Friday, January 17, 2020

Let’s Be Wise About Smartphone Use

Andrew Brooks, MD
Pediatric Resident at The University of Texas at Austin Dell Medical School
Member, Texas Medical Association

Since their invention in the seemingly distant past of 1992, smartphones have evolved from a clunky curiosity the size of a brick to sleek, superpowered machines that fit in our pockets and purses. Ownership of smartphones has skyrocketed from 35% of Americans in 2011 to 81% in 2018 according to the Pew Research Center, and  95% of American teens have access to a smartphone. In the pediatric clinic setting, we see the effects of smartphone usage by our young patients nearly every day: the good – occupying our patient’s bored siblings during a clinic visit; the bad – having to repeat questions to our patients because they’re busy checking social media; the ugly – patients with anxiety and depression associated with problematic smartphone usage; and even worse – motor vehicle accidents associated with distracted driving, often because of smartphone use.

So while often beneficial, these devices can pose problems – so much so that scientists are focusing on the potential negatives.

What is problematic smartphone usage?

The psychologic study of problematic smartphone usage is still a newborn science. Doctors use a resource called the DSM (Diagnostic and Statistical Manual of Mental Disorders) as the gold standard of identifying and diagnosing psychologic problems. Smartphone addiction hasn’t officially been added to the DSM yet, but these major criteria – negative behaviors found to be highly suggestive of addiction – have been proposed in research journals:
According to the Pew Research Center, 95% of American teens
have access to a smartphone. But scientists are focusing on the
potential negatives that result from excessive usage. 
  1. Continued inability to resist the impulse to use the smartphone;
  2. Symptoms of dysphoria (sadness), anxiety, or irritability after a period of withdrawal from use;
  3. Using the smartphone for a period longer than intended;
  4. Persistent desire and/or unsuccessful attempts to quit or reduce smartphone use;
  5. Heightened attention to using or quitting smartphone use; and/or
  6. Persistent smartphone use despite recurrent physical or psychological consequences.

Researchers also recommend assessing people for these functional criteria, which indicate the negative effects of the addiction on a normal lifestyle:

  1. Excessive use resulting in persistent or recurrent physical or psychological problems;
  2. Use in a physically hazardous situations (such as while driving or crossing the street) or situations that have other negative impacts on daily life;
  3. Use that impairs social relationships or performance at school or work; and/or
  4. Use that is very time consuming or causes significant distress.

In their paper, Proposed Diagnostic Criteria for Smartphone Addiction, scholars recommend that for someone to be classified as addicted to their phone, he or she should exhibit at least three of the major criteria above, and two of the functional criteria. So if you experience three of the major criteria and two of the functional criteria, your condition would justify being labeled a mental disorder.

What are the effects of problematic smartphone use?

Research studies have blamed excessive smartphone use on mental health problems. They have linked excessive usage with increased risk of anxiety and depression, poor sleep quality, lower daytime function, and poor performance in school.

The danger of phone use while driving is well documented (and honestly, quite shocking). About 25% of motor vehicle crash fatalities are associated with distracted driving, the largest culprit of which is texting or other use of electronic devices. More than half of all accidents involving teens are directly caused by distracted driving.

What can pediatricians and parents do?

Smartphones have become an integral facet of modern culture and communication, and that won’t be changing soon. This begs the question:  What do we do about the problems these devices can bring?

The American Academy of Pediatrics recommends that parents not allow infants and toddlers younger than 18 months old to use screen media devices (including smartphones) and strictly limit screen time for older children under age five. For older children and adolescents, parents need to firmly and consistently place limits of the type and duration of screen usage, as well as designate smartphone/media-free times and places, such as the dinner table and bedroom. The current generation of parents have a responsibility to guide the development of healthy offline behaviors for children, and healthy online behaviors as well.

As pediatricians, it is our responsibility to be aware of the risks of problematic smartphone usage, and to encourage parents to take control of this new facet of social development.

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