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  5. 儿童手机依赖的深层成因与影响机制研究

儿童手机依赖的深层成因与影响机制研究

深度研究匿名用户发表于 2025年12月22日 16:490阅读
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1. 引言：从“比命重要”现象看儿童手机依赖的普遍性与紧迫性

在当今数字时代，智能手机已深度融入人们的日常生活，尤其是在儿童和青少年群体中，其使用频率和普及程度达到了前所未有的水平。随之而来的“儿童手机依赖”现象日益凸显，甚至出现了“手机比命还重要”的极端说法，生动地描绘了部分孩子对手机的痴迷程度，引发了社会各界的广泛关注与担忧。这种现象不仅仅是个别案例，全球范围内，青少年群体中问题性智能手机使用的普遍率中位数已达23.3% 1。在一些极端情况下，儿童因手机使用而忽略基本生理需求、学业责任甚至人身安全，例如长时间沉迷游戏或社交媒体导致睡眠严重不足、户外活动缺失，甚至在面临手机被没收时出现剧烈的情绪反应，这些都指向手机已成为他们生活中不可或缺甚至超越一切的存在。

智能手机依赖被定义为一种以强迫性使用手机为特征的行为模式，它可能导致身体、心理或社会层面的多种损害 2。这种行为性成瘾与物质成瘾在症状学上存在相似之处，并且其在全球范围内的儿童和青少年中呈现指数级增长 2。鉴于智能手机在儿童日常生活中的普及性及其潜在的负面影响，深入研究儿童手机依赖的深层成因显得尤为必要和紧迫。这不仅有助于我们理解这种普遍现象背后的复杂机制，更能为制定有效的干预和预防策略提供科学依据，以期引导儿童健康、理性地使用数字工具，避免其成长发展受到不可逆的负面冲击。

2. 生理机制：神经奖励系统与身体机能的双重驱动

2.1 多巴胺奖赏回路的强化作用

儿童对手机的过度使用，在生理层面，首先与大脑的神经奖励系统，特别是多巴胺回路的强化作用密切相关。多巴胺是一种神经递质，在大脑的奖赏、动机和愉悦感中扮演着关键角色。当个体从事某些行为并获得愉悦体验时，大脑会释放多巴胺，从而强化该行为，促使个体重复进行以再次获得奖赏3。手机应用和内容，尤其是游戏、社交媒体和短视频等，正是利用了这一机制，通过提供即时且高频率的反馈来刺激多巴胺的释放。

例如，在游戏中获得成就、升级或赢得比赛，在社交媒体上收到点赞、评论或关注，或在观看短视频时不断刷出感兴趣的内容，这些都构成了强烈的“即时反馈”。每一次积极的反馈都会触发大脑多巴胺的短时激增，带来愉悦感和满足感，进而形成一个“即时反馈-持续使用”的成瘾循环3。这种循环使得儿童难以停止使用手机，因为停止意味着失去这种即时且唾手可得的愉悦刺激。有研究指出，数字徽章等简单的奖励就能有效增加用户的动机3。长期暴露于这种高频刺激下，大脑对正常生活的刺激反应可能会减弱，导致对手机的依赖性进一步增强。

此外，多巴胺回路的异常活跃也被认为是注意力缺陷多动障碍（ADHD）相关行为与屏幕时间关联的重要生理基础。有研究表明，过度屏幕时间与ADHD的发生或症状加重存在显著关联45。例如，一项针对美国儿童的调查发现，过度的屏幕时间与行为和注意力问题（包括ADHD）呈正相关，且存在显著的剂量-反应关系，即屏幕时间越长，ADHD风险越高4。特别是在学龄前儿童中，这种关联更为强烈4。另有研究指出，手机成瘾与大脑结构和功能的变化有关，例如在智能手机成瘾者中，左侧前脑岛、颞下回和海马旁回的灰质体积减小，右侧前扣带皮层的内在神经活动降低，这些区域都与认知控制和情绪调节紧密相关6。过度使用手机还可能通过激活多巴胺和奖赏通路，导致与ADHD相关的行为，并可能被误诊为ADHD7。通过控制屏幕时间，可以有效改善ADHD儿童的认知功能8。一些研究还发现，具有ADHD的儿童出现网络成瘾（IA）的风险更高910。甚至有研究表明，旨在提高预期感的视频游戏会增加抽动症儿童的抽动频率，这可能与刺激了阶段性多巴胺释放有关11。这些证据共同指向手机对儿童大脑多巴胺奖赏回路的过度刺激，是导致其手机依赖行为和相关神经发展问题的重要生理机制。

