Ask the Expert ‘Screen Time & Mental Health – Balancing the positive with the negative’ recorded lecture

Matt Kempen
Marketing Manager for ACAMH

Posted on

Dr. Max Davie on ‘Screen Time & Mental Health – Balancing the positive with the negative’. There then followed a Q & A session facilitated by Professor Barry Carpenter. This is the first in a series of free sessions exclusively for teachers and is an exciting new partnership between ACAMH and Coram Life Education (CLE).

Slides from the session. See the session below or direct from our YouTube channel.

If you are a teacher book now for the session on Thursday 25 November, 15:45 – 17.00, Ask the Expert ‘Improving Children’s Sleep; The role a teacher can play’ with Dr. Faith Orchard, and Professor Barry Carpenter.

Key Takeaways 

  • Find out about the latest evidence-base, with a balanced understanding of the positive and negative impacts screen time can have on mental health.
  • Discover a practical guide to identify what problematic screen use actually is, and what can be done.
  • Tips, advice, and recommendations on the actions you can take to assist young people.

Free resources

Screen time, social media and developing brains: a cause for good or corrupting young minds? CAMH Editorial: Volume 24, Issue 3, September 2019

Coram Life Education

Transcript

[00:00:00.610] – Introduction

Hello, we are the Association for Child and Adolescent Mental Health, or ACAMH for short.

[00:00:08.930] – Barry Carpenter

This session is organised by ACAMH. This is part of a project that ACAMH, the Association for Child and Adolescent Mental Health has initiated. I recently joined the ACAMH Board as a Trustee and it’s my great pleasure to be part of that Board, which consists and comprises a lot of very eminent psychiatrists and psychologists, and my own background is that of teacher and head teacher. So I’m coming like lots of you from that education perspective. In initiating this project, the ACAMH Board has partnered with Coram Life Education in the development of the four pilot sessions that will be happening with the one this evening on screen time kicking off this series. Each theme that we’ve chosen for the four sessions and probably for the subsequent development work that we’ll be going into once we’ve shaped this from the trial is taken from the New Relationships Health and Sex Education Curriculum framework from the DFE.

When you look at some of the topics, we now have the opportunity to teach screen time, sleep, for example. Do we really have any pedagogical history as teachers to teach those topics? It’s not literacy, it’s not numeracy. They’ve not reintroduced tutors into history curriculum. It’s about a whole new dimension of work that’s very much needed by our children and young people. We’re all very well aware that this pandemic has had a huge corrosive influence on the mental wellbeing of our children and young people, but some of the topics that RSA gives us the opportunity to teach whilst welcome, we have a knowledge gap and part of the direction of these sessions is to help you as teachers fill in the knowledge that we need to teach.

So obviously tonight’s speaker is not himself a teacher. He’s a paediatrician. So we’re not tonight going to be exploring, well, how do I teach this? Rather, we’re going to get the information that will help us think in subsequent sessions about how do we teach these particular topics? So the remit that we’ve given to our speaker this evening is to define and explain this nominated topic. So that is for the next session on Sleep, which as I’ve said, will be scheduled for probably the same time on the 25 November, information to follow.

So it’s very much tonight about knowledge transfer. It’s not about teaching approaches per se, and once this trial phase is over we will be developing further work that will focus on learning styles, teaching strategies, intervention, etc. However, colleagues from Coram Life Education who are on the call this evening will actually be adding things that they have available from within their SCARF Programme at the Coram Life Education. We really do need you at this point to partner with us on shaping how we get the knowledge transmission right in these ask the expert sessions.

That’s why we’ll welcome your comments as the session goes along. What’s understandable? How is it accessible to you? Is it useful? Did it increase your knowledge of the topic and there’ll be surveys at various points as we go through, so do feel free to comment. I’m now going to suggest that actually before we move on, we just summarise what I’ve said by looking at the objectives, about finding out the positive and negative impacts of screen time on our children’s mental health. We know during the pandemic period there’s been a considerable of necessity use of screens because of the online teaching that many schools have been doing.

We need to identify what’s problematic in screen use and provide recommendations on the actions we can take to assist young people. We’ve got a short activity before we get into the content of the session this evening. So let’s gauge who is with us and tell us in the poll that you’re going to have the opportunity to see what type of school you are representing this evening. We want to constantly widen the scope of participation. You’re the first people to come forward. We hope you will feel able at the end of this session today to be ambassadors for this series of trial sessions and go out and tell others about it in many other settings. It can be open to all teachers in any setting.

So would you like to take a few seconds to fill in what you can now see on the screen, the poll and state which type of sector you’re from? That would be really helpful, and while you’re doing that, I’m actually going to introduce our speaker for this evening. It’s my very great pleasure to welcome Dr Max Davie. Max is a Consultant Community Paediatrician working in Lambeth as part of the Evelina London Community Services. He has a special clinical interest in the assessment and diagnosis of neurodevelopmental conditions in school age children.

He is the Officer for Health Improvement at the Royal College of Paediatrics and Child Health, where he was the author of their Screen Time guidance. He’s actually a Trustee and Founder of the charity ADHD UK. Welcome, Max. We’re very much looking forward to your presentation and its insights. Over to you. Thank you.

[00:06:06.610] – Max Davie

Thank you, Barry. Thank you, everyone. As Barry has mentioned I’m a paediatrician, so I’m a sort of clinician most of the time and in fact, I am currently in one of our teams delivering this. So I have both a sort of scientific and policy hat, but also a kind of everyday working with families hat, and I think that’ll come through hopefully quite strongly. It’s always a bit nerve-wracking presenting and teaching to teachers because it’s a little bit like carving a roast in front of a load of surgeons. You’re not quite doing their job in front of them, but it’s not far off and it’s also unnerving, of course, presenting with no audience, but I will plough on as much as I can.

