1. Electronic Screen Syndrome:
Marie Sherwood, MSc

2. Common symptoms Revved up all the time
Cannot focus and is often defiant. Bedtime is a daily nightmare.
Exhausted and has meltdowns even when receiving sufficient sleep (wired and tired)
Irritable when it is time to stop playing a game
Hard time making eye contact
Child is attracted to screens  
Child is not happy and does not seem to enjoy activities

3. Common symptoms Trouble making and keeping friends Narrowed interests
Trouble in school
Different practitioners give your child different diagnoses
Appears lazy and unmotivated
Stressed even though there are not many stressors
Services do not seem to be helping

4. Possible red herrings
The two most overdiagnosed disorders in the pediatric population are:
childhood bipolar disorder and attention deficit hyperactivity disorder (ADHD or ADD)—both of which can lead to taking medication with significant side effects. 

5. Electronic Screen Syndrome: An Unrecognized, Modern-Day Disorder
Screen-related effects can be present in many shapes and forms.  Although varied, many of the effects can be grouped into symptoms related to mood, cognition, and behavior.   The root of these symptoms appears to be linked to repeated stress on the nervous system, making self-regulation and stress management less efficient. 

6. dysregulation
ESS is essentially a disorder of dysregulation.  Dysregulation can be defined as an inability to modulate one’s mood, attention, or level of arousal in a manner appropriate to one’s environment.  
Level of arousal refers to level of brain stimulation
Dysregulation can be defined in layman’s terms as super silly, super aggressive, super inappropriate, super distracted, super irritable, etc.

7. Fear Changes the Way We Think
Sense of Time is Seriously Affected
Cognition
Abstract
Concrete
Emotional
Reactive
Reflexive
Mental State
CALM
ALARM
FEAR
AROUSAL
TERROR
Primary
secondary
Brain Areas
NEOCORTEX
Subcortex
SUBCORTEX
Limbic
LIMBIC
Midbrain
MIDBRAIN
Brainstem
BRAINSTEM
Autonomic
Sense of Time
Days
Hours
Minutes
Extended
Future
Seconds
Loss of Sense of Time

8. fight or flight
Interacting with screens shifts the nervous system into fight-or-flight mode which leads to dysregulation and disorganization of various biological systems.  Sometimes this stress response is immediate and pronounced (say while playing an action video game), and other times the response is more subtle and may happen only after a certain amount of repetition. 

9. interacting
In short though, interacting with screen devices causes a child to become overstimulated and “revved up.”

10. physiological anxiety
This occurs when one or more of the sensory systems are stressed out.
Sensory system too stressed out from interactive screen time.

11. ESS Characteristics in Children
The child exhibits symptoms related to mood, anxiety, cognition, behavior, or social interactions that cause significant impairment in school, at home, or with peers.  Typical signs/symptoms mimic chronic stress and include irritable, depressed (low) mood, excessive tantrums, low frustration tolerance, poor self- regulation, disorganized behavior, oppositional-defiant behaviors, poor sportsmanship, social immaturity, poor eye contact, insomnia/non- restorative sleep, learning difficulties, and poor short-term memory.

12. ESS Characteristics in Children
ESS may occur in the absence or presence of other psychiatric, neurological, behavior or learning disorders, and can mimic or exacerbate virtually any mental-health related disorder.

13. ESS Characteristics in Children
Symptoms markedly improve or resolve with strict removal of electronic media (an “electronic fast”); three to four week electronic fasts are often sufficient but longer fasts may be required in severe cases. 

14. ESS Characteristics in Children
Symptoms may return with re-introduction of electronic media following a fast, depending on a variety of factors.   Some children can tolerate moderation after a fast, while others seem to relapse immediately if re-exposed.  

15. ESS Characteristics in Children
Vulnerability factors exist and include: male gender, pre-existing psychiatric, neurodevelopmental, learning, or behavior disorders, co-existing stressors, and total lifetime electronic media exposure.  At particular risk may be boys with ADHD and/or autism spectrum disorders.

16. Amount or type of activity or nature
All of the above, but time is the biggest factor contributing to ESS
All screens are included: computers, television, video games, smartphones, iPads, tablets, laptops, digital cameras, e-readers, etc.
Includes time texting, video chatting, surfing the Internet, gaming, ing, social media, using apps, shopping online, reading from a device, word processing, and even scrolling through pictures on a phone.