2.2 生理节律紊乱的恶性循环

除了多巴胺奖赏回路的强化作用，儿童过度使用手机的另一重要生理机制在于其对生理节律，特别是睡眠周期的严重干扰，进而引发一系列的恶性循环。夜间长时间或在睡前使用手机、平板电脑等电子设备，会显著影响儿童的睡眠质量和时长。这主要是由于电子屏幕发出的短波长（蓝光）光线对人体褪黑素分泌的抑制作用12。褪黑素是一种调节睡眠-觉醒周期的激素，其分泌受到蓝光抑制后，会导致入睡困难、睡眠潜伏期延长、睡眠效率下降。

研究显示，青少年睡眠行为的改变与屏幕使用、手机、互联网及社交媒体的使用密切相关，进而导致整体睡眠时间的减少和睡眠剥夺的增加13。一项针对青少年的调查发现，高达51.7%的青少年在就寝后仍然经常使用电子设备，其中25.6%进行屏幕活动（如发短信、社交媒体、玩游戏或看电视），甚至有6.1%的青少年会在夜间醒来玩在线游戏，15.3%发短信，11%使用社交媒体13。这种夜间屏幕使用行为，特别是在卧室放置电脑、手机和智能手机，与学期期间睡眠时间减少、日常功能和情绪的负面影响呈显著关联，且这种影响随年龄增长而增加13。例如，在睡眠不足的青少年中，入睡困难（需要一小时以上入睡的比例高达33%）和早晨起床困难更为普遍13。

睡眠剥夺不仅直接影响儿童的精力水平和学业表现，更会进一步加剧情绪失调和认知控制能力下降。睡眠不足的青少年更容易出现烦躁不安和悲伤情绪13。长期睡眠不足还会导致前额叶皮层功能受损，该区域负责执行功能，包括注意力、决策和情绪调节等。当这些认知控制能力下降时，儿童更容易冲动行事，难以抵制手机的诱惑，从而形成恶性循环。

此外，长期的睡眠障碍与多种身体健康问题紧密相关。儿童和青少年的睡眠特征，包括睡眠时长、连续性和质量，与心血管疾病风险因素（如肥胖、葡萄糖、胰岛素和血压等）之间存在关联1415。例如，儿童肥胖是21世纪主要的健康挑战之一，并且与母亲的述情障碍和儿童不规律的睡眠模式显著相关16。研究表明，睡眠不足会增加肥胖、高血压、胰岛素抵抗的风险1415。虽然现有研究多为横断面性质，难以确立因果关系，但其强烈提示了睡眠剥夺对儿童整体生理健康的累积性损害。尤其对于患有注意缺陷多动障碍（ADHD）的儿童，睡眠质量差异显著，而饮食、体育活动和屏幕时间在ADHD对睡眠质量的影响中起到了中介作用，这表明控制屏幕时间对于改善ADHD儿童的睡眠质量可能具有重要意义17。

3. 心理需求：数字世界对现实缺失的补偿与替代

3.1 社交归属的虚拟满足

儿童和青少年在成长过程中，对社交归属感有着强烈的需求。然而，现实社交环境中可能存在的挑战，如同伴压力、社交焦虑、或因缺乏社交技能而导致的孤独感，往往让他们难以获得充分的满足。在这些情况下，数字世界为他们提供了一个看似低成本、低风险的替代性社交平台。手机上的社交媒体、即时通讯应用以及在线游戏等，允许孩子们在虚拟空间中轻松地建立联系、表达自我并获得认同。

孤独感是推动儿童转向虚拟社交的重要心理因素。多项研究表明，儿童社会网络（如与父母的关系质量、同伴群体规模和同伴支持）的缺乏会增加他们对智能手机的依赖18。换言之，当儿童在现实生活中感受到的支持网络不足时，他们更倾向于通过手机来寻求联系和慰藉。这种虚拟的连接在一定程度上缓解了现实中的孤独，但也可能形成一种恶性循环，即越是沉迷于虚拟社交，现实社交能力越是退化，从而加剧孤独感，进一步依赖手机。