 

The way that I basically communicate with you is via the chat so if there are problems, if you can’t hear me, you can’t see the slides or whatever please do let me know, but the chat is really important for you to feedback to me and ask me questions, so I will have that available. The first question I want to pose to you and I just want you to put suggestions in the chat, is often a kind of narrative that we hear, increased screen time has led to and I just want to know any suggestions for what you would say it has led to.

I’m just trying to resume my share. Okay. Poor asleep, change in behaviour, less creativity, isolation, poor sleep difficulty. Wow, gosh, I’m going to have to expand my chat window. So as a population, this is really what I’m thinking about is what effect it’s had on the population as a whole. So there’s lots and lots of very interesting things being said in the chat, which may be valid on an individual level, and we can dig into that, but I was wondering if people had an idea about the population more generally.

So we’ve got aggression, identity confusion, interesting, unsuitable material, loss of social connection, shorter attention spans, isolation, desensitisation, less family time, increased motivation for sleep, which is one of the first things that came through. There’s loads of these things. So basically any number of different things, and I just think we’ll start off from a better high and hand eye communication. I think maybe co-ordination is maybe what you mean. Yes, all of those things, but generally lots of negatives in terms of the child’s development and I am a developmental paediatrician. So it’s exciting to me that you’ve really honed in on development.

But in order to make the case at a population level that increased screen time has led to increase whatever we have to answer the following questions. Firstly, has screen time actually increased? Now undoubtedly it did through the pandemic. The pandemic is a very special time. I think it’s really fascinating, but I think we need to think about things pre pandemic if we actually want to look at the evidence base because the pandemic has been so messy and difficult in so many ways. Then if you’re thinking about a particular thing, so behaviour problems or mental health difficulties or social, poor social skills, has that actually increased/worsened?

Because if it hasn’t worsened, then we don’t have a problem, and then is there a conclusive and convincing link between the two? So just too quickly go through from the public health perspective. Interestingly, and this is US data, but they’re similar UK data in the sort of decade preceding the pandemic or the few years, there hasn’t been an increase overall in the amount of media that screen based media that children consume. There’s certainly been a transition from TV based to mobiles, and you can have all sorts of arguments about what effect that might have had, but there hasn’t actually been that surge in screen time.

There was probably a surge several decades beforehand, but it isn’t a recent phenomenon. That’s a really important point, and the UK figures are fairly similar to this. Okay, so this is a mental health talk and then it’s interesting that you’ve talked more about behaviour and development because you’re teachers and practical people, but let’s talk a little bit about mental health disorders, and it’s really important to remember when we say mental health disorders in terms of the data I’m thinking of, so I’m thinking of the NHS Digital Mental Health Disorders Survey, which happened in 2004 and then again in 2017 that incorporates anxiety and depression, that incorporates behavioural disorders such as oppositional defiance and also things like ADHD and a few other bits and bobs.

So I want again some interaction from you in absolute terms. So not in relative terms. So in absolute terms and there will be a proportion of math teachers here. So I want to get it right. How much did the prevalence of mental health disorder increase between 2004 and 2017, according to the NHS Digital Survey. Okay, some guesses, 33%. We’ve got 30, 40, 150. Remember it’s absolute terms. So that would mean there’s 1.45 mental health disorders per child. So we’re talking about the absolute increase. So from X to Y percentage, what is the difference?

17 is a very specific guess. Five is the lowest we’ve had so far. 70, 60, 73, 75, 25, one in nine was the figure that came out. So let’s have the answer. It was 1%. The overall absolute terms increase between those two time points was around 1%. So it went up from a little over 10% to a little over 11% in terms of the overall prevalence of disorders. This wasn’t to do with referrals. Of course, referrals in the same period have gone up astronomically and exponentially, but this was the population burden of mental health difficulties.

Another really interesting thing for those people who talk about behavioural difficulties is actually the behavioural difficulties, if anything have gone down a little bit. Whereas emotional difficulties have gone up a little bit within that large cohort and Charlotte makes a point it’s still too high a percentage. That’s undoubtedly true, but actually what’s too low a percentage is the number who actually gets to a mental health specialist, which is only about one in four. That’s the really shocking statistic here, but I’m not talking about CAMHs as a whole.

I don’t want to get off track, but okay, fine, but we have so many every month it would appear a study comes out which makes a link between screen time and X negative impact. So there’s always an association. So children who have an awful lot of screen time have this negative association but of course, we all know from our studies of statistics that simple association does not mean that there’s a causative link. It doesn’t lead to this phrase I use, it leads to this thing leads to the other.

Which is why, and I always look out for this, in a lot of the reporting of these studies the word linked is used because link doesn’t commit you to anything. To be honest, I think it’s a little bit disingenuous because you could link the rise in autism diagnoses to the rise in organic food sales. Of course, there’s no effect. There’s no actual causative link here. It’s just that organic food sales rose during the same period that autism diagnosis rose. It doesn’t matter. So if you do proper analysis and some of the best analysis has been done by the Oxford Group, Amy Orben and Andy Shiboski [s.l. 15:00] and you look in great detail at the kind of effect. If you correct for everything else, you look at the effect on wellbeing of the amount of screen time.

The conclusion that they came to was it’s about the same as whether you eat potatoes or not or how many potatoes you eat and slightly less than whether you wear glasses or not. So it’s a very, very, very at population level, tiny effect if you correct for other things. The final thing, I think, is really important to mention lots of people like to talk about how screen time is harmful, but I’ve not seen a single intervention study that shows that reducing screen time has a positive effect on outcomes.

