When we hear the word ‘addiction,’ we often think of drugs and alcohol, but in the 21^st century, addiction has taken on a new meaning. Lisa Elliott, Ph.D., psychologist and clinic manager of the Behavioral Health Clinic at Cook Children’s in Denton, says children are becoming addicted to their phones and gaming systems, driving parents to seek help through licensed therapists.

“We have the research that shows there is a chemical addiction as well as a behavioral addiction,” Dr. Elliott said.

“I think the thing that makes it even more dangerous for me is this is happening with young children, very young children, as much as it is with teens and young adults.”

In 2019, the World Health Organization (WHO), voted to include ‘gaming disorder’ as an official condition in the International Classification of Diseases, akin to anxiety, depression, etc. This paved the way for psychologists such as Dr. Elliott to bill insurance providers, making access to care more affordable for many families with health insurance. However, aside from video gaming, adolescents and teens are also glued to their electronic devices. She says remote learning due to the global pandemic has also played a major role in this addiction.

Cheryl, a North Texas mother, says her 12-year-old daughter is obsessed with YouTube. The family is now seeking guidance from a Cook Children’s family therapist.

Cheryl and her husband didn’t allow their daughter to have a cellphone until they believed she needed it for safety purposes. She wasn’t allowed to have any social media accounts, but her parents did allow her to watch TikTok videos.

“She has a cellphone and iPad, but we made sure everything had parental controls and restrictions,” Cheryl said.

When they later deleted the TikTok account out of concern for privacy issues, they allowed her to watch YouTube videos.

“She watches kids playing innocent pranks on each other, and she gets invested in that. She consistently talks about who is dating who and is always looking forward to the next update like she knows the people in the videos,” Cheryl explained.

Cheryl added that her daughter knew exactly when the episodes were coming out and had a fear of missing out on what was next in the lives of her favorite YouTubers.

When the Cheryl and her husband realized their daughter was going behind their back to find ways to watch YouTube, after she’d been instructed otherwise, they decided to reach out for help.

“For me, it was really about correcting that behavior because right now she has this temptation in front of her and she's making bad choices,” Cheryl explained.

Why are young people becoming obsessed with a reality outside of their own? Dr. Elliott believes the global pandemic has a lot to do with this rising trend.

“I think it's pervasive, so it's not just from an academic setting, but it's also how kids are filling their downtime. It's how they're maintaining social relationships, whether they're healthy or not,” Dr. Elliott said.

Cheryl and her husband couldn’t agree more. They don’t have any issues with their daughter’s choice of content. The issue is her actions and what these minor actions could lead to in the future when bigger temptation is put in front of her.

Cheryl’s daughter sees Stephanie Golden, LPC, a therapist at Cook Children’s Alliance. Golden has been working as a mental health professional for 20+ years but says phone and social media addiction is something she has seen more in the last three to four years in her practice. While phone addiction isn’t healthy, Golden believes it is treatable.

“It’s certainly a widespread problem, but I believe one that can be improved upon with boundaries,” Golden said.

Boundaries are exactly what Cheryl believes would be beneficial for her daughter when it comes to her desire to watch YouTube videos.

In a 2019 study released by the Child Mind Institute, 1% to 10% of children and adolescents have excessive and impairing online behavior. This behavior impacts a child’s ability to focus, the hours of sleep they get at night, and their social behavior with others when they aren’t behind a screen.

Cheryl says having a daughter that’s addicted to YouTube and going behind her parent’s back to find ways to watch it is hard because there aren’t resources for this problem specifically.

“It was really hard to figure out what to do and how to handle this,” Cheryl said. “We tried every single thing we could, from taking away her devices and even sitting down with her and asking her what she needed and how we could help.”

Cheryl and her husband struggled even more because they felt their daughter’s actions were ‘minor’ and ‘innocent’ because she wasn’t struggling with substance addiction. However, Dr. Elliot says addiction is handled the same whether it’s social media or something severe like drug use and gambling. She also notes until more research is done, therapists have to continue to rely on coping mechanisms and techniques they’ve used for adults who’ve struggled with addiction for many years. However, she says that it is scary because she doesn’t want to see adolescents fall into deeper temptation in the future.

“My concern is, if children are creating this addictive response, which we know happens, what kind of addictions does this lead into later?” Dr. Elliott asked. “So I'm concerned about the potential risk they might have for other addictions down the road.”

Cheryl and her husband also struggled with the guilt of putting their daughter in therapy because they didn’t want to take a seat of a child who might’ve needed the resources more.

“She isn’t suicidal and she isn’t depressed,” Cheryl said. “But I had to remind myself that we are putting her into counseling so she can learn skills and those skills can be applied to other areas of her life as well.”