疫情期间的社交隔离，更凸显了虚拟社交对于满足儿童和青少年归属感需求的重要性。由于学校停课和居家隔离，许多青少年失去了面对面的同伴互动机会，这导致了普遍的焦虑和孤独感增加19。在这种特殊时期，手机和互联网成为了他们与外部世界保持联系、维系同伴关系几乎唯一的途径。例如，一项针对土耳其青少年的研究发现，在COVID-19大流行期间的居家隔离措施，导致了青少年焦虑和孤独感的上升19。手机在此期间发挥了双重作用：一方面，它缓解了因隔离带来的部分负面情绪；另一方面，也可能因此强化了对手机的依赖，因为手机成为了他们获取信息、进行社交和排解无聊的主要工具20。

此外，虚拟社交平台通常提供即时反馈机制（如点赞、评论和分享），这些都为儿童提供了快速且可见的社会认同，这比在现实社交中获得认同更为直接和容易。对于那些在现实中可能感到不自信或难以融入群体的孩子来说，虚拟世界提供了一个相对安全的“避风港”，让他们能够尝试不同的角色，或是更容易地找到兴趣相投的同伴群体，从而获得在现实中可能缺失的归属感和自我价值感。然而，这种虚拟的归属感往往是脆弱且表面的，长期来看并不能替代高质量的现实社交互动。

3.2 自我认同的数字建构

在儿童和青少年心理发展的关键时期，建立清晰、积极的自我认同感至关重要。自我认同感涉及个体对自身特质、能力、价值观以及社会角色的认知和评价。当现实世界中，如学业压力、家庭忽视或人际交往困难，未能提供足够的自我表达和价值实现途径时，手机所构建的数字世界往往成为他们寻求自我认同的替代性场域。

在数字平台，特别是短视频创作和在线游戏中，儿童和青少年可以相对自由地表达个性、展示才华并获得即时反馈。例如，通过创作并分享短视频，他们能够尝试不同的风格、展示独特的视角，并在收到点赞、评论和转发时，体验到被关注和认可的成就感。在线游戏也提供了类似的机制，玩家通过提升技能、完成任务、获得高分或在团队中发挥关键作用，可以赢得同伴的尊重和虚拟世界的地位，从而满足其对能力和价值的肯定需求。这种“数字成就”往往比现实生活中的某些成就更容易获得，且反馈更为迅速和直接。

相比之下，现实生活中的自我认同构建可能面临诸多挑战。学业压力是许多儿童和青少年面临的普遍问题。在竞争激烈的教育环境中，成绩成为衡量自我价值的重要标准，但并非所有孩子都能在学业上取得成功。对于那些学业表现不佳的孩子来说，他们可能难以通过传统学业途径获得成就感和自我肯定。此外，一些儿童可能经历家庭忽视，父母由于工作繁忙或其他原因，未能给予足够的关注和情感支持，导致孩子在家庭中感到被边缘化或缺乏价值。研究表明，父母的忽视与青少年的述情障碍（alexithymia）和短视频应用成瘾呈正相关，而述情障碍在其中起到了中介作用，这意味着被忽视的青少年可能更倾向于通过手机寻求情感满足和自我价值 21。此外，父母的“手机冷落”（parental phubbing，即父母在与孩子互动时沉迷手机）已被证实与儿童的自尊心下降呈负相关 222324，这进一步削弱了他们在现实生活中的自我价值感。

在这些现实缺失的背景下，数字世界提供了一个“平行”的自我建构空间。在这里，他们可以创造一个理想化的数字形象，或是通过虚拟角色的成功来弥补现实中的不足。例如，一项研究发现，自尊心较低的个体在接触理想化的身体形象时，更容易进行外貌比较，从而导致更大的身体不满，这间接说明了自我认同模糊的个体更容易受到外界（包括数字世界）形象的影响 25。低自我概念清晰度（即对自己身份缺乏清晰认识）的个体，更容易受到媒体中理想化形象的影响，进行外貌比较，并导致身体不满 25。虽然这项研究主要关注外貌，但其核心思想——自我概念模糊导致对外部参照的依赖——同样适用于数字世界中自我认同的构建。

