Workgroup Breakout Sessions

Thursday morning’s session was a special opportunity for attendees to address and explore two current challenges that lay at the intersection of science, medicine, social sciences, academia and public health. Pre-designated workgroup leaders Dimitri Christakis, Paul Weigle, Stephen Uzzo, and other invited guests acted as facilitators where each group addressed the research questions that Children and Screens’ posed in an effort to find concrete solutions. Participants chose a scribe within their group and were provided with supplies to detail their experimental approaches. At the end of the meeting, each team provided a brief report out to all Congress attendees.

Media Screening Toolkit (MIST) Workgroup

Objective:

Establish a development path for an innovative suite of instruments for (i) screening, monitoring, and measuring media habits in toddlers, children and adolescents (e.g., addictive screen use, displacement of adequate sleep, exposure to inappropriate content, overuse of social media, engagement with inappropriate violent or sexual screen media, etc.) and (ii) for determining if, and how, those behaviors present in clinical settings.

Questions for Consideration:

  1. What new, or updated screening tools are needed to detect or assess mental disorders in youth or be adapted to incorporate media-related prompts, and what would those prompts look like?
  2. How can such tools or screening methods help researchers better understand the relationship between mental health disorders and media use in children and adolescents?
  3. Can protocols be developed for the use of such tools so that effects can be characterized and/or codified?

Report:

This workgroup devised an adaptive and iterative “big data” measurement strategy. The implementation of this strategy would look like a work group or entity. It would meet regularly to develop and maintain these instruments and adapt them to changes in constructs and technologies. (The NIH Toolbox is an applicable conceptual model, and a potential funding model also.) The result could be described as an “open source data federation”. Two acronyms were suggested to describe this undertaking. The first was MUSIC (Media Use Screening Intervention Consortium). The second was MIST (the Media Involvement Screening Toolkit). All DMDM2 attendees will receive an email regarding the implementation of this workgroup’s recommendation.

Cognitive Effects

Objective:

Effects of media on addiction, memory, stress, behavior, attention, language development, emotional regulation, imagination, and creativity.

Questions for Consideration:

  1. What are the short- and long-term effects of media use (both interactive and conventional video) on executive function (including planning, working memory, sustained attention and impulse control/self-regulation) for toddlers, children and adolescents?
  2. If there is an effect, what about the media experience produces it, and why?
  3. What are the short and long-term effects of media use on language development?
  4. How do action games influence basic executive control processes and real world attention problems (attention deficit disorder, attention-deficit hyperactivity disorder, impulsivity)?
  5. With respect to cognitive development, are there good and bad ways to use media with the very young?
  6. Which technology risks are more or less serious? And for whom?
  7. What are the long-term effects of the false memories created by virtual and augmented reality?
  8. Do children have problems distinguishing real vs. virtual memories?
  9. Does media multitasking modify the brain and behavior, or do pre-existing states or trait variables increase the probability of engaging in media multitasking behavior?
  10. Are younger populations especially susceptible, and is there a vulnerable period when younger populations should abstain from media multitasking?
  11. What is it about media multitasking that makes it different/more detrimental than non-media multitasking?
  12. Do particular types of media multitasking affect key factors (neural, cognitive, psychosocial, academic achievement) differently?
  13. How does the nature of play today through video games affect kids' capacity for imagination and creativity?
  14. During the 0-6 ages and stages of development, what are the strongest opportunities and vulnerabilities regarding the use of digital media, or are there developmental windows of opportunity or risk for introducing media to optimize benefits/minimize harm?

Report:

The Cognitive Effects workgroup designed a two-phase study. Phase 1 would have a sequential design, following three cohorts. The first cohort would enter the study at 24-36 months of age, the second at 4-5 years, and the third at ages 9-10. Each cohort would be followed for two years, with intermediate behavioral assessments and comprehensive exposure assessments. Phase 2 would be an intervention study to test the effect of best practices and exposure instructions (based on findings from Phase 1). Consideration would be given to differential susceptibilities and content and context effects discovered in Phase 1. These would inform the Phase 2 interventions. Outcomes would include school readiness in younger cohorts, school achievement in the older one, and execution function and attention measures, emotion regulation, and creativity or diversion thinking generally.