I’ve not seen a single one. If they start to produce them, then I’ll start to listen a bit more. That screen time in itself is a valid target for therapy, but I’m not convinced at the moment. Then there’s this idea, which is an interesting idea that maybe it’s not just that you should not have too much, but maybe there’s a right amount. Maybe too little isn’t great and too much isn’t great and there’s a sort of Goldilocks hypothesis sort of, not too cold and not too hot.

And there’s something there isn’t there, because I think even in our list of outcomes some positives have come out, but the problem is that doesn’t lead you to a clear conclusion as to how much is too much. Here’s some data again from Mandy Shiboski team about what different kinds of screen time just simply in terms of how they are associated with different levels of wellbeing, and essentially you don’t need to look at the specifics, but basically if you have no TV, you’re a little bit better off watching an hour of TV versus no TV.

But if you’re watching 7 hours of TV, you’re worse off than no TV and that’s, kind of, not a big surprise, but actually look at this and the computer is halfway between. Video games, you really have to play a lot of video games, like a really ridiculous amount in order to have worse wellbeing than no video games at all. So should we be prescribing video games for children who are not doing well with their mental health? No, but what we’re saying is the relationship between…

First of all, the relationship between this Goldilocks, this sort of Goldilocks idea of the right amount of screen time seems to really vary [a] from person to person, but also from what kind of screen time you’re talking about. Also we don’t really know how much is too much. So Gareth has commented, anything can have too much. Yes, absolutely, right. Very, very good point, Gareth. So anything can be excessive but to focus on spending time to the extent that the media and certain professionals have doesn’t seem to me to fit in with that simple understanding that anything can be taken too far.

So the definition of wellbeing is a sort of validated self-reported wellbeing questionnaire which produces scores in this particular study. Wellbeing can, of course, we can spend a whole, a couple of hours talking about how we define wellbeing and we can get very philosophical about it and I’m very happy to do that. I’m really glad that we’ve talked a little about some bits of child development because there is an instinctive feeling that too much screen time is harmful to child development, and there’s a sub-class of these papers that sort of track difficulties with social interaction against child development, against screen time, sorry.

 

We didn’t find, we did a systematic review at the Royal College and we didn’t find any convincing evidence of the causal link. The other thing is, of course, in the face of this kind of screen time, kind of, explosion, allegedly, or the kind of change of screen time and the screen time becoming more toxic. In many respects child development is getting better, partly because of the excellence of our teachers, but if you think about the children, this is the percentage of children in England achieving a good level of development has gone up year on year.

Can we be having a crisis of child development if we’re having improved results? I don’t quite get that. On the other hand, we are having increasing, surging rates of, for instance, autism but we could also put a similar graph up for ADHD and other developmental disorders, except for learning disability. I’ll come back to that, and of course that is concerning, but I think there is convincing evidence that the vast majority of the rise in autism diagnosis is due to greater awareness and a sort of looser and more flexible definition of criteria.

I think that’s overwhelmingly the most likely explanation for this increase, to be honest with you, and this is something that’s very much the core of my work. But saying all of this, where is there a problem, because mental health is creeping up? It’s not actually surging. Child development is doing well, but if you actually talk to people on the front line, why do things feel harder? I have to be very careful not to become political at this point, because things are harder.

But I think families are under more pressure. Financial pressure, work pressure, pressure of expectations, pressure of various different sorts, and children are feeling that pressure and schools are feeling that pressure from again, financial pressures, kind of pressures from above, pressures from below, everyone is feeling under more pressure over time. That’s not the same as diagnose or mental health problems, but I do think it means that for a certain degree of symptoms or condition, the children are functioning less well, and there are more complexities to the work that you’re all doing with children.

So I completely acknowledge that things feel harder, but it’s not because of the iPhones. At the population level, the narrative that’s being used leading to worst outcomes just doesn’t stack up. No part of that argument stacks up and actually supported by evidence. However, there is no question that there is such a thing as problematic screen use at an individual level, as there is problematic gym use or problematic… I just want to go back very quickly, a quick historical diversion which I cut out of the slides, but there’s always been concerns about people doing the new things, the latest thing excessively.

And in the 19th century there was a bit of a moral panic about novels and the young ladies reading too many novels and becoming pale and not going outside enough. Now, of course, we regard novel reading as one of the most kind of improving things we can do. So it’s just important to bear in mind that we are always progressing from a very specific cultural position, and currently screen time is this new thing, and we’re kind of putting a lot of things at its door.

However, that said, there’s no suggestion that you can’t have, a question that you can’t have screen time being problematic. You can decide what is problematic in a number of different ways. You can use duration based criteria. So basically you can say, like in this particular, this is not specific, this is what the old American guidance used to be. No screen time before, two, which leads to ridiculous things, like somebody who I know from America saying, Can I watch football while I’m breastfeeding my baby? Of course you can.

Don’t be ridiculous, but if you strictly follow the American Academy of Paediatrics you wouldn’t be allowed to. So the problems are there are various definitions of screen time. So the American Academy has now said, oh, well, homework doesn’t count. Well, doesn’t it? Well, how is it different? It’s very popular with health bodies. The World Health Organisation is fond of this. The American Academy have kind of adapted their position a little bit, but essentially they’re still kind of based on duration, but it’s scientifically unsound for the reasons that I’ve laid out. There’s no evidence the duration of screen time on its own will tell you whether it’s having a negative effect.

