April 10, 2019 -- “Dawn” was always a sweet, shy child who didn’t mind playing alone and could easily get lost in her books and TV shows, says her mother, “Melissa.”
As a teen, her love of Veggie Tales and Curious George gave way to more grown-up fantasy books, along with shows and movies with a darker edge, like Harry Potter, Supernatural, Riverdale, 13 Reasons Why, Hunger Games, Girl, Interrupted, Miss Peregrine’s Home for Peculiar Children, and the young adult horror novel series Asylum. When making friends became a challenge after a move to a new state, Melissa says, screens and the digitized worlds they offer became even more of an escape.
“She was trying to figure out her identity and copying all these characters she would see,” Melissa says. “We now know that she was having nightmares about murder, suicide, and other gruesome, gory, and even demonic things she saw in the storylines, too.”
Melissa says it became difficult and then almost impossible to keep Dawn away from screens. She’d sneak them to school or into her bedroom at night. They had epic battles as Melissa and her husband tried to enforce limits and encourage their daughter to do school and family activities. Melissa says her daughter became defiant, belligerent, and eventually started hurting herself -- cutting her wrists with a razor and concealing it with long sleeves. When her parents discovered the marks on her arm, they rushed her to the ER.
Doctors there referred the family to a counselor who diagnosed Dawn with depression, started her on an antidepressant, and recommended nearly 2 weeks of inpatient treatment for self-harm at a local mental health facility. Meanwhile, her parents desperately stressed to her doctors that their 16-year-old needed treatment for a technology addiction, too.
“We knew we couldn’t help her with that if we brought her home,” Melissa says.
Help was tough to find, as Melissa and her husband learned there is no official medical diagnosis of “technology addiction” or even “screen addiction.” Still, their search for help led them to an outdoor wilderness program in Utah that focuses on helping teens with digital addictions. Dawn spent about 5 months in the outdoor therapy program in late 2018 and early 2019. Her family says it took that long for her to “detox” from her screen addiction and get to the root of the problems that caused it.
Like all participants in the program, Dawn lived outside, slept under the stars with a tarp as her only shelter, and cooked her meals over a fire. She also got intensive therapy, slowly became accustomed to living a life unplugged from technology, and her family says she eventually regained her identity.
“I didn’t realize I was becoming addicted,” Dawn wrote to WebMD. “I felt like I needed to have a phone with me at all times. Isolating myself to watch TV made me forget about reality, and in the moment it was nice to get away. At the end of the (wilderness) program I realized how much I was thankful for it. If I hadn’t gone there, I’d be dead.”
The wilderness program Dawn attended is among a variety of places -- including residential treatment facilities, boarding schools and even summer camps -- that offer treatment programs for teen digital addiction. The Association of Experiential Education and the Outdoor Behavioral Healthcare Council have accredited 16 wilderness therapy programs around the country.
Because digital addiction is not an official diagnosis, families face many challenges getting help when they see concerning behavior between their teens and technology. Without a diagnosis code, insurance will not pay for medical help, and figuring out the right treatment can be tough since there’s no consensus on the best approach.
Michael Bishop, PhD, used to run a psychology practice, but 2 years ago he founded the therapeutic Summerland Program, a summer “wellness” camp that advertises itself as a way to help teens break a “technology overuse habit." In its first year, in 2018, Bishop says it served as a “reset” experience for about 140 teens at two locations -- one in North Carolina and one in California. He’s expecting the same amount of campers in 2019 at one location in the Pocono Mountains.
“The commonality is that we are treating young people who are using screens to control the way they feel,” he says.
Bishop says they did that by establishing a “no screens” rule at camp and talking often about healthy technology habits. They also engaged kids with “old-fashioned” activities like capture the flag, hide and seek, Frisbee golf, rock climbing, white water rafting, and more.
According to the camp website, the goal is not to prepare teens for a life without screens. “We teach our campers how to live with the constant distractions of screen-based technologies. It’s unreasonable to just exclude technology from our lives,” the website says.
Summerland is not a wilderness camp but is part of Camp Pocono Trails, a summer camp that stresses fitness, weight loss, and overall health, according to the camp’s website. Multi-week stays at the camp cost between $4,000 and $10,000.
“It was about trying to rekindle their interests in different things,” Bishop says. “It was about getting back to nature, teaching mindfulness, and that it’s OK to be bored or with your thoughts and not stimulated all the time.”
Experts stress that digital addiction treatment programs vary widely in their experience and approach. They say parents should investigate them thoroughly and carefully -- especially wilderness programs, which aren’t regulated. Children have died while in the care of some of them in recent years.
“The truth is, some of these programs are excellent and some of them may be worrisome, and the challenge is trying to sort that out,” says Victor Fornari, MD, director of the Child and Adolescent Psychiatry Division at Zucker Hillside Hospital in Glen Oaks, NY.
“There is really no good evidence or data on which program is successful for this specific treatment because it is such a new frontier. So we have to be careful we aren’t playing into a for-profit business that is established just because there is a new market.”
Some experts also question whether you should treat teen screen use as its own condition or a symptom of another mental health issue. Fornari says in his clinic, they do the latter.
“If a child is depressed or anxious or has ADHD, we try to treat the underlying problem because there is no specific pharmacology for screen compulsion,” he says.
Addiction expert Maia Szalavitz, who has won awards from the National Institute on Drug Abuse and other organizations for her 3 decades of writing on addiction, drug policy, and neuroscience, agrees.
“Treat the problem,” she says. “You may need to deal with the screen in treating other issues, but if a kid is being bullied and spending a lot of time on screens, address the bullying. If a kid is anxious or depressed, treat that. I don’t think you will find people with compulsive screen time who don’t have something else going on.”
