Pediatric Associates of the NW Blogs

When Screens Take Over: Problematic Interactive Media Use

Shannon Odell, PsyD
October 29, 2018 11:30AM

How many hours per day does your child spend on screen media?

In this day and age, it’s hard to be sure. Schools now use Chromebooks or iPads as part of the curriculum starting in elementary school. Add to that whatever time they spend on a device once they’re home from school, plus any collective “family TV time,” and your child has likely logged a lot of hours.

I’ve seen a steady uptick in patients who present to behavioral health with some sort of conflict with parents around screens at home. Some of these problems have gone so far as children refusing to go to school so they can stay home and play Fortnite or watch YouTube. According to the Center on Media and Child Health (CMCH) at Boston Children’s Hospital, adolescents aged 13-18 spend an average of 9 hours per day using screen media. At least 1/3 of that time includes children using two screens at the same time, resulting in upwards of 12 hours per day of media exposure. Shockingly, 24% of teens felt that they were “constantly online,” and nearly half (HALF!) of teens feel that they are addicted to their devices.

Clinicians and researchers around the globe are seeing problems with gaming, social media, pornography, open-ended searching of short-form videos (like on YouTube), memes, hyperlinks, wikis, and other media black holes that CMCH has termed “information-bingeing.” CMCH has labeled this over-use of screens Problematic Interactive Media Use (PIMU), and it has been found to cause significant harm to a teen’s academic performance, relationships with family and friends, and physical and mental health (here’s a link to my previous blog about Smartphones and mental health).

According to CMCH, the symptoms of PIMU include excessive use of video games, social media, pornography, and/or online information seeking. While the primary symptom is a fixation on screen use, other symptoms can include neglecting personal hygiene, a decrease in school performance or outright school refusal, relationship conflicts, and/or social withdrawal. A study published in 2014* found that many of the young people who have PIMU are also struggling with other underlying mental health conditions such as attention deficit hyperactivity disorder (ADHD), anxiety, and depression that may have been masked by the over-use of screens.

This interactive media environment provides a distressed child/teen plenty of distraction, mastery, or “self-medication” to cope with uncomfortable symptoms.  When I ask a child or teenager what they do to cope with sadness or anxiety, the number one response I get is “watch Netflix or YouTube.” It turns out that using a screen to reduce feelings of distress is a slippery slope and can end up creating a dependence on interactive media to provide an escape from their emotional discomfort, no matter how minor the discomfort might be (for instance, being bored while waiting at a doctor’s office).

The following are tips from CMCH to help your child/teen who struggles with screen time:

  • Watch for warning signs, such as spending time with screens for long periods, lying or hiding about the amount of time spent, or using media to escape from other issues such as anxiety and depression.
  • Create rules for healthy media use, such as time limits. A device like Circle can help with that. Make sure that children are using media for a specific purpose (such as homework or watching a movie), and not in place of other activities (i.e., homework, chores) or to avoid dealing with problems.
  • If you notice your child displaying signs of PIMU, be sure to talk to them about their media use and seek outside help from a doctor or professional counselor. You can also visit The Center on Media and Child Health’s website for more information.

I don’t write about this topic to scare parents, and I certainly don’t intend to shame anyone for allowing their children to use devices. Screens are part of the world we live in, and to be successful in this day and age we must know how to use them competently. The media and the Internet are not the problem; it’s how our children use these tools that results in positive or negative outcomes. As with all things, moderation is best, so help your child (as much as you can) set limits and keep an eye on how they’re using their time on screens. Help them learn how to cope with negative emotions with self-soothing activities that don’t involve a screen. And, every once in a while, send them outside to play.

*Ho, R.C., Zhang, M.W.B., Tsang, T.Y. et al. (2014). The association between internet addiction and psychiatric co-morbidity: A meta-analysis. BMC Psychiatry, 14,