这种数字化的自我建构，在短期内能够提供心理慰藉和满足感，但长期来看，其可能存在的负面效应不容忽视。过分依赖数字世界的认同，可能导致现实自我与理想自我之间的差距拉大，或使得儿童难以在现实社交和成就中建立稳定的自我价值感。自尊心对个体的健康发展至关重要。研究发现，父母的教养方式对青少年的自尊心和价值观内化有显著影响，其中，宽容型（indulgent）父母的青少年自尊心得分最高，而专制型（authoritarian）父母的青少年得分最低 26。父母的手机冷落行为不仅直接影响亲子关系，也通过影响儿童的自尊心，进一步加剧其问题性手机使用 2324。更有研究指出，在家庭功能失调的背景下，父母抑郁症与青少年自尊心低下之间存在关联，且这种关联部分由家庭情感卷入（familial affective involvement）所介导 27。这些研究均强调了现实环境中，特别是家庭和教育中，积极的自我认同构建对儿童健康发展的重要性，以及当这些需求未被满足时，手机可能扮演的补偿性角色。

总之，手机成为儿童构建自我认同的重要工具，尤其是在现实世界中自我价值感缺失的情况下。短视频创作和游戏成就等提供了即时且易得的认同感，但这种数字化的自我建构需要警惕，以避免其对现实自我认同和心理健康的潜在负面影响。

3.3 情绪调节的被动依赖

手机作为一种强大的情绪调节工具，在儿童和青少年群体中扮演着越来越重要的角色。当面对负面情绪，如抑郁、焦虑、压力或无聊时，许多儿童会不自觉地转向手机寻求慰藉或逃避。这种将“屏幕作为情绪缓冲器”的心理机制，解释了手机为何在短期内具有吸引力，但同时也揭示了其长期使用的成瘾性和潜在危害。

负面情绪是促使个体寻求情绪调节策略的常见驱动力。对于儿童而言，他们尚未完全发展出成熟的情绪调节技能。当感到无聊、沮丧、愤怒或孤独时，手机上的各种应用，如短视频、游戏、社交媒体等，能提供即时且易得的刺激和分散注意力的机会。例如，观看有趣的视频可以暂时消除无聊感，玩游戏可以带来成就感和愉悦，与朋友聊天可以缓解孤独。一项研究发现，儿童在感知到智能手机的益处时，例如减少无聊，会更倾向于使用手机，这进一步证实了手机在情绪调节中的作用28。这些即时反馈和短暂的积极体验，使得手机成为了一个看似有效的“情绪避难所”，帮助他们暂时摆脱负面情绪的困扰。

然而，这种通过手机进行的被动情绪调节，虽然在短期内可能有效，但从长远来看，却具有显著的成瘾性并阻碍了儿童心理韧性的发展。首先，过度依赖手机来应对负面情绪，可能导致儿童缺乏学习和运用更健康、更积极情绪调节策略的机会。例如，与其通过与他人交流、进行体育活动或培养兴趣爱好来排解压力，他们更倾向于沉浸在数字世界中。这种回避式的应对机制，使得他们无法真正面对和解决产生负面情绪的根本原因，反而可能使情绪问题长期化。

其次，手机的成瘾机制本身就可能加剧负面情绪。例如，有研究表明，问题性手机使用与抑郁、焦虑和压力等心理健康问题之间存在关联29。虽然这种关联的因果方向复杂，但可以推断，通过手机逃避负面情绪的行为，如果发展为依赖，反而可能导致更严重的心理困扰。例如，一项针对大学生的研究指出，负面情绪与网络成瘾呈正相关，且疲劳在其中扮演了中介角色，意味着负面情绪可能会通过引发疲劳，进而促使学生寻求网络来缓解，最终导致网络成瘾30。

心理韧性，即个体在面对逆境、创伤、悲剧、威胁或其他重大压力时，能够很好地适应并从创伤中恢复的能力，对于儿童的健康成长至关重要。过度依赖手机进行情绪调节，可能会削弱儿童的心理韧性。当他们习惯于通过简单的屏幕滑动来“解决”情绪问题时，面对现实生活中的挑战和挫折时，就可能缺乏有效的应对策略和内在资源。一项评估智能手机应用JoyPop韧性干预的研究显示，该应用旨在通过自我调节技能（如情绪调节和执行功能）来促进韧性，结果发现持续使用该应用能够改善情绪调节能力并减少抑郁症状，特别是对于有不良童年经历（ACEs）的青少年，其情绪调节的改善速度更快31。这提示我们，主动的、有指导的情绪调节干预对于提升心理韧性是有效的，而手机作为情绪缓冲器的被动依赖，则恰恰相反。

因此，虽然手机在短期内可以作为儿童应对无聊和负面情绪的便捷工具，但长期来看，这种被动依赖可能形成恶性循环，阻碍其心理韧性的发展，并加剧心理健康风险。认识到这一点对于理解儿童手机依赖的深层心理机制至关重要。