Psychological Effects

Objective:

Effects of media and social media on the developing mind in terms of self-image, empathy and perspective taking, self-regulation in social interactions, socialization, and peer to peer interactions.

Questions for Consideration:

  1. How is growing up using social media affecting very young kid’s/children’/tweens’/adolescents’ social/emotional/behavioral development by age?
  2. How does social media relate to and influence intimacy, narcissism, socio-emotional bonding/relationships, ideation, and negative social outcomes?
  3. What is the right age from a developmental perspective to join a social media site and which ones should they join or not join?
  4. What factors link and mitigate relations between social media and both positive and negative outcomes?
  5. What are the advantages, disadvantages, risks and opportunities of social media relationships?
  6. Does social media us lead to positive well-being outcomes, social connectedness, and empathy? If so, how, where, when and for whom?
  7. What types of social media promote patterns of use that encourage positive well­-being, social connectedness, and empathy?
  8. What is the impact of virtual and/or augmented reality on children’s psychological well-being and development?
  9. Are younger cohorts any more vulnerable than older groups, and is there a sensitive period during which virtual environments and/or augmented reality should be avoided?
  10. What is the impact of the ability to virtually embody others and its influence on stereotypes, empathy, and perspective-­taking?
  11. Do users really believe they are “there” -- do users feel they are having a real-world experience when engaging in virtual reality?
  12. Which types of virtual reality and/or augmented reality platforms are most helpful to which types of activities, and which features (e.g. photographic realism, dynamic interaction, single versus multi-user platforms) offer optimal outcomes?
  13. Can the short- and long-term effects of exposure to or participation in cruelty via social media be identified?
  14. How can we better understand and identify the qualitative differences between digital and interpersonal aggression, and how social actors' perceptions and social norms differ between digital and non-digital environments?
  15. What other behaviors, such as individual or social play or sleep, are being displaced by media-related activities or otherwise influenced by media exposure?
  16. How can we better understand and identify the qualitative differences between digital and interpersonal aggression, and how social actors' perceptions and social norms differ between digital and non-digital environments?
  17. Could over reliance on digital media devices interfere with early childhood "normal" emotion regulation development?

Report:

The starting point for any future study should be that media exposure is not necessarily good or bad. It’s also not going away. We have to learn to work with it. When a research plan emerges from this workgroup’s discussions, it will combine longitudinal components, ecological momentary assessment (“EMA”), and a sample population followed from sixth grade or so through the transition to high school. Media exposure will be considered both through serial assessment at the previously mentioned EMA. This team’s deliberations did not produce more specific recommendations.

Physical Effects

Objective:

Effects of media on motor skills, sleep, obesity, general fitness and health.

Questions for Consideration:

  1. What are the short and long-term physical effects of media use (both interactive and conventional video/television), for example, on fine and gross motor skills, posture, obesity, sleep in toddlers, children and adolescents?
  2. Are pediatric orthopedic issues relating to digital media use such as text neck, carpal tunnel, text thumb or general muscle weakness increasing in prevalence?
  3. How do we determine/measure how digital media use affects the developing body, and what further research is needed in this area?
  4. What are the trends regarding the amount of sleep that children and adolescents are receiving each night?
  5. How does digital media use affect the quality and length of sleep in children and adolescents, from the perspectives of neurology and biophysiology?
  6. How do we measure the impacts of digital media on sleep, and what are the methodological issues involved with doing so?
  7. To what extent do the effect of digital media on sleep affect and/or magnify other health and developmental outcomes for children?
  8. What are the safe limits of evening technology use for children's sleep?
  9. Are there unhealthy behaviors that digital media do, or could, displace, in young children’s lives?
  10. Are there methods that can be employed for parents to control the amount of screen time before bed?
  11. Is there an association between child and adolescent digital media use and child and adolescent obesity rates?
  12. What are the most common study methodologies and tools used to study the association between screen time and obesity in child and adolescent populations?
  13. What interventions mitigate the adverse effects of digital media use on obesity?
  14. What do we know about the effects of screen time on developing eyes?
  15. How can we measure the effects of digital media on children's vision?
  16. What is the prevalence of myopia in children and adolescents?
  17. What do we know about Computer Vision Syndrome?
  18. How can time spent outdoors mitigate a growing myopia issue in childhood?
  19. What are the recommendations to prevent eye strain and other ocular issues (e.g. myopia, headaches) relating to digital media use in toddlers, children, and adolescents?

