2014). While more research needs to be completed to determine the exact cause for the rise in depression, the finger is being pointed towards social media, specifically cyberbullying. It is believed girls place more stress upon themselves when there are disagreements between family and friends than boys do, according to a 2014 study in the Journal of Psychological Science. We know technology cannot be escaped. However, it can be “unplugged.” While social media platforms can potentially enhance relationships and strengthen support systems, they can just as easily weaken and break the bonds. Communicating online is the way of life for teenagers, especially teenage girls. As providers, parents, and teenage girls, we need to be aware of the negative repercussions social media offers. Depression continues to rise among teenage girls. We must recognize the symptoms and determine if they are occasional rather than continuous. Key symptoms can include unrelenting unhappiness, lethargy, irritability, and poor school performance (Smith & Segal, 2016). In order to combat the negative outcomes that can be caused by excessive screen time, it must first be acknowledged. I recommend that parents lead by example while enforcing daily screen time limits. Designate a “tech-free” night for the entire family or identify 1-2 hours each night without electronics. The American Academy of Pediatrics (2016) recommends that each family impose a daily screen time limit without neglecting exercise, sleep, and other behaviors essential to a healthy lifestyle. Lastly, ask questions, encourage communication, listen, be present, and remain aware of social media content. This year, the National Screen Free Week will take place May 1 – May 7, 2017. I challenge everyone, young and old, to participate.