Except unless you talk about the context. However, you could think about content criteria and I think some of that is bubbling up in the chat and of course, people are very concerned about, and still talk about video games and the link with violence. I just want to lay it out that with 30 or 40 years of research there is no connection between video games involving conflict and weaponry and later violent conduct as a whole. That evidence base just doesn’t exist, and it certainly has been looked at very extensively.

So for me Fortnite is not a worry. I don’t worry about kids playing Fortnite. I do, of course, worry about kids playing things which are either horrifying, is going to scare them, so they don’t sleep or hugely violent and gives really kind of negative messages, and the certification system force gains is really important and people ignore it routinely and they probably shouldn’t. Should we say, okay, well, they shouldn’t be playing Fortnite? They should be watching Horrible Histories, which is on the right side, and I love it.

I think Horrible Histories is tremendous and very entertaining, but how do we tell that that is more beneficial than playing Fortnite? The evidence that you can teach skills to people via television programmes and interactive things is quite weak. You need a person. You need a teacher to actually teach skills, although you will learn individual facts from Horrible Histories, you won’t actually necessarily learn skills, and equally for Fortnite you might learn some kind of skills in hand, eye co-ordination and planning. It’s actually got quite a lot of construction in Fortnite. So there’s quite a lot happening in there that actually some of the children are actually picking up while they’re there.

Interesting, a lot of people think they are triggered by screen. What I’m trying to say is we can’t be sure about that and we really need to be scientific about this. Whatever we think day to day the science is out there really questioning our beliefs about whether screen time is actually triggering behaviour difficulties. Then, of course, there’s social media and people do worry a lot about social media. So just to reiterate my point about how everything that’s new becomes something of a moral panic. There’s this lovely quote from Douglas Adams.

So basically, anything in the world that you’re born with is normal and part of the natural order of things. If it’s invented between 15 and 35. It’s new, exciting, and you might get a career out of it, and if it’s invented after you’re 35 it’s against the natural order of things. So we’re all very worried about TikTok, aren’t we? But we’re not worried about Facebook because we’re all on Facebook and it’s sort of, I don’t know, in 20 years’ time there will be the new thing and everyone will be like, well do your Remember TikTok.

That was fun and this new thing is evil. I just want to be really careful. We want to be really careful that we’re not falling into that trap of something new being automatically scary. There’s a couple of comments that, you know, what if we did a more modern kind of now survey. That survey by NHS Digital is being repeated year on year. Now, there has been a surge where there’s been a worsening of mental health during the pandemic, but we don’t know that that’s anything to do with TikTok, and it’s probably not anything to do with TikTok. It’s to do with the global pandemic that has been ravaging us for the last 18 months.

We won’t know what the long term effects of these things are until we’ve had a few more years of the survey. So the way of thinking of social media, I don’t want to say that it’s entirely benign, but I think we’ve got to separate out what I’ve been asked to talk about, which is screen time from the sort of other effects of social media, because effectively social media is a window into another world. It’s a window into other people, a portal to other people. Just to give my very geeky kind of reference point.

This is the Mirror of Erised from Harry Potter and what the Mirror of Erised does is show you what you most desire, and someone presented this kind of wonderful and, kind of, benign thing I think it would be a terrible thing to happen because it shows but doesn’t give you what you most desire, which is a lot like Instagram in a way, isn’t it? I think that’s part of what negative effects may be happening is if someone is vulnerable, they’re being shown this perfect life that other people are presenting and that can, of course, in a vulnerable person have a negative psychological effect.

And the other thing, of course, is it’s more or less unfiltered access to other people, but of course the thing to remember is the thing that’s toxic is not the window. It’s the people. It’s access to toxic people. So that is something that is untrammelled by social media, but it’s not the only way of accessing toxic people. So bullying is something that people worry about as well on social media, and the thing to remember about bullying is that bullying only happens within a social, some sort of social structure.

Otherwise you just walk away. Bullying has to happen sort of repeatedly, and it has to be within some kind of social hierarchy, and the vast majority of cyberbullying, as it’s called that happens to young people, is done by people who know them in real life, and actually the vast majority of people who are cyberbullying, about 99%, are also bullied in real life. So cyberbullying is an extension of real life bullying. We can’t think of it as a separate category, and we can’t think of it as a separate thing.

We can’t think of it as a separate problem. It’s got to be within the problem of bullying overall. So I prefer,  I would say that the most sensible criteria to think about whether the screen time is problematic is what impact the screen time is having on the person’s life, and that kind of connects it with the person’s actual life. So the main things that can have an effect on us sleep, really important. Sleep can be very much affected, particularly if they’re taking devices to bed, and of course we can give lots of advice about that.

But sleep is a really vital part of physical, mental, and academic development. So focusing on the interaction with sleep is actually a genuine concern. Academic work, of course it can interfere with academic work if it’s a distraction, and of course there’s a conversation that needs to be had if somebody is falling off academically because they’re spending too much time on their phone. That is a valid conversation to have, and of course family functioning, and that’s not just for children’s screen time, but the parents screen time and everyone’s screen time.

It can interfere with family functioning because family functioning requires time together. It requires interaction. That’s undoubtedly true. Now that interaction can be online, our family WhatsApp is a lively place, but it does also need to be occasionally topped up with in person interaction. That’s undoubtedly true. Okay, so we’ve got this kind of, we might for a proportion of people want to decrease screen time. What are we going to do? Are we going to present them an ideal, as in you should be giving no screen time to your under twos?