Golden agrees with that sentiment and says in situations like this, she also gives guidance to families/parents.

“Set boundaries around cell phone usage and be consistent with the rules,” Golden said. “Following suggestions from experts can help protect a child’s mental health.”

Dr. Elliott adds another reason boundaries are important is that peer pressure and the need to fit in as at an all-time high. The Child Mind Institute reports 81% of teens say social media makes them feel more connected to their friends.

Cheryl agrees her daughter fits into that category.

“When we ask her why she wants it so bad or feels the need to sneak around to get what she wants, she tells us all of her friends in class are on YouTube all the time on their devices,” she said.

Dr. Elliott urges all parents to keep a very close eye on children’s social media and device use. She says not only can addiction to devices impact schoolwork, it can affect social relationships with others. When a child’s brain is still developing, she says children need healthy and appropriate social interactions to learn empathy, how to relate and communicate, as opposed to learning unhealthy social skills through a device/gaming system.

Cheryl understands the importance of limited screen time and says adolescents don’t fully understand phone etiquette, and how to properly interact with their peers and it is important to set an example and put boundaries into place at an early age.

As Chery’s daughter continues to see Golden, and the family works through this issue, Golden says it’s important to “face the issue with compassion, understanding and firm kindness.” She goes on to add “We don’t always like to have rules, but it’s often healthy and good for us when we follow them.”

Find more technology guidelines from Dr. Elliott shares with her patients from the American Association of Pediatrics below.

• Birth to Pre-School Years
  • There should be no technology from birth to 3 years.
  • Any screen time at this age impairs social communication, development, and attachment to family members.
  • This age should be devoted to social development, sensory-motor skills, and reading skills.
  • Limited exposure may be introduced at 4 years with only high-quality programming.
  • American Academy of Pediatrics (AAP) cautions that all technology programs should be watched with their children.
  • Parents have to lead by example: Do not check messages at the dinner table, do not become absorbed by devices, look at people when they are talking – children notice and mimic everything!
  • Never undervalue unstructured “free play.”
  • Parents should not give their children a tech device as a reward for good behavior. Children must learn to self-soothe.
  • Appropriate activities for 4 year olds
    • Periodically use eReader for storytime.
    • Allow limited access to electronic toys that educate and teach numbers, letters, and vowel sounds.
    • Utilize mobile apps/tech devices for sorting shapes and finding objects.
  • It is critical children engage in physical play, have social engagements and read books!

• Grade School Age Years
  • Create a balance between technology, along with social and physical play.
  • AAP recommends no more than two hours of screen time per day with close parental supervision! And that should be less during the younger grade school ages.
  • It is critical to watch alongside your kids to point out messages that are not congruent to your values.
  • Parents need to designate media-free spaces, including bedrooms, meal times, and playtimes.
  • Screen time should be quality; age-appropriate, share your values, and engage your child’s imagination.
  • Never make screens a reward or consequence.
  • Encourage other activities such as free play outside, playing sports, creating hobbies, arts and crafts, and social activities.
  • Appropriate activities for grade school
    • The goal is to teach responsible use.
    • Use internet under supervision only.
    • Create tech-free talk each day.
    • Institute strict time limit restrictions and rules for use.
    • Monitor computer homework; eliminate all technology when screen time rules are broken.
    • Children need to stay involved with school activities and friends.
    • Model appropriate technology behavior

• Preteen and Teen Years
  • It is critical parents model appropriate technology behavior – they have to practice what they preach.
  • Parents need to establish the rule that their children will agree to “friending” them on social media platforms.
  • Parents should have access to passwords.
  • Maintain open dialogue about what is and is not appropriate sharing on social media platforms.
  • Parents and their tween/teens should develop a social media contract that includes expectations, violations as well as discipline for violations. Try out this great free tool from @AmerAcadPeds: http://www.healthychildren.org/MediaUsePlan
  • Bedrooms should be tech-free, all devices should be removed from bedrooms at night.
  • Snapchat is the most difficult platform to monitor – may be wise not to allow this platform.
  • It is imperative to teach your children about the potential consequences of their postings on social media platforms.

And, I’m pretty sure my freshly minted 10 year old will soon be asking about his own Twitter, Instagram or YouTube account soon. I realize this is a tricky situation. Especially since I’m the medical advisor for Digital Health at Cook Children’s and I’m active on social media.

Trust me I see the irony … or maybe the hypocrisy.

But Right now I’m planning to hold off AS.LONG.AS.I.CAN.

Why?

Because I’m a parent. I worry about my kids like everyone else and I want them to be safe and protected

I’m also a pediatrician and I talk to too many kids in my office who are dealing with the negative fall-out of social media. I also see way too many studies addressing how social media has caused harm.

