- Welcome to "Healthy Minds."

I'm Dr.

Jeff Borenstein.

Everyone is touched by psychiatric conditions, either themselves or a loved one.

Do not suffer in silence.

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(gentle bright music) Today on "Healthy Minds."

- The two groups that showed higher addictive levels of usage, the group that started out high at 10 and the group that became high between 10 and 14 had a two to threefold greater rate of suicidal behavior than the group that remained low addictive use throughout the whole follow-up period.

- I just wanna reiterate how important this finding is that addictive use is what significantly increases the risk of suicidal behavior, thoughts and behaviors about suicide.

You know, that's a sentence that should be on the front page of every newspaper.

That's today on "Healthy Minds."

This program is brought to you in part by the American Psychiatric Association Foundation, the John and Polly Sparks Foundation, and the WoodNext Foundation.

(gentle bright music) Welcome to "Healthy Minds."

I'm Dr.

Jeff Borenstein.

Social media, video games, mobile phones.

Today I speak with leading expert, Dr.

John Mann, about screen addiction and what every parent needs to know.

(gentle bright music) John, thank you for joining us today.

- It's my pleasure.

Thank you.

- I wanna jump right in and speak with you about addictive screen use among youth.

So tell us what we know, what we're learning, and what parents need to know about this important issue.

- It seems, when one looks at the numbers, there has been an astonishing increase in screen use among youth since the late sort of 2018 to 19, et cetera.

And the main reasons for that, probably, are availability.

At the same time, and of course, all this is entangled with COVID, at the same time, we've seen a significant deterioration in youth mental health.

A big increase in demand, rising suicide attempt rates, disproportionately rising suicide rates amongst youth relative to younger adults and older adults.

So naturally, people have sort of drawn a parallel between these two trends and postulated that maybe because kids are spending so much time on screen time, that this may have something to do with their deteriorating mental health.

However, when one looks at the original studies that have been done examining this specific question, the relationship quantitatively between screen time and mental health is extremely weak.

Screen time accounts for very little in terms of mental health outcomes.

This idea, this observation, however, was swept away by a lot of news hype, charismatic figures with strong opinions, popular books, and the general public's need for some explanation as to what's going on.

And that's where we decided to do a study using the, probably the most well-known major study of child mental health, the ABCD Study funded by the NIH, in order to try and understand more clearly what is the relationship between screen use, social media use, mobile phone use, video games, and child and adolescent mental health.

- So you did this study making use of the data from the ABC study, which is a large population-based study of youth, and came up with some very interesting findings.

Please share with us what you've come up with.

- So in doing this, I was privileged to work with a rather brilliant sort of computational epidemiology social sciences colleague, Yunyu Xiao from Cornell.

I wanna acknowledge her major part in all of this.

But we kind of combined skills, psychiatrist with computational epidemiology, and we had been working with the ABCD Study for some time.

It is a study involving more than 11,000 children from about 26 sites across the United States.

And with efforts to be representative of the US general population.

These kids have been enrolled in this study at about the age of 10.

And at the time that we did our research, we had data on these kids until the age of 14.

Now we have data until the age of about 16 or 17.

But the paper, the study that we originally did, and the paper we published in "JAMA Psychiatry" in 2025, covers the period from 10 to age 14.

The first thing we did was to look at levels of addictive behavior because there had already been some suggestion that kids using these different forms of screens showed addictive types of behavior in the use of those screens.

Meaning they tended to spend more time than seemed appropriate on those screens.

When they were asked or they wanted to try to cut down the amount of time, it was difficult for them to do that.

They felt a craving to return to the screen.

And this was despite the fact it was causing them harm in the sense of their schoolwork, time to exercise, relate to other people, even gain weight, and so on.

So these are all the criteria of addictive behavior, but played out in the arena of screen use.

So we decided to follow this up more thoroughly, and we were able to do that because after the baseline assessments that were done at age 10 in the ABCD Study, the researchers who were running the study introduced a series of rating scales that looked at addictive behavior tailored to mobile phones, social media usage, and video games.

So we used the data from those rating scales to rate the degree of addictiveness in their behavior when they were using those modalities over the next few years through the age of 14.

And then we used a computational method to look and see if the kids fell into different trajectories of addictive use.

And sure enough, for things like mobile phones and social media use, you could see that the kids fell into three different groups.

One group already showed addictive behavior, about 1/5 of the kids at the age of 10.

A second group looked like they had no addictive behavior of any note.

It was lower levels at the age of 10, but that group bifurcated into two groups after age 10, a group that showed higher addictive levels by the time they reached age 14 and a group that remained low all the way through.

So this was fascinating because we could now track what happens if you're addicted at age 10, what happens if you become addicted over the follow-up period, and what happens if you don't become addicted, and see if this correlated with mental health outcomes in those kids.