Report:

This workgroup took a solutions-oriented approach to its content, in the sense that it focused on how to harness the power of digital media to do good. This is reflected in its decision to test an intervention. There was some bias toward looking at sleep issues. The context for this team’s recommendations is that screen time is linked to shortened and disturbed sleep, and specifically to delayed sleep onset and impaired quality. Poor sleep leads to poor health and developmental outcomes (including not only cognitive and psychological outcomes, but also sports-related injuries and obesity). The intervention to be tested is the common guideline of no screen hour within an hour before bedtime. Comparisons would be made between a cohort of middle school children who follow that guideline, another with no restrictions on screen time before sleep, and a third that would use a mindfulness app (a potentially positive use of digital media in the sleep domain). The study would have four arms: (i) no screen time guidance and no mindfulness app; (ii) just screen time guidance; (iii) just a mindfulness app (8 minutes of use before bedtime); and (iv) both screen time guidance and a mindfulness app. This team expects the first group to have the worst outcomes, and the fourth group to have the best. Study methods would include actigraphy (to measure sleep and physical activity) and a passive media measurement app to monitor actual phone and tablet use. Outcome measurement would include psychological outcomes (such as anxiety and depressions), motor skills, eating behavior, diet, physical activity, and sleep.

Culture and Societal Effects

Objective:

Effects of media on civic engagement, sociopolitical activity, education, communication, public health.

Questions for Consideration:

  1. What effective media exposure interventions and evidence-based options (based on large-scale, multi-site, multi-year studies) exist for public policy makers and consumers to implement?
  2. How do youth perceive and understand privacy in social networks?
  3. How should we educate youth about privacy and what policies are needed?
  4. Given social media privacy settings, how can interventions based on the interactive nature of social media be developed for clinical practice or educational settings, such as schools, clinics or universities?
  5. How do different types of involvement across digital platforms (e.g., social media, games, Internet-connected objects) impact a child’s or adolescent’s ability to understand the inherent privacy risks?
  6. What ethical guidelines can guide researchers in the areas of virtual and augmented reality for toddlers, children and adolescents?
  7. How do social media relate to and influence identity development and sense of community?
  8. What is the impact of desensitization to violence on individuals and society?
  9. Given the persistent inequalities with respect to access, capacity, educational opportunities, and digital literacy, what terms and conditions will prevent the digital realm from perpetuating and even broadening existing differences in other areas of children’s education and lives?

Report:

This workgroup applied a critical, theoretical perspective to questions about technology in service of the public good. Rather than resorting to a technologically deterministic framework, or treating technology as an independent variable, it chose to think of technologies as cultural tools. They are reflections of historical processes that span generations, and as much outcomes of culture as they are influences on it (and on our psychological health and well-being). This workgroup also framed its task in terms of moving away from individual blame, and toward institutional and societal (rather personal) responsibility for regulating media use. This contributed to a “dignity framework” and thinking about the values embedded in our technologies. How can we shift away from values focused on individual competition, consumption, and economic growth, and toward dignity, communal well-being, and community values? One goal was to raise awareness of such issues among those who create apps, games, entertainment content, robots, and devices and programs that employ artificial intelligence. There was some discussion, for example, about harnessing people’s natural caring instincts and ethics of care, in combination with evidence-based information. Dialogue within and among families was identified as one means of doing so, since the ethics of care already are embedded within family structures. In this context, the Cultural and Societal Effects devised three specific research opportunities. The first is to examine the values embedded in the most popular apps, video games, entertainment media, and AIs, and emerging technologies. There are three ways to do this. A coding scheme could be applied to this content, based on values theory, users’ perceptions, and creators’ intentions. This would permit comparisons across those three domains, the results of which would help creators to recognize how their intentions might translate into users’ experiences. The second of this workgroup’s proposed projects is based on the fact that activists are using technology to strategize, mobilize, and build consensus around social change. The ease with which activist movements can be launched undermines their longevity and sustainability. Research is needed to identify the technology-based opportunities and challenges for activists and how that knowledge can inform their strategies. This workgroup’s third research proposal was to investigate how existing digital citizenship curricula can be improved so that they resonate more with participants. There is evidence that these curricula don’t currently lead to actual change.