17. Interactive and passive screen-time
Interactive is defined as interfacing with a device: touch screen, keyboard, console, motion sensor, etc.
Passive is simply watching. eg. TV. Viewing on an iPad, laptop or handheld device is more stimulating therefore, for the brain, it is labelled as interactive.

18. Screen time and health issues
According to research both interactive and passive have been linked to obesity, attention problems, slower reading development, depression, sleep problems, diminished creativity, and irritability.

19. which is worse? By far interactive screen-time is worse.
Many parents have limits on passive use, as it is associated with laziness and a lack of activity. For this reason, many parents have limit on TV.
Parents are encouraged to use interactive screen-time, as it is seen as engaging the child’s brain.
If children are thinking and doing puzzles on a screen rather than passively watching, it must be better for them, right? NOT
The interaction produces more hyperarousal and any benefits of the interaction is overridden by a stress-related reaction.

20. Interactive and passive
Caudate nucleus is part of the basal ganglia; thalamus is used for sensory interpretation; hippocampus: long term memory

21. Same parts of the brain

22. Basal ganglia
Basal Ganglia System (BGS): The basal ganglia are responsible for voluntary motor control, procedural learning, eye movement, cognitive, and emotional functions.

23. 4 to 1 First Stage Response releases: adrenaline and noradrenaline
Stage Two Response releases: cortisol
Complicating Factors:
More involuntary symptoms and factors
If you get into stage two, you can have lingering symptoms. It will take four times as long for your system to calm down.
Increased electrical activity in the brain
4 to 1

24. Violent gaming
Researchers found that those who played the violent video games showed less activity in areas that involved emotions, attention and inhibition of our impulses. “Behavioral studies have shown an increase in aggressive behavior after violent video games, and what we show is the physiological explanation for what the behavioral studies are showing,”

25. less responsive to violence

26. stress-related reaction
The interactivity then causes the user to feel a sense of control, choices and immediate gratification which contributes to the reward circuits being kept on longer causing a compulsive and/or addictive use of the devices.

27. sleep
Sleep and memory can be seriously affected after one episode of excessive time of interactive use, while excessive TV watching produced mild sleep issues and no memory issues
In a study comparing interactive and passive:
30 minutes of interactive can cause disruption in sleep
2 hours of passive can cause the same amount of disruption in sleep
Of people affected by sleep problems: 94% had at least one of the following: Mood (85%), School issues (83%), home life (72%), social life issues (68%).

28. affects on the neural connections
Neural connections are affected to the point where excessive use of Internet and gaming can resemble damage done by drugs and alcohol.
Hyperarousal causes neural connections to deteriorate.
Any gaming including educational or seemingly benign like puzzles or building games can also cause this damage.

30. Research on self-esteem and mental health
Trinh, L., Wong, B., & Faulkner, G. E., (2015).
Screen times were associated with low self-esteem, poor mental health and lower academic outcomes.

31. difference between gaming and violent gaming
Any and all gaming can cause dysregulation
Violent games have the added ability to sensitize the amygdala (Amy).
Amy tries to keep us safe. When someone plays a violent game, Amy does not know it is not real. She sees it as a threat.
Amy is sensitive to the “look and feel” from any previous situations. eg. If a game is set in a desert, deserts will trigger a stress response.

32. more research
Internet Gaming Disorder (IGD) resembles drug addiction in the brain.
Diminished brain regions responsible for attention and control, impulse control, motor function, emotional regulation, sensory-motor coordination
Lower white matter density in brain regions that are involved in decision-making, behavioral inhibition and emotional regulation.
Videogame playing involved changes in reward inhibitory mechanisms and loss of control
dopamine release similar in magnitude to that of drug abuse
Weinstein, Aviv; Livny, Abigail; Weizman, Abraham (2017)

33. more research
Brain scans from nearly 200 adolescent boys provide evidence that the brains of compulsive video game players are wired differently. Chronic video game play is associated with hyperconnectivity between several pairs of brain networks. Some of the changes are predicted to help game players respond to new information. Other changes are associated with distractibility and poor impulse control. 
Perry Renshaw (2015)