4. 家庭环境：代际示范与互动模式的隐性塑造

家庭环境是儿童成长过程中最重要的生态系统，对儿童的行为习惯、认知发展和情绪健康有着深远的影响。在智能手机普及的时代，父母的手机使用行为、亲子互动模式以及家庭管理策略，都在无形中塑造着儿童对手机的态度和使用习惯。许多儿童的手机依赖问题，并非孤立产生，而是家庭内部代际示范和互动模式隐性塑造的结果。

4.1 父母手机使用的“榜样效应”

父母是儿童最重要的模仿对象，他们的行为对孩子的成长具有强大的“榜样效应”。在智能手机使用方面，父母的习惯往往会直接影响儿童对手机的认知和使用模式。当父母自己频繁使用手机，甚至表现出一定的手机依赖特征时，儿童很可能会将这种行为视为常态，并加以模仿。这种现象在学界被称为“屏幕育儿”或“手机陪伴”，即父母在照看或陪伴孩子时，注意力却被手机内容所吸引。

多项研究证实了父母手机使用与儿童手机使用之间的正相关关系。例如，一项研究发现，父母手机成瘾程度与孩子过早接触手机之间存在显著关联，母亲的手机成瘾行为尤其会影响孩子首次接触智能手机的年龄 32。研究表明，高风险的母亲群体（即母亲存在手机成瘾）的孩子比低风险群体的孩子更早接触智能手机 32。另有研究指出，父母和孩子在数字媒体使用上存在显著关联性，尤其是在工作日和周末，父母的数字媒体使用时间越长，孩子的数字媒体使用时间也越长 33。这表明，儿童不仅模仿父母对手机的使用行为，还可能受到父母对手机的态度和价值观的影响。

父母的榜样作用不仅体现在使用频率上，还包括使用场景和使用目的。当父母在处理家务、安抚孩子情绪、甚至在孩子睡前都将手机作为工具时，孩子会内化这种行为模式。例如，有研究发现，父母在做家务时给孩子使用设备（70%）、为了让孩子保持平静（65%）以及在睡前使用（29%）是很常见的现象 34。这些行为无形中向孩子传递了一个信息：手机是解决问题、排解无聊、甚至辅助睡眠的有效工具，从而强化了孩子对手机的依赖性。

此外，父母对数字媒体的态度和认知也会影响孩子的屏幕时间。一项对学龄前儿童父母的调查显示，父母认为孩子使用数字媒体的重要性、以及父母对儿童数字媒体使用指南的认识和执行情况，在“重度使用者”（heavy users）和“轻度使用者”（light users）的父母之间存在显著差异 33。这说明，父母对手机使用的认知和态度，直接影响了他们对孩子使用手机的引导和管理。

父母对手机的过度使用，不仅是简单的行为模仿，更深层次地可能导致亲子互动质量的下降，这为儿童转向手机寻求满足创造了条件。例如，有研究表明，父母和/或孩子使用智能手机的时间与亲子依恋结果之间存在负面关联 35。当亲子依恋质量受到影响时，孩子可能会寻求其他途径来获得情感满足，手机就成为了一个显而易见的选择。

因此，父母手机使用的“榜样效应”是一个不容忽视的因素。父母自身应审视和管理自己的手机使用习惯，以身作则，为孩子树立健康的数字行为榜样。这不仅有助于减少儿童手机依赖的风险，也能促进更高质量的亲子关系和家庭互动。

4.2 亲子互动的“技术干扰”

父母的手机使用不仅体现在榜样作用上，更可能以“技术干扰”（Technoference）的形式，直接侵蚀亲子互动的质量，进而间接推动儿童转向手机寻求情感慰藉 36。技术干扰指的是电子设备（尤其是智能手机）在使用过程中对人际互动产生的干扰，它会导致亲子沟通的减少、质量下降，甚至引发亲子冲突 3738。当父母在与孩子相处时频繁查看手机、回复信息或沉迷于屏幕内容，他们的注意力便被分散，无法全身心地投入到与孩子的互动中，这种行为被称为“父母手机冷落”（Parental Phubbing）3739。