You should be giving one hour screen time at most to two to five year olds. That feels to me like an unattainable ideal for most families. So this is what I mean. This is a very ideal family, and I love this picture because I just wonder what the dog is saying. He’s sort of looking off camera going save me. I’ve been abducted by robots because what we can sometimes do is present this ideal thing to families of this is what you should be doing and actually families, unless they think that this is achievable, will just get turned off and feel shamed and feel blamed, and that is only going to lead to them just disengaging and not taking the advice at all.

It’s much more helpful to go from where they are and help them along the way with small steps. So our approach from the Royal College of Paediatrics was the following really, the question is, is family screen time under control? And I use those words deliberately. It’s not just kids. Is everyone screen time under control, and I use under control deliberately because it’s sort of your control for younger children, but for older children are they able to balance it?

So with the secondary school, we’ve got some secondary colleagues here. Within that are they able to, the secondary school pupils to balance work against and being able to sleep against their kind of FIFA career. When they start to get a little bit more control and autonomy are they putting those balances in? Are they being sensible about it? So if it’s not under control, then we’ve got a problem, even if it’s not that much. If the parents and the young people don’t feel it’s under control then that is a problem.

Does it interfere with our family activity?  Does it interfere with sleep? So we specifically go to sleep and are you in control of snacking during screen time? We’re not really talking about physical health today, but there does seem to be some connection with obesity, partly because they tend to be sedentary activities and partly because there doesn’t seem to be such control of satiation. So much control of being able to know when you’re full when you’re also interacting with the screen. So you can basically just eat too much and you can see at the end of a cinema how much, how many calories have been left on the floor.

So these are our top tips for controlling screens. So the first is have a plan and stick to. It doesn’t really matter what the plan is, as long as the plan aims to reduce that interference with family activities and interference with sleep, and for parents also to think about their own media use. Often some of the difficulties come because particularly with behaviour where the parents are not responding to positive behaviours. They’re only responding to negative behaviours, and that can be quite problematic, and if you’re constantly scrolling Facebook, you’ll only be responding when the kids are smashing stuff up.

So prioritising face-to-face interaction. We do think that there’s something qualitatively different about face-to-face interaction, and it is useful, but it doesn’t mean that online interactions are worthless. They’re certainly not. You can have very strong interactions, and I think particularly there’s a few things about SEN coming up, actually, particularly adolescents with autistic spectrum disorders actually face-to-face interaction can be really difficult for them, and the online interaction can be much, much easier and actually very positive. So we shouldn’t just have a simplistic view on that.

Being snack aware. We’ve talked about that with the screen time and obviously protecting sleep. We think sleep is really vital. So protecting sleep, having devices put away before you go to sleep is absolutely essential. We have at times had a recommendation of an hour of screen free before bedtime. Actually, that doesn’t seem to be essential for all children. If you have a sleep problem, it probably is useful, but for most children it doesn’t seem to be entirely necessary. You know, if you’re having something relatively calming before you go to sleep, if you’re watching an iPad doesn’t greatly matter.

It dosn’t look like, and the other question is, is it a screen problem? You have a child who’s refusing to get off his Xbox. You have a family who are kind of shouting all the time and fighting all the time, and the parents are saying, oh, it’s all to do with the iPads. Is it, though because that can be a really easy scapegoat for actual real problems either within the relationship, within parenting or within the mental health of the young person? The young person at secondary school perhaps who’s locking themselves away playing World of Warcraft.

Well, is that a World of Warcraft problem, or is that a mental health problem? So that would be my question. So oppositional behaviour, treat as oppositional behaviour. If they’re refusing to get off screens then you’re out of control. Actually, the treatment for that is parenting intervention, parenting group support to get the parents to be authoritative within the household. Family discord. Again, it’s about the whole family screen strategy. So maybe the parents need to put their screens down and everyone needs to sort of have these more positive interactions, if possible, rather than just blaming it on the kids and Fortnite again. So you get the idea.

Is it anxiety and low mood? Are they avoiding school? Are they staying up late because they know that they won’t be able to get up in the morning and because they’re scared about school? There’s something going on at school. There’s all these other things that we need to think about before we leap to the conclusion that it’s a screen problem. So that was it really. That’s all I wanted to say. There’s lots and lots of questions come through. So I think I need a bit of help with marshalling some of those things.

If anyone wants to pick these things up with me, they’ve got my email there and Twitter, which hasn’t gone down account if people want to send appreciative messages or abuse. That is absolutely fine, but that was the kind of brief overview of what I had to say about screen time.

And thank you, Max. Thank you very much. Indeed. You’ve certainly, I think stimulated a lot of thinking there because what you’ve gone through is actually a succession of myth busting, factual things and you’ve given a very erudite exploration of the evidence base. You’ve tried to be very scientific. You have been very scientific, and you’ve given I think those last slide, you’ve given some very positive ways of managing and I like the way you’ve put it into the family context, the way parents need to model some of the behaviours. What I’m reading, and people are very, very appreciative of the quality of what you’ve said, but there seems to be a disparity between your position as a paediatrician and the obviously heavily scientific base that you work from and the lived experience of teachers in terms of what they’re seeing, and I wonder if I can pick up on a few of the themes that have emerged. The first one being is gaming addictive? What would your response to that be?

It depends what you mean by addictive. I think it’s very compelling. So addiction, if you were being really kind of pedantic about it would mean that, so for instance, you would have a process of being addicted where you would need more and more and more to have the same psychological effect. You would have a negative effect on your life because you were constantly going to do this thing that you would be angry at other people because they were trying to challenge you about it and that you were having withdrawal effects when you weren’t doing this thing.

