Ep. 76: What's Keeping Kids Up at Night? The Impact of Excessive Screen Time on Adolescents with Dr. Paul Weigle

Dr. Weigle joined us live from the Pediatric Academic Societies (PAS) Annual Meeting  to discuss the impact of excessive screen time on adolescents and how parents can support healthy limits.

Recorded live at PAS 2024 in Toronto, Canada, on May 4, 2024.

Watch on YouTube. 

Guests:
Paul Weigle, MD, Associate Medical Director, Natchaug Hospital of Hartford Healthcare, and Assistant Professor of Psychiatry at UConn School of Medicine

Host: Carol Vassar
Producers: Carol Vassar, Joe Gillespie and Sebastian Riella

Views expressed by guests do not necessarily reflect the views of the host or management.

Subscribe, review or let your voice be heard at NemoursWellBeyond.org.

Transcript

Carol Vassar, podcast host/producer:

Welcome to Well Beyond Medicine, the Nemours Children's Health podcast. Each week, we'll explore anything and everything related to the 80% of child health impacts that occur outside the doctor's office. I'm your host, Carol Vassar. And now that you are here, let's go.

Music:
Let’s go…Well Beyond Medicine

Carol Vassar, podcast host/producer:

With me right now live from the Pediatric Academic Society's meeting, PIS, in Toronto, Canada is Dr. Paul Weigle. Dr. Weigle is Associate Medical Director of Natchaug Hospital, part of the Hartford Health Care Behavioral Health Network, and a friend from my time at Hartford Healthcare. We're talking social media, sleep, and the mental health of teens. Dr. Weigle, thank you for being here. Welcome.

Dr. Paul Weigle, Hartford HealthCare:

Thanks for having me, Carol.

Carol Vassar, podcast host/producer:

What is it about teens and social media, and how does excessive social media use impact the sleep patterns of teenagers these days?

Dr. Paul Weigle, Hartford HealthCare:

So social media and the more advanced video games that kids are engaging in today have really transformed childhood and adolescence. Kids are spending roughly twice as much time on entertainment screen media now as they were even 15, 20 years ago, and about twice the amount of time they're spending in schools over the course of a year. So really a huge part of their lives. One of the biggest impacts that all that screen media engagement and social media engagement has had on their health has been through sleep. There are hundreds of studies which confirm that engaging screen media at bedtime in the bedroom is really bad for sleep. And so it's not surprising that more kids are sleep-deprived than ever before. A majority of teenagers are not getting the recommended sleep they need in order to have good physical and mental health.

Carol Vassar, podcast host/producer:

I'm glad you brought up the fact that the scenario has changed in terms of video games and social media changing over the last 15 to 20 years. We're looking at parents who maybe were into MySpace and the early years of Facebook when they were growing up, but for them, it's a very different world. How do parents deal with this? Are they looking at the fact that things have changed?

Dr. Paul Weigle, Hartford HealthCare:

Yeah, so it is really tough time to be a parent. So many parents have expressed feeling like their relationship with their kids is a constant battle over screen media and trying to maintain healthy limits. And so this creates a lot of conflicts, and a lot of parents feel powerless because the kids are so attached to their screens. And so, for a parent to try to make an intervention like taking the cell phone for a day as a consequence, that can turn into a crisis and even a safety issue.

Carol Vassar, podcast host/producer:

When we look at teenagers, we know teenagers require a lot of sleep. They sleep many, many hours, and that's just the normal fact of their life at that moment. Let's talk about the act of sleep deprivation, of staying up a good portion of the night on TikTok or playing video games. How does that affect adolescents when they don't get enough sleep?

Dr. Paul Weigle, Hartford HealthCare:

So, insufficient sleep is a powerful predictor of mental and physical health problems. In particular, deep sleep is necessary for encoding of the memories of our day. So, it's very important in learning, and sleep deprivation has a powerful negative effect on kids' ability to achieve academically. But not only that, sleep deprivation is a powerful predictor of depression, of anxiety, as well as obesity. So it's not a mystery why in the setting of kids getting less sleep than they ever have before, teenagers in particular, we're seeing these terrible increases in depression, anxiety, self-harm, and suicidality.

Carol Vassar, podcast host/producer:

Talk about that, that seems to be particularly an issue with adolescent girls.

Dr. Paul Weigle, Hartford HealthCare:

Yeah, so adolescent girls are particularly engaged in social media. Boys tend to spend twice as much time playing video games. Girls spend more time on social media. And the time they spend on social media can have very high stakes for their psychological health. Looking at curated social media profiles, it does give kids the sense that their peers are living better lives, are better looking, and are having more fun than they are. Even though kids know rationally that what they're looking at does not necessarily represent reality, studies show that unconsciously they adopt these as norms and they come to assume that this is the lives that other kids are leaving, and it leads them feeling low about themselves.

Carol Vassar, podcast host/producer:

As we talk about depression and anxiety in teenagers, you talked about how sleep deprivation could be a cause of that anxiety and being on social media could be a cause of that anxiety. What other issues are you seeing that are causing anxiety online?