这种技术干扰对亲子关系的负面影响是多方面的：

首先，它减少了亲子沟通的机会和深度。高质量的亲子互动，包括面对面的交流、共同的游戏和情感的分享，对于儿童的情感发展、社交技能培养和安全依恋关系的建立至关重要。然而，当父母的注意力被手机占据时，他们可能错过孩子发出的情感信号，对孩子的提问敷衍了事，或者根本无暇顾及孩子的需求。例如，一项对新生儿重症监护室（NICU）中母亲与婴儿互动模式的研究发现，尽管母亲身在婴儿附近，但在83%的时间里，她们并未与婴儿进行积极的互动，而最常见的非互动替代活动就是使用智能手机 40。即使在进行一些非专注性互动时，手机使用也普遍存在 40。虽然这项研究的背景特殊，但其揭示的现象——父母在场但注意力分散——在普通家庭中同样存在。长此以往，孩子可能会感到被忽视、不被重视，从而产生孤独感或疏离感。

其次，技术干扰可能导致儿童情感需求的未满足。儿童天生渴望父母的关注和回应，这是他们建立安全感和自我价值感的基础。当父母因手机而表现出心不在焉、冷淡或不耐烦时，孩子的情感需求无法得到及时有效的满足。这种情感上的“空缺”可能促使孩子转而从其他来源寻求满足，而手机所提供的即时娱乐和虚拟社交恰好填补了这一空白。例如，有研究表明，父母手机冷落与儿童电子媒体使用增加之间存在关联，其中亲子冲突在这一关系中起到部分中介作用 37。这意味着，父母的手机使用导致亲子关系紧张，进而可能促使孩子更多地使用电子媒体。

最后，技术干扰还会影响父母对孩子情绪和行为的敏感度与回应性。当父母的注意力被手机分散时，他们可能难以察觉孩子情绪的细微变化，也无法及时对孩子的不良行为进行干预或引导。这种缺乏敏感回应的育儿方式，可能导致孩子的情绪调节能力受损，甚至出现行为问题。一项研究发现，父母手机冷落与学龄前儿童的行为问题之间存在关联，而父母的正念注意力意识（mindful attention awareness）在其中起到了完全中介作用 39。这表明，当父母更专注于手机而缺乏正念时，对孩子行为问题的管理能力也会下降。

值得注意的是，并非所有父母的手机使用都会对亲子关系产生负面影响。一项多变量分析研究发现，智能手机使用与育儿质量之间的直接关联相对较弱且复杂，反而与技术干扰的程度密切相关 41。当技术干扰程度较低时，适度的手机使用甚至可能与更高的育儿质量相关联 41。这提示我们，问题的关键不在于手机本身，而在于其如何影响父母的注意力和亲子互动模式。

综上所述，父母手机使用导致的技术干扰，通过削弱亲子沟通质量和满足孩子情感需求的能力，为儿童转向手机寻求慰藉提供了土壤。这种隐性的互动模式塑造，是儿童手机依赖问题中不可忽视的家庭因素。

4.3 家庭管理的“失控困境”

在儿童手机使用问题上，许多家长面临着一种“失控困境”：一方面，他们认识到过度使用手机可能带来的危害，试图通过限制来管理；另一方面，无论是过于严厉的强制限制，还是过于宽松的放任自流，都可能导致不良后果，甚至加剧儿童的手机依赖。这种困境与家长的教养方式密切相关，不同的教养方式对儿童手机依赖的形成和发展起着隐性塑造作用。

强制限制，尤其是在缺乏解释和沟通的情况下，往往会引发儿童的逆反心理。儿童和青少年处于自我意识发展和追求独立的关键阶段，过度的、不合理的限制会被他们视为对其自主性的侵犯。在这种情况下，孩子可能会采取秘密使用、谎报使用时间或与家长发生冲突等方式来对抗，从而使手机使用问题从简单的行为习惯上升为亲子关系的紧张源。

与此相反，放任自流的教养方式，即家长对儿童的手机使用缺乏有效监督和管理，则更容易导致儿童形成过度依赖。当家长未能设置明确的规则、边界，或对孩子长时间使用手机视而不见时，孩子会认为手机使用没有限制，从而更容易沉迷。尤其是在儿童自控力尚未完全发展的阶段，缺乏外部约束会让他们更难以抵制手机的诱惑。研究发现，忽视型（neglectful）教养方式与儿童手机依赖的发生率显著相关 4243。忽视型父母通常表现出对孩子不关心、不参与，对孩子的要求反应迟钝，很少提供情感支持和行为指导。在这种家庭环境中成长的孩子，可能因为情感需求未被满足，缺乏父母的有效引导，而转向手机寻求慰藉和娱乐，最终形成依赖。