Now I would argue that most people who are really into games don’t quite have that relationship to them. They really love them, and they get a lot out of them but they haven’t got that, I need more and more and more and more and more in order to get the same thing out of them. So I think that’s where it falls down a little bit. I think games are incredibly compelling and particularly games which have encouraged lengthy play. You need to be quite careful about, but in itself is gaining addictive, I don’t think in the real strict psychological sense. It certainly is something that when you get into gaming, particularly as a young person, you do need to get that balance right.

 

[00:40:34.570] – Barry Carpenter

Gareth, there is asking, is it habitual? Many teachers would report, but it’s still I think factual that they know that children are staying up into the early hours of the morning are gaming, and I like the fact you raise sleep, which is a nice lead into our next topic in this series, but they see children tired in school, and if they know that children have been gaming till the early hours there’s an obvious link there.

[00:41:05.830] – Max Davie

Of course, there’s no question.

[00:41:08.170] – Barry Carpenter

So is that then still down to parents having a routine of the screen goes away before bed.

[00:41:20.190] – Max Davie

Yeah, absolutely. I think the thing that’s difficult is if you are somebody who’s really, really into reading books and you go to bed with a book, you’re going to fall asleep because they don’t stimulate in the same way that video games do. It’s hard to read until two in the morning, although I have done it. I read the last Harry Potter book and stayed up all night doing it. So that can happen, but the video games it’s very common to want to carry on and keep going, keep going, partly because of the nature of them, but it is ultimately to do with the parents, I have to say, and when they get older, the young people to have boundaries and to stick to those boundaries of, well, it’s time to go to bed.

And I don’t want to get into the situation of blaming parents. Usually when that system of boundaries is broken down there’s usually very good reason for it. Parental mental health, oppositional behaviours. All sorts of things might be going on in these families, and we need to address all of those things, but ultimately it’s not because they’re kind of so addicted that they’ve lost all kind of will.

The boundaries aren’t in place effectively enough to get them off their screens. I have three, well I have two official teenagers and 11 year old who acts like a teenager at home and we do have this every evening. You need to get off your phone. Give me five minutes. No, you need to get off your phone and it is a constant negotiation, but ultimately you have to do it. You say you have to get up in the morning, get off your phone. I’m ultimately the parent here.

[00:43:00.450] – Barry Carpenter

There’s a persistent question coming through about how can we use social norms in our teaching?  Now I think that’s verging on asking you to be the teacher, but let’s just see what your response would be to that, Max.

[00:43:13.020] – Max Davie

I don’t know what you mean by social norms. So I saw that comment and I was hoping you wouldn’t ask me because what do you mean? You might have a better idea of what the question means.

[00:43:21.250] – Barry Carpenter

What that’s coming from Coram, who are synthesising the questions. So, Donna, do you want to comment on that?

[00:43:31.990] – Donna

Yeah, absolutely. We use social norms a lot in our teaching anyway, but an awful lot of what Max in his talk saying about because actually the positive data about screen time, and actually that it’s not particularly negative on mental health and there’s lots of positives around social media or screen time. So how can we use that in our teaching rather than it being such a negative message?

[00:44:04.670] – Max Davie

So I think in that sense, you can certainly use it. You can say here is this amazing thing, here is this microprocessor in your pocket, which is far more powerful than what they used to go to the moon. What are you going to do with it? How are you going to use it to kind of get the best out of it, and I think, like I said with social media, I absolutely support all of the teaching about safeguarding on social media and safety and  the media literacy of what are these people selling you?

 

And this isn’t really real and this has been photo-shot. I think that’s all really valid to kind of keep yourself grounded in this social media world. That’s all valid stuff and I think that feels to me like a really important sort of bit of discussion. Call it teaching, but actually it often ends up as discussion, doesn’t it? When they get beyond a certain kind of stage within school and my kids talk about it all the time and they’re very literate about it, which I think is marvellous.

[00:45:04.070] – Barry Carpenter

So do you think, Max, a line that teachers should explore in terms of developing teaching strategies to match the sort of things you’ve been discussing this evening. Look towards encouraging young people to go about self-regulation of their own screen time.

[00:45:20.720] – Max Davie

Yeah, I think it depends on the level and we were expecting at predominantly primary school, but I think in secondary school you’ve got to start moving towards that. You’ve got to start moving towards a vision of okay, how much sleep do you need? When do you need to go to sleep? How are you going to structure these things? I understand that Apex Legends is an important part of your life, George, but we also need to fit in these other things in our day, and how are we going to plan that so that you can still go to bed at a certain time.

So it’s simple planning, and it’s the beginning of taking responsibility for your own time, I think.

[00:46:00.270] – Barry Carpenter

Yeah. There was a thread coming through around children with special educational needs, and you yourself mentioned at one point learning disabilities, and you’d like to come back to that. I’d kind of like to do that if we could…

[00:46:14.800] – Max Davie

Oh, yes. Sorry, I forgot. Learning disability diagnosis has gone down because most of them are being converted to autism. That’s the reason I mentioned that in the registers. I think the strand that came through in the comments was that sometimes SCN kids were more vulnerable to becoming quite obsessive about certain screen activities and also were more vulnerable on social media, and I think those are both true, but it depends what you mean. So with the autistic kids often I have conversations with families and they’re like, he never wants to talk to anyone.

He never wants to make friends. He’s always on his iPad. I’m like, well, if you took the iPad away that might not make any difference to how he wants to make friends because he might not be ready. He might not have the skills. He might prefer to be on his own, and I think sometimes the screens are a way that we project how we want the children to be onto who they are, and sometimes if you took the screens away you wouldn’t necessarily change who they are. So I think for the autistic kids sometimes screen based activities are such a haven that I’m really wary of taking them away because the messy, kind of, physical world is so terrifying for a lot of these kids that the more ordered online world can sometimes just be so much easier for them.