Dr. Paul Weigle, Hartford HealthCare:

I should say that not all screen media is the same with regard to its effect on sleep. Watching a movie or listening to an audiobook certainly is not the same as when you're involved in an active, engaging screen activity like video games or social media. Studies show that it takes two and a half times longer to fall asleep after you're engaged in video games, even once you turn it off or in social media, than it does if you're watching a movie or reading a book. So, not all screen media is equal in that way.

And certainly, I see a lot of young people who feel a great deal of anxiety about their presence on social media. Of course, kids have always placed a high emphasis, teenagers, on their peers and what their peers think of them. That has always been natural, but on social media, the stakes are so much higher. If you make a mistake, if you embarrass yourself, it's not just witnessed by a couple of people. It can be witnessed by everyone. And public shaming and online cruelty it is very common. It's actually girls that tend to be not only more likely the victims but more likely the aggressors online too.

Carol Vassar, podcast host/producer:

The perpetrators. I wanted to ask about that, online bullying, online cruelty. That, I'm sure, it's got to be anxiety-producing. I remember that in the early days of Facebook with my own children when they were teenagers. Talk about that.

Dr. Paul Weigle, Hartford HealthCare:

Unfortunately, online aggression is not common. I'm sorry, is not uncommon. And it's very often something that kids will tell me is causing a great deal of unhappiness in their lives. It's certainly something that kids worry about happening to them. Yeah, it's something that kids talk about a lot, and unfortunately is strongly linked to depression and to suicidality. And so, online, kids behave differently than they do in person. If two kids are socializing, someone says something cruel, and they see the other person being heard, they're likely to self-correct as often as not. Online, that doesn't happen. And oftentimes kids, they know they're not supervised by adults online, and oftentimes they are less likely to face consequences for cruelty. And so they're more likely to act cruel if they think they can get away with it. And simply online, they more often do.

Carol Vassar, podcast host/producer:

Is social media good for anything, for teenagers, for adolescents?

Dr. Paul Weigle, Hartford HealthCare:

That's a tough question. So certainly adolescents will often tell me that they value social media as a way to be inspired or as a way to connect in person with their peers. And studies show that kids who use social media in this way to arrange in-person, face-to-face social engagements are actually healthier than their peers. And certainly kids who are video chatting with friends or with family members, this all can be healthy uses. But unfortunately, with teenagers, it's very hard to get the good and not the bad, especially among the most vulnerable kids.

Carol Vassar, podcast host/producer:

They don't have the experience, the life's experience oftentimes.

Dr. Paul Weigle, Hartford HealthCare:

Absolutely. And they're at a developmental stage where they are more impulsive, they don't judge risk as well, and they suffer from a psychological phenomena where they feel like everyone is looking at them and judging them all the time. This makes them particularly sensitive to feedback on social media, which unfortunately seems more often to be a negative in terms of their self-esteem than a positive.

Carol Vassar, podcast host/producer:

You've alluded to this, I think, already talking about there are some online and on-screen platforms that can benefit, like audiobooks, but how does content consumed on social media platforms affect the mental well-being of teens and their sleep as well?

Dr. Paul Weigle, Hartford HealthCare:

Yeah, so it really depends to a large degree on what content they're consuming. Experimental studies have shown that if the Facebook or the social media feed is altered to give you more positive content, it actually has a positive effect on your mood. But if you're engaging in more negative content, the opposite happens. And so what I often see with young people who are suffering from depression or anxiety, I often ask them, "Hey, would you show me your social media feed?" And a lot of kids are happy to do that. Very often, it is filled with negative content, other people talking about their depression and eating disordered habits. And oftentimes, the content actually seems to glorify or recommend eating-disordered or self-harm behavior. So studies show that the more the kids engage in content that has to do with depression or anxiety, actually the worse these symptoms get for themselves, not better.

Carol Vassar, podcast host/producer:

Let's talk about the parents here. They have a responsibility for their children as they are still adolescents. What kinds of strategies can parents employ to help their teenagers develop healthier sleep habits, maybe get off the social media as they age into and go through adolescence in a very social media world?

Dr. Paul Weigle, Hartford HealthCare:

So, like I mentioned earlier, parenting kids and establishing healthy screen media habits is really hard for parents. Part of the problem is that parents, we haven't really been working together. If your kid is the only kid who doesn't have a cell phone or who is not online at 3:00 AM when the other kids are talking, they can really feel left out. So one thing that parents can do is get together and collectively make decisions about how screen media is going to be in the lives of their kids. So, for example, there is the Wait Until Eighth movement, which recommends or advocates that parents make an agreement that they're not going to give their kid a cell phone or let them set up a social media account until eighth grade. And when a lot of parents in one school are doing it together, it's a lot easier on the parent and on the kid as well.

Carol Vassar, podcast host/producer:

Are there specific social media activities that are maybe more harmful to the mental health of teens than others?