进一步来看，不同的教养方式对儿童手机依赖的影响存在差异：

  • 专制型（Authoritarian）教养方式：这种家长对孩子有高要求、低回应，倾向于通过严格的规则和惩罚来控制孩子。虽然表面上手机使用受到严格限制，但儿童可能因为缺乏情感支持和自主空间，反而更容易产生逆反心理，寻求秘密使用手机，或将手机作为逃避压力的工具。有研究指出，专制型教养方式与儿童的手机依赖程度呈正相关 43。
  • 溺爱型（Indulgent/Permissive）教养方式：这类家长对孩子有低要求、高回应，通常对孩子有求必应，缺乏必要的管教和约束。儿童在这种环境下，可能因为缺乏规则意识和自我控制，更容易沉迷于手机，难以形成健康的使用习惯。溺爱型教养方式也被发现与儿童手机依赖增加相关 43。
  • 忽视型（Neglectful）教养方式：如前所述，忽视型父母对孩子的要求和回应都较低，缺乏关注和参与。在这种模式下，儿童往往得不到足够的情感支持和行为指导，手机可能成为他们寻求关注和满足的替代品，从而更容易发展出手机依赖 4243。
  • 民主型/权威型（Authoritative）教养方式：这种教养方式的家长对孩子有高要求、高回应，他们会设定明确的规则和界限，但同时也会倾听孩子的意见，并给予情感支持和解释。在这种模式下，儿童更容易理解并遵守规则，发展出健康的自我管理能力。研究表明，民主型教养方式与较低的儿童手机依赖相关 43。例如，对日本学龄儿童的研究发现，父母控制（parental control）是影响儿童屏幕时间的重要因素，较高的父母控制能够显著减少儿童的屏幕时间 44。

值得注意的是，家庭管理不仅仅是单一的教养方式问题，它还涉及到父母自身对手机的态度和使用习惯。当父母未能以身作则，自身也表现出手机依赖时，其对孩子的管理效果将大打折扣。儿童可能会质疑父母管教的合理性，从而使得家庭对手机使用的管理陷入更深的困境。因此，解决家庭管理的“失控困境”，需要家长首先审视自身的手机使用行为，并采取一致的、民主的、有回应的教养方式，与孩子共同建立健康的手机使用规则。

5. 社会文化：数字生态与成长环境的结构性推动

儿童手机依赖的形成，并非仅仅是生理、心理和家庭内部因素的简单叠加，它更深层次地嵌入在当前独特的社会文化环境中。数字生态的快速发展和儿童成长环境的结构性变化，共同构成了推动儿童手机依赖的重要外部力量。

5.1 同伴文化的“技术准入”压力

在儿童和青少年的成长过程中，同伴关系占据着极其重要的地位。他们强烈渴望被同伴群体接纳、认可，并从中获得归属感。在当今社会，手机已不再仅仅是一个通讯工具，它更是同伴群体内部社交的“入场券”和身份的象征。因此，在同伴文化中，逐渐形成了“无手机=无社交”的隐性规则，这种规则对儿童和青少年构成了强大的“技术准入”压力，迫使他们不得不拥有并积极使用手机，以维系其在同伴群体中的地位和联系。

这种压力体现在多个方面：首先，手机是同伴之间进行即时沟通、分享信息、组织活动的主要媒介。如果一个孩子没有手机或不被允许使用手机，他可能会错过重要的群体通知、无法参与同伴间的线上讨论，从而感到被排斥和孤立。其次，社交媒体和在线游戏平台是同伴群体互动的重要场所。在这些平台上，孩子们分享生活、展示个性、参与共同的游戏体验，这些都是建立和巩固同伴关系的关键环节。缺乏手机意味着失去了这些重要的社交场景，进而影响其融入同伴群体的能力。

同伴间手机使用行为的模仿与强化，进一步加剧了这种“技术准入”压力。当大多数同伴都在使用某款热门应用、玩某款流行游戏时，个体为了不被“边缘化”，也倾向于跟风效仿。这种模仿行为不仅源于归属感的需求，也可能源于对被动接受信息的渴望，或是为了获得同伴间的共同话题。此外，同伴群体还会通过点赞、评论、转发等方式，强化和鼓励彼此的手机使用行为，形成一种正向反馈循环，使得手机使用成为群体规范。