Family Effects

Objective:

Effects of media on parenting, discipline, interaction with caregivers, guardians and siblings.

Questions for Consideration:

  1. How do parents’ digital media behaviors and environments influence their parenting, and to what effect in their children?
  2. What is the impact of parent and young child use of personal digital devices in the home context and elsewhere?
  3. Research with very young children strongly suggests that the cognitive impact of television is related to family dynamics, particularly parent­child interactions. As mobile personal digital devices are increasingly common, there is potential for an even larger impact as parents and children are distracted by their own devices. What is the impact of parent and child use of these devices in the home context and elsewhere?
  4. How are toddlers, children and adolescents engaging with digital media in the home, child-care settings, preschool settings and at school, by themselves, with their parents and siblings, their friends and with their caregivers and educators?

Report:

The crucial consideration in this area is the age and developmental stage of the children involved. There is some concern that parents not only don’t know the guidelines promulgated for children and media, but also, that they don’t want to know. This suggests that we may not know what kind of information families actually want to have. We also lack clearly delineated media rules for children of different ages. This workgroup chose to look specifically at the barriers and facilitators around parenting, media, and technology, and how they can be used to tailor interventions for diverse families. Absent specific knowledge about what to look for, qualitative research is the starting point. In particular, this workgroup recommended that focus groups be conducted with families, and that the research then progress to ethnographic observations to see how media use looks in home settings. The relevant age groups for such research would be narrowly defined in the preschool years (0-1, 1-2, 3, 4-5), then 6-9, 10-12, 13-15, and 16-18. Each of these represents a distinct developmental process. For each age group, the research questions would be, “What is working well for them, and what is problematic? What kind of advice can be tailored to families regarding strengths within media and technology use, and regarding the conflict and agitation related to such use?” Answering these questions could lead to recommendations grounded in both child development and in the ecologies of diverse families.

Technology in the Classroom

Objective:

Computers’ and cell phones’ impact on teachers, students and learning, and constructive uses of classroom media as an adjunct teaching tool.

Questions for Consideration:

  1. How has education changed in the age of technology?
  2. Are laptops being harnessed to improve students’ learning outcomes? If not, can they be, and how?
  3. What is the impact of screen-based instructional materials on reading comprehension and retention, problem-solving skills, and deep thinking?
  4. How do we leverage the benefits of digital platforms (personalization, real-time adjustment based on student performance, engagement, etc.) while avoiding the negative side effects (distraction, addiction, inability to focus)?
  5. How do we currently measure the impact of technology platforms and laptop programs on student achievement?
  6. Do we need new metrics for measuring progress?
  7. What teacher training is needed for laptops in the classroom?
  8. How much screen time is healthy and appropriate during the school day given that children are on the screens after school for homework, communication and entertainment?
  9. What are current best practices for use of laptops in the classroom?
  10. What are the learning objectives for technology in schools (e.g. 21st-century platform for teaching core disciplines, equipping students with digital skills, instruction on the safe use of technology, etc.)?
  11. How is the use of laptops currently aligned to classroom objectives/curriculum?
  12. How can school based education concerning social media’s effects on adolescents’ anxiety and well-being reduce negative effects? Is it helpful to discuss social desirability, authenticity, and the differences between online and real identity? If it can cause increased anxiety symptoms, what are the mediators and moderators of this effect?

Report:

This workgroup identified the need for more collaboration with psychologists and pediatricians. In addition to recognizing that need, it also identified an opportunity to use digital and media literacy instruction to mitigate some of the negative effects of technology use. The workgroup proposed a study examining at in-school instruction on these topics and the outcomes associated with that instruction (possibly in conjunction with the design, deployment, and evaluation of new instructional modules). Collaborators would be needed to contribute their knowledge of how to measure sleep, physical problems, and aggression (to complement educators’ own knowledge of how to measure learning outcomes).

Neurobiological, Neurophysiological, and Neurochemical Issues

Objective:

Effects of media on neurological system structure and function, neurochemistry, arousal, and emotional reward pathways.

Questions for Consideration:

  1. Does media addiction modify the brain, or do pre-existing states or trait variables increase the probability of engaging in media multitasking behavior?
  2. How do salient features of media (such as sound effects, visual cues, and interactive game play) influence infants, toddlers, and children neurobiologically, neurophysiologically, and neurochemically?
  3. What is the neurobiological basis of media addiction?