Dr. Paul Weigle, Hartford HealthCare:

Yeah, certainly, studies indicate that engaging in content that has to do with the self-harm, eating disorder, suicidality, unfortunately is not hard to find on social media. And kids who engage with this content are more likely to increase these behaviors in their lives rather than decrease. The other is the setting. Being on social media during the day has very different health implications than being on at night. So a lot of the kids that I see who suffer from the worst depression, after school, they come home, they lie in their bed, and they scroll social media, and then they're up late at night. And so, one of the things that I've had success with in working with kids with depression is setting up a rule that the screens don't enter the bedroom. And that keeps them from lying in bed during the day and it gets them to sleep better at night. The parents can supervise a little bit more what's going on. Kids are less likely to engage in sending inappropriate pictures of themselves. I've had a lot of success. A lot of kids come to me asking for sleep medication, and what they really need is to have their cell phone charge in their parents' room. So if I can get them to agree to a trial, oftentimes, no sleep medication is needed.

Carol Vassar, podcast host/producer:

The idea of actually cutting off internet access at a certain time, is that something that is a little bit of a bridge too far for some families?

Dr. Paul Weigle, Hartford HealthCare:

It is very challenging, and partly is because that upward of 95% of teenagers have a smartphone. So turning off the Wi-Fi doesn't necessarily address that. It'll help the kids with their tablets, but even then, they can play a lot of games that are not online. So shutting off Wi-Fi can be really helpful, but for a lot of parents and families, it just isn't sufficient, unfortunately, because kids have other ways and they are so engaged that they are willing to go to all sorts of different lengths to engage in screen media at night, even though it really is terribly unhealthy for you.

Carol Vassar, podcast host/producer:

What about parental modeling? How important is that?

Dr. Paul Weigle, Hartford HealthCare:

So important. So, the biggest determinant of child media habits is parent media habits. And when I've met kids who suffer from terrible addictive habits to video games or social media where it's taking up 12, 13 hours of their day and displacing school and socializing, very often I find that the parents have similar problems with their own screen media use. And plus, parents can't effectively enforce structure or rules if they are excessively over-engaging in screen media themselves. It's tough for us too.

Carol Vassar, podcast host/producer:

Mm-hmm. This is a community concerns sleep deprivation due to social media, due to video game, online time by adolescents. What role do schools, community leaders, physicians play in all of this?

Dr. Paul Weigle, Hartford HealthCare:

Well, one of the things I think physicians can do, as well as parents, is help to advocate. Really, what we need is a safer, healthier internet. And this can happen. And of course, we hear social media companies, for example, or video game companies, they do pay lip service to making their... and they have made some moves to make the platforms healthier, but really, it would be very easy for them to limit access to kids under 13 for social media platforms by doing age verifications or to limit or even shut down access after 2:00 A.M. for example. Or to send notifications to kids, "Hey, you've been on three hours. Maybe it's time for a break." But the truth is that social media companies and video game companies, they're just not currently motivated to do so because their business model is increasing engagement to the maximum. And so, really, I think that until there is government regulation of industry, the problem is just going to continue. And that's something that physicians and parents can advocate for to make a healthier internet for all of us.

Carol Vassar, podcast host/producer:

That is going to be my next question, policymakers, their role, it sounds like is really important here in Keek. Are they missing from being at the table?

Dr. Paul Weigle, Hartford HealthCare:

Certainly, there are encouraging signs that the US Senate asked social media companies to come and testify about just this kind of thing. Currently, 49 states are suing Meta about its effect on the mental health of kids. So there is movement towards this, but just like the cigarette industry, industries aren't very good at controlling themselves with regard to their effect on health, and really that external oversight is required.

Carol Vassar, podcast host/producer:

Anything I've missed here, anything else you want parents, physicians, policymakers, kids to be aware of?

Dr. Paul Weigle, Hartford HealthCare:

I think that the most important thing is to remember that the human body really requires sleep. If kids are not getting their nine hours a day, there's a price to pay, a price with their academics, with how they feel, their mood, and their propensity to suffer from anxiety. We all need a break, and so keeping screens out of the bedrooms of kids and younger adolescents is oftentimes the best thing that parents can do for the health and well-being of their kids.

Carol Vassar, podcast host/producer:

Dr. Paul Weigle, Associate Medical Director of Natchaug Hospital with the Hartford Healthcare Behavioral Health Network in Connecticut. Thank you so much for this great advice and thank you for your time.

Dr. Paul Weigle, Hartford HealthCare:

Thanks for having me, Carol.

Carol Vassar, podcast host/producer:

And thank you for your time, for listening, for watching. Keep an eye on the Nemours Well Beyond Medicine podcast site, that's nemourswellbeyond.org, for more podcasts from PAS. Also, check out our YouTube channel, we may be going live again before you know it. We are here at PAS in Toronto with many thanks to our production team, Joe Gillespie, Sebastian Riella, Che Parker, Cheryl Munn, Drew Landmeier, and the entire Nemours team here, as well as the stateside team, Susan Masucci and Lauren Tatter, for taking care of things back home. I'm Carol Vassar, and remember, together we can change children's health for good going well beyond medicine.

Music:

Let’s go…Well Beyond Medicine!