So in many ways, this was an unprecedented data set, and there really are next to no studies of addictive behavior in 10-year-olds because there's just about nothing that 10-year-olds become addicted to in any meaningful way at that age.

So when we did that, we found that the two groups that showed higher addictive levels of usage, the group that started out high at 10 and the group that became high between 10 and 14, had a two to threefold greater rate of suicidal behavior than the group that remained low addictive use throughout the whole follow-up period.

Now, there were changes, there were differences in terms of internalized behavior, and externalizing behavior, and so on and so forth.

Those effects were weaker.

There was a striking effect on suicidal behavior.

To put this in context, if you look at the general population, you don't see a big increase.

You see very low suicidal behavior in the pediatric population until about the mid-teens, around 16.

Then it begins to take off.

And by the end of teenagehood, 19, it's approaching adult levels.

So there's a steep rise, but it starts at about 16 and proceeds through the late teenagehood.

To see something that produces a two to threefold increase in suicidal behavior at age 14 is truly remarkable.

That is a very powerful effect.

When we tried to do the same calculations to see the effect of total time usage, it didn't correlate at all.

You can detect it.

If you don't account for addictive use, it's very weak.

And if you throw in addictive use as the factor, then you completely lose the effect of total time of usage.

Total time of usage is misleading.

It's really due the addictive use that is the driver of this effect.

And it is a bigger driver of other effects like internalizing, externalizing symptomatology.

- Let me just restate this extraordinary finding, which is not necessarily the total amount, but that addictive use is what significantly increases the risk of suicidal behavior, thoughts and behaviors about suicide.

You know, that's a sentence that should be on the front page of every newspaper, given the concerns we all have about suicide risk in our youth.

So I just wanna reiterate how important this finding is for the general population, and certainly for parents, to know.

- Yes, that summarizes the situation perfectly.

And it also has huge implications for designing a prevention approach.

One would not be designing a prevention approach with necessarily with, like, blanket restriction of use.

One would be thinking about managing this as an addiction.

And there are specific, designed treatments, interventions, for treating addictions.

And this would require the implementation and the testing of an addiction-based therapeutic approach for this problem, which would be much more targeted.

It would target the kids that show problematic levels of addictive behavior.

- For a parent watching this right now, what should they know, given the information that we currently have at hand?

How do they know if their child is becoming addicted during, let's say the 10 to 14-year-old age range?

How do you know if that's happening to your child?

- Well, there are general guidelines.

As I respond to your question, I am sure parents listening to this program are going to resonate with this.

So first of all, one clue is that the child is spending too much time as judged by the fact that the child is no longer going out and playing sport, or meeting friends, or working on their homework, or talking face-to-face with anybody, and maybe gaining weight.

Maybe a very good clue is that they are not going to bed at the proper time, that they're staying up late at night.

Maybe the parent isn't even aware of this, but they will stay up until the early hours of the morning.

They're spending six, seven hours a day on screen use, even during the school week.

So excessive use is definitely one indicator, but more compelling is when the parent asks the child to discontinue use, and now, you know, have dinner, work on their homework, go and play ball with one of their friends, and so on, and the kids can't stop themselves.

They'll put it down, and then they'll have come back.

They can't even sustain a conversation for any length of time because they have to come back to the screen.

Difficulty discontinuing is another sign, maybe combined with anger, irritability, protest, temper tantrums, all of those kinds of things indicating a difficulty dissociating from this activity.

Then, of course, not able to do this despite the fact that it's causing harm to them socially, educationally, et cetera.

So these are things that parents can observe.

One of the things that we've found that may be helpful for parents is that there are homes where screen time is regulated.

Educational use of screen time is allowed, there's an effort to steer the kid to more constructive uses of screen time, and those things help.

- Is there a sense at this point about the mechanism that this occurs?

Is it rewiring the brain?

Is the brain changing as a result of so much screen time, and then that sort of becomes a snowball effect?

What's our current understanding of why this is happening?

- Our current understanding is actually very current.

This is exactly what we are doing at the present time.

We are studying the various neural pathways in the brains of these kids.

At age 10 was the first set of MRI studies, and we can already see in the group that shows high addictive use patterns of change in their brains which are similar to those reported, up to this point in time, only seen in adults.

So now we know several things.

It looks like, you know, these kids' brains, to the extent that their brains resemble adult brains, show some of the, already, the changes of addictive use that are seen in adults.

And this is seen with a, this is a behavioral addiction.

This is not substance use addiction, but it's the same type of thing.

- Is there a difference between those that went on to increase use, that started at a lower level and then increased, versus started at a lower level and continued at the lower level?

- We don't know the answer to that question.

It's a very good question.

That's actually the subject of our current research.

We are attempting to match the evolution of the brain's development with the appearance or nonappearance of increasing addictive use.