Social media can lead to:

• A fear of missing out. I wasn’t cool in high school (this may shock you and if it doesn’t just stay quiet) but I really didn’t know what I was missing out on. Everyone partied on the weekend but didn’t say much to me about it on Monday. If there had been pictures and posts from the weekends, I would’ve understood how left out I probably was.
• Inappropriate expectations of appearance. We don’t look like the celebrities we follow on social media and we probably never will. Sometimes though it’s important to remember the celebrities don’t look like the celebrities when they are on social media either. They are photoshopped and edited many times. But still, our kids are left to compare themselves to people who taking professional photos or using editing software to make everything look perfect. It’s their job after all. Unfortunately, that doesn’t keep many of us from feeling jealous or feeling like we’ve fallen short when we don’t.
• Bullying. Anonymous or even semi-anonymous (or “behind the screen”) empowered bullying can cause isolation and fear. And it doesn’t stop when you go home from school like it did when I was a kid/teen.
• A lack of ability to process our feelings. The constant ding of dopamine we get from the amount of likes on our posts enables us to continue posting to get our fix rather than process and dive into our sadness.
• Oversharing and shame. Teenagers and preteens don’t understand the significance of oversharing and what can happen later when those details (or pictures) get shared to a wider audience.

So what should we do as parents?

Here’s what I recommend:

• Keep your child off social media as long as possible. I know. I hear it too with my three kids. But the longer you can keep them away from it, the more time you have to talk to your kids about this issue and let them mature to handle what will inevitably come their way.
• When they get on, you get copies of their passwords and connect with their accounts. You can have privacy when you are out from under my roof. Oh man, I’m starting to sound more and more like my dad. But until then, sorry kids, I’m doing everything in my power to protect you.
• You reserve the right to delete the account and take their phone at any time. I paid for it and I can take it away.

I hope this helps. Just know I’m dealing with it too and would love to hear your thoughts. Again for irony … on social media.

It took that long to outrage a country from what was seen and heard by members of Sigma Alpha Epsilon fraternity at the University of Oklahoma chanting a racial epithet on a bus.

While the video shows that we haven’t progressed as far as most of us would like as a society, it also proves once again that our children need to learn the life-changing consequences of going viral.

Jody S. Hawkins, Information Systems Security Officer at Cook Children’s, gives a presentation to children called, “The Virtual World.” He explains the permanence of everything we post to the Internet.

“Like a face tattoo, the things your child posts to the Internet in public forums could be discoverable by potential college recruiters, employers or those out to paint your child’s character in a negative way,” Hawkins said. “What does your child aspire to be when he or she grows up? Are the things your children are doing on the Internet today going to have a negative impact on that career choice?”

Considering the speed of today’s technology, it’s important for kids to understand that everything they do is permanent, even if it’s been deleted. Thanks to screen shots, a careless text message can be frozen in time and put on social networking sites, forever subject to public scrutiny.

Hawkins recommends parents talk with their kids and express the need for self-control when they interact with others, even when they aren’t speaking face-to-face. Explain the importance of cooling off before sending that angry text message, commenting on a blog or posting an aggressive Facebook status. And if someone is doing something inappropriate, walk away or don’t participate. Everyone has a recording device in their hands these days.

A study from the University of Massachusetts’ Center for Market Research found that 21 percent of college admissions offices research their applicants via social media sites. An offensive blog post could overrule a stellar SAT score and change a university’s admission invitation.

“Kids don’t think about the harms they could be causing themselves,” Hawkins said. “They tend to have this, ‘Look ma, no hands’ mentality while we watch them and freak out. But those split second decisions can have forever consequences.”

About the source

Jody S. Hawkins, Information Systems Security Officer, has been in technology for medical facilities since early 2000 and has been practicing for more than 20 years with his start in the United States Air Force. He is a part of Cook Children's Experts on Call Speakers Bureau. Hawkins specializes in privacy and technology safety and is a regular speaker at the National HIT/HIPAA Conference. He has been quoted and published in several national publications, including Health Information Management Magazine.

Hawkins' can speak on a variety of security topics facing our children & parents today, including:

• Social media
• Cyber bullying
• Sexting
• Safety online (Parents & Child)
• General home networking security
• Virtual Child (Parents)
• Internet Safety (Parents & Child)

I love to watch them play and have fun, but I’m not watching them every single second. I’m usually reading something on my laptop and I glance up here and there to see what they’re up to. More often than not, they’re pausing to get the rules straight before they conquer that which would destroy us all. However, I have found myself jumping from my seat and running to the back patio door to tell them to stop! Why? Because I notice them doing something with their sticks that has a high potential to hurt one or both of them.

