When the U.S. Surgeon General's Advisory on Social Media and Youth Mental Health came out in 2023, it identified three important gaps in the scientific research on screen use among children and teens.

First, the advisory noted the need for long-term prospective studies, since previous research had only looked at screen use at one point in time. Second, because most of the studies that had been done had focused on overall screen use, the Surgeon General identified the need to look at problematic or addictive screen use. And third, the report noted the need to examine screen use in preteens and young teens because early adolescence is a critical time, a period when mental health challenges and sleep problems can start to develop.

Not all screen use is the same. Problematic screen use is defined as kids' being unable to limit their screen time.

To address these gaps, a team of American and Chinese researchers analyzed the effect of problematic screen use on young adolescents' mental health. They followed more than 8,100 participants in the Adolescent Brain Cognitive Development Study for a year. All the children were 11 to 12 years old.

Two established questionnaires were used to quantify how problematic a tween's mobile phone use was; and, among those who had social media accounts, how problematic their social media use was.

By the end of a year, those preteens with problematic smartphone and social media use were found to have concerning scores on tests of depression, attention-deficit disorder, oppositional defiant disorder and behavioral problems.

Concerning levels of smartphone use were also connected to suicidal behaviors and sleep problems, and the start of marijuana, alcohol or nicotine use.

Problematic video game use was also associated with higher scores on tests of depression, attention-deficit and oppositional defiant disorder, and a greater risk of suicidal behaviors and sleep problems.

Not all screen use is the same, Jason Nagata, lead author on the study, pointed out. Problematic screen use is defined as kids' being unable to limit their screen time, even if they try, so it causes problems at home and school, Nagata, an associate professor of pediatrics at the University of California, San Francisco, told TheDoctor in an email.

“The real risk comes when screen use becomes addictive…when kids can't stop or feel stressed if they can't use it, or it starts to disrupt sleep, mood or family life,” he said. As with other addicted behaviors, screen use addiction can lead to wanting more screen time to feel satisfied, having feelings of withdrawal, and having multiple relapses when trying to reduce use.

Problematic video game use was also associated with higher scores on tests of depression, attention-deficit and oppositional defiant disorder, and a greater risk of suicidal behaviors and sleep problems.

Addictive patterns of screen use can be changed, so interventions that target young adolescents are needed. “Our findings suggest that digital platforms and families should consider ways to reduce addictive features of apps and social media,” said Nagata.

The American Academy of Pediatrics offers some simple tips for making a family media plan, including:

  • Have “screen free” zones, such as at the dinner table, during homework or before bed.
  • Have a “one screen at a time” rule. Turn off devices when they are not in use.
  • Turn off auto-play and notifications features, which are designed to keep kids engaged longer.
  • Plan non-screen activities. Family games and hobbies, reading, sports and outdoor activities like biking and hiking can prevent screens from crowding out other important experiences.
  • Set parental controls on wireless routers, tablets, laptops, smartphones and gaming consoles to track digital habits about time spent online, downloads, contacts and purchases.
  • Model the moderate screen use you want to see in your kids. Put your own phone or tablet away.

The study is published in the American Journal of Preventive Medicine.