I think for the ADHD kids it’s slightly different because they are so kind of video games are absolutely perfectly like tap net for these kids’ brains, and I think there is a little bit of a, obviously a difficulty getting them out onto more boring activities. So that can be quite a struggle because of course they’re also emotionally they can be a bit dis-regulated. So they become very angry when they’re taken off. So that can be a real struggle, but again it’s part of ADHD parenting. It is part of parenting ADHD child, which is an extremely challenging job and part of it is managing video games essentially.

[00:48:25.290] – Barry Carpenter

Yeah. I think you’re absolutely right there. There’s a question, particularly for our colleagues in Northern Ireland who just wanted you to expand a bit on why learning difficulties have been diagnosed.

[00:48:38.170] – Max Davie

So it’s not learning difficulties. Learning difficulties is not a health term, and I never really worked out what it means. It’s learning disability. The rates of learning disability diagnosis between the 1990s and the 2010s declined in quite striking mirror of the increased rates of autism. So the same children in the 1980s would have been diagnosed with a learning disability and now being diagnosed with autism. They may still have a learning disability, but autism is now kind of spotlighted as their principal diagnosis, and that’s what goes into the disability registers.

So to an extent, this is not the whole story. The story behind the rise of autism diagnosis is partly a re-labelling of existing kids.

[00:49:30.910] – Barry Carpenter

Can we drill down a little bit more because I think in that myth-busting to probably destabilise some teachers how they tackled this issue, which is now, you know, we need to be very clear about this. It is now a statutory requirement that teachers now teach this within the new Relationships Health and Sex Education curriculum, and that teaching could therefore be inspected by Ofsted. So we need to be sure that teachers are confident in the base they’re operating from and being destabilised and be a safe base. So if we drill down by picking up the question here, how influenced do you think parents, adults, teachers are by the media portrayal of the negatives of screen time, that sort of moral panic, and how does this influence their attitudes towards their children’s use of screens?

[00:50:26.410] – Max Davie

I think it’s a huge influence, and I think people’s default setting is true of doctors who, frankly, should have read the evidence. It’s a very convenient scapegoat for a lot of what we perceive as societal ills. As we get older, we all get older, there’s always a temptation to see society as getting worse and children is getting worse. If you look back though that’s always been the case, especially at the time of Socrates, they were talking about the youth becoming more disrespectful. So I’m always a little sceptical of that actually happening.

I think the current generation of youth are quite remarkable and amazing, actually. So yes, I think it is a big influence, and I don’t think on an individual level, we have to say, oh, don’t worry, but I just think from a public health point of view, from an evidence based overall population point of view, screen time is not driving our big crises of childhood. Whether screen time is driving a particular crisis or a particular problem in an individual’s life is something that is specific to that context, we can have a conversation about.

And I have a lot of conversations in clinic about screen time. So I think, yes, it’s a big influence, but we can cut through that by saying it’s not why… Things are not necessarily getting worse, and if they are not necessary screens.

[00:51:57.210] – Barry Carpenter

Should we differentiate more than, Max, between screen time and social media because if we go to social media, my daughter is a clinical mental health lead in West Midlands region, and certainly her evidence base is that often when say young people come to the clinics with eating disorder, particularly the girls they’ll have been onto that website called Annie, which sounds very cute, doesn’t’ t it, which is actually short for anorexia and a lot of their ideas for how they are perceiving themselves and what they’re doing in their behaviour from that website.

So is that a social media issue rather than a screen time issue?

[00:52:38.050] – Max Davie

I mean, I think social media has very specific effects on vulnerable people which can be highly negative, and we all know the cases where somebody has committed suicide or gotten themselves into a lot of trouble, various criminal cases where social media has been involved in the run up, but I think that’s not to say that social media is then necessarily dangerous. If you have somebody who has got themselves into a vulnerable position and is starting to have these thoughts, then access to a community of people who think like this is quite likely to amplify these thoughts.

And eating disorders is a very good example of somewhere, of a condition where this kind of thought distortion is a really powerful driver of the pathology. So yes, I think for that particular group we have to be really careful and it’s part of safeguarding I think. In the same way as grooming by sex offenders. That is the kind of grooming for me. So in those individual cases, absolutely, we should be very cautious and careful. The problem is how at an individual level, you can look up young people and my advice, of course, would be for young people to be able to have open conversations with the adults in their life about what’s happening for them on social media and actually what’s happening for them in terms of their relationship with their bodies and their relationship with food.

That should be part of our culture but at a policy, a kind of governmental level, it’s really hard to see what is going to be effective in clamping down and that’s the difficulty. We all want these websites to be clamped down, and we all want these kind of groups to not be leading people down the wrong track and leading people down these kind of distorted patterns of thinking. How you actually do that is really tricky from a legislative point of view, just from my kind of involvement in the College.

[00:54:40.260] – Barry Carpenter

Okay, there’s an interesting question just come through from Paula Ato, and it’s about particularly young children where we are, and many early childhood teachers would factually report, and their profiles of language development would reflect this. So that’s our teacher evidence base. That we’re seeing more and more children with very poor speech and language skills on entry to school compared to what we would have seen, and her hypothesis is she’s therefore seeing less parental interaction in terms of talking to children where parents are arriving, scrolling their own screens just about nod to their children, hold a hand and away they go, still looking at their screens. Do you see that?