And the reason that that's a much more challenging research question is that at the time of the original group showing high addictive use, 10 years of age, the neural circuitry isn't fully developed.

These are developing brains.

Nearly all of the studies, practically just about every study you can think of that's been done in the field of addiction, has been done in brains from people that are, you know, whose brain development is complete.

But in this period, like teenagehood, early preadolescent period, and then adolescence, the fibers that are innovating the prefrontal cortex where you have the cognitive control, and reward pathways, and many other things are still myelinating, and the white matter is still forming around those axons.

And the white matter that forms around those axons, this myelination process, is fundamental to the acceleration of signaling along those pathways.

- You described steps that a parent can take with their own child.

Are there things that we should be doing as a society, whether it be schools limiting the amount of use?

Are there broader steps that should be taken to help decrease the risk of these events taking place amongst our youth?

- Our data indicates that parents have a role to play, steering their child to more constructive uses of their phone and social media is a good thing.

Limiting the use is a good thing.

Kids that are able to not use the phone that much, even on weekends, have better outcomes.

So, and this can be helped by the parent.

So that's a very important thing.

Now one needs to remember that there are many constructive uses of social media and the phone.

The phone is definitely a big aid for doing homework, for example, and just self-education.

Huge amounts of information, very interesting things can be obtained.

AI can be an extremely constructive tool for any age group.

These constructive uses should be encouraged, recognized, encouraged.

There should be an open dialogue between children and their parents about how the kid is using social media and their mobile phone.

Now, there's a whole separate domain of activity that's going on around schools.

Of course, many schools have... Well, now, in New York State, for example, kids are supposed to hand in their phones before they begin school.

I mean, the kids have little workarounds to keep their phones despite this.

But this has a different purpose.

Its main purpose in reducing availability of phones during school hours, we shouldn't kid ourselves.

It's not specifically targeting the ones who have adverse mental health outcomes or have addictive use problems.

It's really designed so the kid will pay more attention to the teacher and engage with the school process while they're at school.

So if that's our goal, then maybe that has merit, and maybe we should be measuring the effectiveness of that strategy to justify it going forwards.

We've implemented a multimillion dollar program in New York State to do this, but have we implemented a comparable effort to quantify the outcome of this strategy?

That would be really crucial to know.

- I think that's a very important point.

And the finding and focus on the addictive use is important for all of us to understand.

And I think that parents can be role models.

You know, we all have our phones with us at all times, and being able to sit at the dinner table, and not check your phone every minute, and be engaged in a conversation certainly can allow us to be role models for youth about how to appropriately make use of the benefits of the phone without, you know, too much of a good thing becomes too much.

And I think parents can be role models for their children.

- You'd think that would be a good idea.

But it's amazing to me, when I've given a talk that's included parents, that how many parents have said to me, "You know what, I now realize that I'm addicted (laughs) to the phone."

So they're not a very good role model.

And, you know, and increasingly you go to restaurants and other places, and you see, ride the subway in New York, and look how many passengers are on their phone doing stuff the whole time they're on the subway.

- Yeah, it's amazing to see people sitting at a restaurant together and none of them are interacting with each other directly.

They're all interacting with who knows what on the phone.

And I think we all need to move away from that.

And especially our young people who've grown up with this from age zero, they have seen this.

- Yes, that's true.

You know, we've actually been looking at, you know, when these kids start using, the ABCD kids started using phones.

We could only include people in this study who actually had access to a phone, but that was, like, the overwhelming majority of these children.

- John, before we finish up, I wanna ask, where do you see this going over the next two, five, 10 years?

Where is the research going to lead us, and what will be the new interventions for our youth?

- We're going to learn something about the development of addictive behaviors, which I think is gonna be incredibly informative for the entire field of addiction.

Second, we're going to definitely learn a lot more about the factors that influence mental health in our youth.

But in mental health, we are experiencing a dramatic deterioration in youth mental health.

And this ABCD Study has come along at just the right time for us to do an extremely detailed study of the evolution of neural pathways, genetics, social determinants of health, all in the same population of kids.

And that's gonna teach us a lot about what's going on in the rest of the country, and hopefully will inform us about what are important and new prevention opportunities.

What are modifiable factors that we can use to try and prevent and reverse adverse mental health outcomes in kids?

- John, thank you so much for the work that you have done, continue to do.

And thank you for joining us today.

- Thank you, Jeff.

(gentle bright music) - If you're concerned that your child or teenager is becoming addicted to social media, video games, their cell phone, take action.

Remember, with help, there is hope.

(gentle bright music) Do not suffer in silence.

With help, there is hope.

(gentle bright music) This program is brought to you in part by the American Psychiatric Association Foundation, the John and Polly Sparks Foundation, and the WoodNext Foundation.

(gentle bright music) (gentle bright music continues) (gentle bright music continues) (gentle bright music continues) (gentle bright music fades)