Can Teens Get ‘Addicted’ to Technology?
Fornari has been practicing for 35 years and says while the nature of psychiatric problems hasn’t shifted, overuse of screens is adding a new dimension to just about every case he sees.
“Usually parents bring their children to me because of an issue with anxiety, depression, or behavioral issues, but regardless of those problems, the interface with screens always comes up. It is now always an issue,” he says. “Screens are like oxygen for teens, which makes sense because we now have the beginning of a generation that is born practically holding these handheld devices from infancy. It has evolved very rapidly.”
Child and adolescent screen use and overuse are evolving so fast, the medical and psychiatric world can’t keep up.
The most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, DSM-5, which was published in 2013 and is used to diagnose mental health disorders, doesn’t include digital addiction. It does discuss addiction to Internet gaming but found more research was needed to declare that a unique mental disorder. So Internet gaming disorder was placed in a section of the manual called “Conditions for Further Study.”
The American Psychiatric Association has invited proposals for changes to DSM-5, and with advances in digital publishing, changes can now be made on a rolling basis. But the APA says no proposals have been submitted regarding digital and technology addictions or Internet gaming disorder.
“I hope it doesn’t take 40 years for us to start recognizing that these tech addictions can be very serious for some people and they need help,” says Douglas A. Gentile, PhD, a professor of psychology at Iowa State University in Ames who has been studying teen addiction as it relates to video games since 1999.
There is now more research outlining teens’ overuse of technology and its negative impacts. That includes:
- A research letter published in JAMA Pediatrics in February that said only 5% of teens are meeting recommended guidelines for screen use, sleep, and exercise. Those guidelines for screens are less than 2 hours of exposure to screen-based digital media in a 24-hour period.
- A January research paper published in The Lancet found that teenage girls who use social media the most, meaning more than 5 hours a day, had a 50% increase in symptoms of depression. For teen boys, the authors found a 35% increase in symptoms.
- A study of 40,000 children and teens published in 2018 found teens used screens for more than 7 hours a day were more than twice as likely to be diagnosed with depression or anxiety or treated by a mental health professional. Moderate use of screens -- 4 hours a day -- was also associated with lower psychological well-being.
- And a study out of Duke University published in early 2018 found a link between more use of technology and later increases in attention, behavior, and self-regulation problems for teens already at risk for mental health issues. It also found that on days when teens used their devices more, they were more likely to have conduct and behavioral problems like lying and fighting.
What More Can Parents Do?
If you think it’s time to seek professional help for teens in your life, experts recommend starting with your pediatrician or family doctor, or seeking out a therapist, counselor, or psychiatrist.
Experts agree that when teen screen use is out of control, changes have to be made at home. The first step toward a healthier relationship between teens and technology almost always involves parents assessing their own behaviors. “Part of the problem is parents themselves are struggling with screen use. How does a parent expect to set limits for their children if they don’t have some for themselves too,” Fornari says.
Experts say parents need to be mindful of the family environment and monitor stress in the household. “When things get heated, try to step back and do something about it. Is there too much tension or fighting or anger? Because all of those are potentially toxic factors that might encourage a child to retreat to a screen,” Fornari says.
He says when teens retreat into screens, it’s also often because parent-child communication has broken down, so he also encourages all of his patients to make sure they’re really talking with their children. He says one way to do this is over technology-free family meals.
“If you only have dinner together once a week, try to increase it to twice a week. A lot of teens are ordering fast food three times a week and eating it on their own, while they’re on social media, watching TV, listening to music, and doing their homework,” Fornari says. “Parents have to realize if they are leaving their child to relate to their technology, there will be risks.”
Access is an issue as well. “What we know about other addictions -- both behavioral and substance use – is, the number one predictor of whether you get addicted is access,” Gentile says. “I think it’s not that there is something magically different about technology itself, but the universal and permanent access does seem to be different from other addictions.”
To create some boundaries with technology for your teens, experts recommend that you:
- Create structure and rules, when possible, before you give a child or teen a device.
- Set family limits for daily use.
- Keep screens away from meals and out of bedrooms.
- Have a family docking station for devices at night, and take devices away for a day if they aren’t used.
- Set a family rule that parents have to approve all apps before they are downloaded.
- Restrict video games to weekends.
- Make screen time depend on doing homework.
- Introduce teens to tech and activities that tap into their skills but don’t involve screens, such as drones, computer programming, coding, puzzles, and more.
- Encourage physical exercise and school and family activities to get teens outside and away from technology.
- Carefully monitor what teens are watching on their phones, computers, and televisions.
Bishop says ultimately, parents have to realize they can’t police their kids into compliance but instead need to focus on teaching them healthy habits and behaviors so they can find balance on their own.
Dawn’s parents say seeking help has brought big improvements to their family. Melissa and her husband have been taking parenting classes. And now that their daughter has graduated from the wilderness program, she’s settled in to a boarding school with programs that help students build healthier habits with technology and that teach them how to build and rebuild healthy relationships.
“There is more work for her and us to do, but things are moving forward in a very good way,” Melissa says.
Dawn agrees. “Living in a world where technology is everywhere you see is going to be hard when I go back into the world,” she says. “I hope that I’ll be able to establish healthy boundaries with screens and acknowledge when I’m having trouble.”
The 16-year-old says she also hopes her story is a warning for other parents and teens about why it’s important to work to set these boundaries when it comes to technology and screens.
“I know it’s hard. I had to do it. But I’m glad I did. I have a future in store for me -- a bright one,” Dawn says. “I came from the darkness -- emotional, physical, mental, and spiritual -- and now I’m making a life in the light.”