In and of itself a stick is not dangerous. A stick is a stick. You can poke in the mud with it, you can use it to imagine slaying dragons, or you could run with it out in front of you (the tip only inches above the ground, bobbing with every stride) and potentially impale yourself with said stick. Or, you could witness your 4-year-old swinging his stick wildly as the 8 year old, backing up to prevent being struck, stumbles over a toy wheelbarrow while the 4-year-old continues his assault. That’s what got my attention.

So, let’s talk about sticks … I mean apps. It’s the same conversation. Sticks come in all shapes and sizes. Some may be too big for my 4-year-old to handle; however, being a bit older, my 8-year-old may not have a problem with a slightly larger stick. Comparing this to apps on the tablets, my 4-year old does not understand some of the games my 8-year-old might play; but, he loves Reading Eggs®! But, since my 8-year-old is reading chapter books, Reading Eggs® (which helped him at one time) is now a “boring baby game.” For one, the stick is too small. For the other, the stick is just right.

As they grow older, they will want to delve into apps that challenge their maturity level and hold their attention. In the tween years, they will become more and more enthralled with social apps. On into the teen years, connecting with friends will more than likely become far more important than playing Cut the Rope® or Where’s My Water?®. It’s during these transitional periods that we’ll want to glance up from the kitchen table to take a quick peek into the virtual backyard. Knowing how to do this is half the battle.

Any app – even ones designed specifically for the facilitation of risky behavior – can be used in a way that is benign. All children are different and most are going to push the boundaries at some point or another. It’s our job as parents to guide them. In order to guide them, we need to be able to “glance up” to see what they are doing. Are they using social media apps? Are they playing games? What apps do they have loaded on the device? Are they chatting with strangers? What information are they giving out? I could keep adding questions. First, let’s talk about the most dangerous app of all.

Depending on their temperament, maturity level, risk taking, decision making skills, and overall attitude, the most dangerous app could be between your child’s ears. On the flip-side, it could also be the best security app available. Apps are not dangerous. Impaling yourself with apps is dangerous. Teaching your child good decision making skills and helping them to keep their compass as north as possible is the number one best way to prevent harm, period. In order to do that, you have to be able to “glance up” to ensure the compass needle is not falling.

There are two ways to secure a mobile device. One way is preventative security. Net Nanny® is a great app for enforcing parental controls for younger children. It prevents the errant Youtube video from introducing your child to inappropriate content as they follow the rabbit hole after searching for Spiderman. As they get older (and a bit wiser), preventative security measures lose their potency and can lead to a false sense of security for the parent. That’s why I recommend monitoring software.

There are several monitoring software packages available and, as with apps in the app stores, they are a moving target. iSpyoo® for iOS and Android (and other mobile phones) has received an “outstanding” editor’s rating on CNET.com. The review (which can be found on the CNET.com site and a search for iSpyoo) is for Android specifically; however, iSpyoo’s website boasts that “iSpyoo works on all mobile phones and networks from around the world.” Whichever monitoring software you choose, ensure it (1) cannot be detected by your child and (2) can send periodic alerts to your email address. A quick scan of the activity could either set your mind at ease or raise red flags. However, in order for this to work, you must maintain ownership of the device.

As a security professional with over 20 years of experience, I am 100 percent against giving smartphones, tablets, and other devices as gifts unless the rules are laid out appropriately. My rule is that, until you are on your own, you are borrowing MY device. I am the administrator and you are my child. That phone is on MY data plan and, while I did name it as your phone on the carrier’s website, I still pay the bills and I can cancel at any time. If you lay these rules out from the beginning, you could potentially run into far fewer problems down the road.

The bottom line is, yes, there are apps on the markets that give us concern. Some apps can be used for setting up a rendezvous with a stranger in a dark alley. If I were to tell you about specific apps today, I would miss the ones that will be coming out next week, month, or year. In all of my research and expertise, I still have not figured out how to definitively foretell the future. I can predict with a high degree of certainty, however, that there will be more apps coming. Keeping track of what your child does on their phones, tablets or computers will always be the best way to protect them. Just remember to bring your own stick to the game.

About the author

Jody S. Hawkins, Information Systems Security Officer, has been in technology for medical facilities since early 2000 and has been practicing for more than 20 years with his start in the United States Air Force. He is a part of Cook Children's Experts on Call Speakers Bureau. Hawkins specializes in privacy and technology safety and is a regular speaker at the National HIT/HIPAA Conference. He has been quoted and published in several national publications, including Health Information Management Magazine.

Hawkins' can speak on a variety of security topics facing our children & parents today, including:

• Social media
• Cyber bullying
• Sexting
• Safety online (Parents & Child)
• General home networking security
• Virtual Child (Parents)
• Internet Safety (Parents & Child)