[00:55:24.750] – Max Davie

Well, I don’t know how you square that with the evidence on the earliest foundation stage. Good level of development, which is going up year on year. I don’t know how you explain that. I mean, I’ve been working in this service for 12/11 years and I’ve been in paediatrics for 20 years and I haven’t noticed that children have stopped being able to talk and interact. First of all, I don’t really think we have the data, the sort of robust data to say that speech and language has got worse. However, again, on an individual basis, yes.

If you feel that somebody has poor speech, speech and interaction skills then looking at family screen time as a whole is a valid way of doing it. A speech and language therapist would absolutely say, well, you need to spend a certain amount of time interacting with your child face-to-face and there’s no screen based alternatives to that. So absolutely, if you have specific clinical difficulties, difficulties with interaction and communication, then cutting down on screen time can in individual cases be a useful strategy, but I don’t think we can say that there is a deterioration  of development overall because the evidence isn’t there.

[00:56:44.010] – Barry Carpenter

Okay, thank you. It’s good you’re bringing us back constantly to where is the evidence for that and I think you’ve sounded some warning bells this evening that people will need to be mindful of in terms of what we present as lesson content to be sure that we’re not blaming children, but rather encouraging positive and as you’ve implied self-regulatory behaviours and knowing how to use screen time. I did like your phrase, and several people have commented about social media being a portal to other people. I think for people with autism it’s had huge benefits because they find face-to-face social interaction difficult.

Conversely, in some instances it has fed some obsessive behaviours, but we know of many other things that feed obsessive behaviours with autism. So there’s a series of recommendations coming through of resources.

I want to now just before [inaudible 00:57:47]. I said in my opening remarks that Max has been our first brave guinea pig into this particular venture. Thank you, Max, but we need to keep constantly shaping this because we do eventually want to partner this with some very specific advice through a parallel webinar on what the teaching content should be and how we develop schemes of work, for example, from the RSA content, the DFE has published. So you’ve seen that there’s a poll come up on your screens about recommendation to colleagues.

So can we ask you on that ten point rating scale to the session you’ve heard this evening would you recommend that to a colleague, starting with one as definitely not through to ten, absolutely, I would. And this is going to record it. So you will actually get the opportunity to share this with a colleague. So can I just ask you all to have a go at that poll? I’m actually logging off at this point, I want to actually bring this session properly to a close. Okay, again to remind you that the next event is going to be on the 25 November and that’s going to be sleep.

And as I said, I think Max has given us enough segway into that topic and exploring that more deeply. Great. Max. We’ve got 51% of people, so 47% of people saying they would certainly recommend it and lots of other very high scores. So well done.

Someone said you filled it in the wrong way around. Don’t worry, I won’t take it personally.

Even our teachers they know how to fill in forms.

[00:59:53.910] – Max Davie

No, Teresa, just posted to say she put it the wrong way around.

[00:59:57.490] – Barry Carpenter

Great. Thank you for that. You’ve certainly this evening, I think given us a lot to think about. I think you perhaps challenged us to make sure that there is a secure evidence base, but I don’t think for one minute you’ve said you shouldn’t talk about screen time with children. I think in a 21st century curriculum for 21st century children this needs to be a topic as much as other more traditional topics might be in the curriculum. It does have that interface in the broad domain of the mental wellbeing is what the RSHE curriculum is calling it, and certainly mental health is a diagnosis. We are not diagnosticians as teachers. We are educators and I think mental wellbeing now is probably the term we increasingly need to move towards to describe what we do within that broader mental health domain.

What is specific for teachers? We have an opportunity to work in this area, Max, that we have never known. I’ve been a teacher for over 40 years. We’ve never had this opportunity to teach in this area in quite the way.

 

And DFE initiatives around mental health leads. Senior mental health leads, the fact that DFE bought the RSHE curriculum forward by a year. There are lots of opportunities to move forward and certainly when I launched the RSHE curriculum for the DFE I talked about it being the heart of the curriculum. Yes, maths and English needs to be the core, but more than ever and I hope that you would agree post-pandemic, we need some heart, some compassion. Kindness is certainly going to be key as to how we rebuild our school communities and beyond that our societal communities too.

[01:01:38.870] – Outro

Find out more about becoming an ACAMH member and to be part of the advancement of child and adolescent mental health. Visit www.acamh.org.

 

About the Speakers

Dr. Max Davie
Dr. Max Davie

Dr. Max Davie is a consultant community paediatrician, working in Lambeth as part of Evelina London Community services. He has a special clinical interest in the assessment and diagnosis of neurodevelopmental conditions in school-age children. He is Officer for Health Improvement at the RCPCH, and trustee and founder of the charity ADHD UK.

Barry Carpenter
Professor Barry Carpenter

Professor Barry Carpenter has been appointed to the ACAMH Board with special responsibility for disseminating our work to schools, teachers, and others involved in the education of children and young people. Barry is the UK’s first Chair of Mental Health in Education, at Oxford Brookes University

In a career spanning more than 40 years, Barry has held the leadership positions of Headteacher, Principal, Academic Director, Chief Executive, Inspector of Schools and Director of the Centre for Special Education at Westminster College, Oxford. In 2009, he was appointed by the Secretary of State for Education as Director of the Children with Complex Learning Difficulties and Disabilities Research Project. Since completing that research, Barry has overseen the development of a national project developing online ‘Training materials for teachers of children with severe, profound and complex learning disabilities’ www.complexneeds.org.uk

Full bio on ACAMH Board page

 

Discussion

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Thankyou for the recording, I was unable to attend the live webinar as the link was not received.
A balance is definitely needed and definitely a concern within our times not just within the youth but also amongst adults.

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