  4. What are psychological and neural mechanisms are the basis for learning from digital media? For example, impact does video game play (which could include physiological arousal, changes in task difficulty and input variability) have on brain regions that are receptive to reward and reinforcement?
  5. How do very young children’s mental processes and brain mechanisms change for good or ill because of the digital media to which they are exposed?
  6. How do media affect the primary tasks of early childhood, when the brain is not yet fully formed, such as communication, empathy, learning, memory, motor development, executive functioning, sleep cycles, and brain development?
  7. Is there a common pathway between digital media and Internet addictions and other behavioral addictions, and between these addictions and alcohol/drug addiction?
  8. Does digital addiction fit into clinical neurochemical models for addictive behaviors in terms of neurochemical pathways?
  9. What functional and structural changes take place in the neural circuit?
  10. What does withdrawal involve in terms of behavioral and brain circuits and processes, and physiological processes?

Report:

This workgroup focused on the question of how screen time impacts the brain’s ability to regulate stress in teenagers. It proposed to consider both stress vs. no-stress conditions and both short- and long-term stressors. Tools applicable to such a study include functional magnetic resonance imaging (fMRI), functional near infrared spectroscopy (fNIR), galvanic skin response (GSR), and measures of heart rate variability and neurochemical levels. Screen time could be measured in several different ways (including on-screen, through screenomics, and through experience sampling. Neurochemistry could be monitored using cortisol swabbing across time and other methods. Among the questions embedded in this proposed study are: Does teen’s stress increase over time? Are they using social media because they’re stressed? Is it helping them to reduce stress, or exacerbating it?

Digital Addiction

Objective:

Characterizing and understanding the evolution of addictive behavior and the role of media in causing or exacerbating addictive behaviors and reward centers.

Questions for Consideration:

  1. What is the earliest age that one can be addicted to digital media?
  2. Is the Diagnostic and Statistical Manual 5 criteria for gaming in usage of different media forms valid?
  3. Is internet gaming disorder a distinct disorder that should be included as a distinct category in the Diagnostic and Statistical Manual 5 or is it best understood as a symptom of other disorders or conditions?
  4. Could overdependence on digital media devices interfere with the development of normal emotion regulation?
  5. What are the paramount risk factors for developing internet gaming disorder and for digital addiction?
  6. How long does internet gaming disorder take to develop and how long does it last? Is internet gaming disorder continuous or intermittent? What is its clinical course?
  7. Are the Diagnostic and Statistical Manual 5 criteria valid for gaming in usage of different media forms?
  8. Is internet gaming disorder co-morbid with such other disorders and mental health issues as anxiety, depression, and attention deficit hyperactivity disorder?
  9. What game characteristics are more or less connected to internet gaming disorder, and what characteristics determine the direction of influence?
  10. What is problematic social media use?
  11. Are younger cohorts any more vulnerable to digital addiction than older ones?
  12. What roles do tolerance and dependence in digital addiction?
  13. Do digital media addicts need to use larger amounts of digital media over time?
  14. How do young people suffering from depression use different types of communication technologies, does such use alleviate or aggravate their depressive symptoms, and does this have an effect on the likelihood of becoming addicted to media?
  15. How can the cycle of digital addiction be broken?

Report:

This workgroup considered questions regarding comorbidities, risk factors for addiction, biological markers, and the time course and natural history of addiction. It identified, as a research priority, the definition of the comorbid conditions that occur with digital addiction or overuse. Better information about this subject will empower clinicians to treat the comorbid conditions with which they are already familiar and comfortable, as an indirect way of addressing the digital use and abuse issues with which they are not. To accomplish, the workgroup proposed a retrospective, cross-sectional, multi-site study of patients at psychiatric clinics, built around a screening questionnaire administered as part of each clinic’s intake process. That screener would solicit information on how incoming patients in four age groups (middle school high school, college, and adult) use media, what types of media they use, and so on. The resulting data would be correlated with these patients’ ages and diagnoses to identify patterns of comorbidity associated with digital media overuse. The initial data-gathering process could be repeated every two years to identify changes over time. (This workgroup consciously opted not to speak in terms of “addiction” because of that term’s negative connotations.)