34. More research
The IGD (Internet Gaming Disorder) subjects showed reduced regional centralities in the prefrontal cortex, left posterior cingulate cortex, right amygdala, and bilateral lingual gyrus, and increased functional connectivity in sensory-motor-related brain networks compared to the HC (Healthy Control) subjects.
Wang, Lingxiao; Wu, Lingdan; Lin, Xiao; Zhang, Yifen; Zhou, Hongli; Du, Xiaoxia; Dong, Guangheng (2016)

35. more research
The IGD group showed increased activation in the right superior parietal lobule, right insular lobe, right precuneus, right cingulated gyrus, right superior temporal gyrus, and left brainstem.
Meaning: increases in aggression and loss of control
Internet videogame play activates the vision, space, attention, and execution centers located in the occipital, temporal, parietal, and frontal gyri. Abnormal brain function was noted in IGD subjects, with hypofunction of the frontal cortex.
Meaning: less thinking, more aggression, less memory
Liu, Jun; Li, Weihui; Zhou, Shunke; Zhang, Li; Wang, Zhiyuan; Zhang, Yan; Jiang, Yebin; Li, Lingjiang

36. more research elevated brain reactivity to game-related cues
self-reported increase in desire for the game
The results indicate that exposure to either Internet games or TV dramas elevates the reactivity to visual cues associated with the particular exposure.
Meaning: Amy is more sensitive to the particular cues that have been stimulated in the game.
Ahn, Hyeon Min; Chung, Hwan Jun; Kim, Sang Hee (2015)

37. more research
The results also contribute to a growing body of evidence indicating that the P300 is attenuated across a broad range of task conditions in high- externalizing individuals.
Meaning: If you have a child that has reactive aggression, they will be more prone to proactive aggression if exposed to gaming.
Bernat, Edward M.; Nelson, Lindsay D.; Steele, Vaughn R.; Gehring, William J.; Patrick, Christopher J., (2011).

38. Every child?? Every child is affected differently.
There are too many variables to assess in order to compare children.

39. cognitive load
Cognitive load is the reason why reading a book is easier on your system, then reading on an electronic device. eg. Kindle
Cognitive is defined as the amount of energy needed to process and synthesize information.
Kindles are supposed to read like regular books, but they do not.
Kindles (or other electronics) cause slower reading times, in addition to negatively affecting recall and comprehension.
Sensory feedback from a real book help us incorporate the information.

40. Our screens are so ingrained into our lives.
an inconvenient truth
It would be easy to decide to discredit this information or to work around it.
Our screens are so ingrained into our lives.

41. Never??
An electronic fast is a good way to reset a child’s brain. A minimum of 4 weeks is necessary, but 8 weeks is a much better idea.
My Challenge: No interactive electronics for the summer.
After the Fast: no more than 30 minutes interactive use and a maximum of 2 hours in total of interactive and passive.

42. objections Way too hard Child’s reaction
Guilty for taking away a fun past time
Resent losing their electronic babysitter
Doubt that electronics are an issue
What others will think?
Annoyed by the inconvenience of removing or restricting laptops, iPads and mobile devices

43. Common statements Screen-time is the only time my children are quiet
Electronics allow me to get things done.
Screen-time is the only motivator that works.
It’s what all children do, and anyway my child uses it a lot less than others.
I only let them play educational games.
FACT: Feelings will diminish as you take action.

44. biggest objection
One of the biggest objection is linked to guilt, as parents have a hard time thinking that they have contributed to something that is hurting their child(ren).
The truth is most parents already have a feeling that they are allowing too much screen-time.
Children who protest very strongly probably have an issue with electronics.

45. less painful method
If you plan on doing the electronic fast, start reducing the combined screen time to no more than 2 hours per day.
Slowly start introducing a more active lifestyle, so that children do not have as much opportunity to use screens.
Children actually get over the new lifestyle much more quickly than parents first thought. As children become happier, better behaved, and more focused, parents find it easier too.

46. educational use
There is a belief that there is a risks versus benefits factor.
The research does not prove that screen use for educational use enhances learning or brain development.
There are biofeedback programs that are classified as interactive that have shown benefits, but children do these programs for 10 minutes per day.