有研究深入探讨了青少年手机依赖与同伴关系之间的复杂中介机制。例如，一项针对中国青少年的研究发现，良好的学生-学生关系（同伴关系）能够负向预测青少年智能手机成瘾，而自尊在其中起到了部分中介作用45。这意味着，拥有良好同伴关系的青少年，其自尊心可能更高，从而减少了对智能手机的依赖。进一步的分析还指出，“归属感需求”在这一间接关系中发挥了调节作用，对于那些归属感需求较强的青少年来说，高自尊对智能手机成瘾的保护作用会更弱，因为他们可能更容易受到同伴群体的影响而发展成瘾45。这表明，虽然健康的同伴关系可以成为手机成瘾的保护因素，但当个体对归属感的需求特别强烈时，他们更容易为了融入同伴群体而过度使用手机，即使这可能与高自尊带来的保护作用相悖。

另一项研究则指出，同伴关系对青少年手机成瘾的影响，可以通过心理需求满足（如自主、能力和关联需求）来介导，但这种介导作用并不总是显著的46。这可能意味着同伴关系对手机依赖的影响机制更为复杂，并非单一地通过某个心理需求满足来实现。然而，这些研究都强调了同伴关系在青少年手机依赖形成中的关键作用，提示我们在干预时需要充分考虑同伴文化的影响。

综上所述，同伴文化通过“技术准入”的隐性压力、行为模仿与强化，以及对归属感需求的满足，深刻影响着儿童和青少年的手机使用行为。理解并应对这种社会文化驱动力，是解决儿童手机依赖问题不可或缺的一环。

5.2 教育场景的“屏幕渗透”

在数字时代，教育场景的变革也成为了推动儿童手机使用的重要因素，尤其是在线学习和教育类APP的普及，使得屏幕在儿童日常生活中的渗透率急剧上升。这种“屏幕渗透”模糊了“必要使用”与“过度依赖”的边界，让家长和孩子都难以准确界定何为合理的手机使用。

在线学习平台和教育类APP的广泛应用，在很大程度上增加了儿童的屏幕时间。特别是在COVID-19疫情期间，全球范围内的学校停课，远程学习成为主流教育模式，儿童不得不长时间通过电子设备进行学习 4748。例如，土耳其一项研究发现，在疫情期间，6-13岁儿童的肌肉骨骼疾病与屏幕时间增加、智能手机使用以及不正确的坐姿显著相关 49。韩国的一项研究也指出，在疫情相关的学校停课期间，儿童的媒体使用时间显著增加，除了在线学习内容（97.2%），YouTube（87.6%）和游戏（78.3%）的使用率也很高 48。这些数据表明，疫情期间在线学习的刚性需求，直接导致了儿童屏幕暴露的常态化和长时间化。

这种由教育需求驱动的屏幕使用，使得手机不再仅仅是娱乐工具，而是学习的必需品。这给家长带来了管理上的困境：一方面，他们需要确保孩子能够接触到在线教育资源；另一方面，又担心孩子将学习工具用于娱乐，从而发展成手机依赖。这种两难局面使得“学习刚需”与“过度依赖”之间的界限变得模糊不清。

远程学习的普及，也暴露了一些儿童在使用屏幕设备时出现的新问题。例如，一项关于儿童在线学习设备字体大小和观看时间的研究发现，儿童在连续观看视频超过25分钟后，需要更多关注他们的观看距离 50。这不仅影响视力健康，也可能因长时间近距离用眼导致身体疲劳，进而影响学习效率和情绪。

此外，疫情期间的远程学习还与儿童和青少年的心理健康问题呈显著关联。社交隔离、学习压力以及对未来不确定性的担忧，都可能导致儿童出现焦虑、抑郁等负面情绪。在这样的背景下，手机和互联网不仅是学习工具，也成为他们寻求心理慰藉、排解压力的途径 5152。一项关于移动健康与青少年心理健康的研究综述指出，在疫情爆发后，许多关于移动健康干预的研究集中在解决青少年心理健康问题上，这间接说明了疫情期间心理健康挑战的普遍性 53。当手机同时承载学习和情绪调节的功能时，儿童更容易在学习的幌子下，将更多的精力投入到非学习相关的娱乐活动中，从而加剧手机依赖。

因此，教育场景的“屏幕渗透”是儿童手机依赖形成的重要社会文化结构性推动力。它不仅增加了儿童的屏幕暴露时长，模糊了使用界限，还可能在特殊时期（如疫情）与心理健康问题相互作用，使手机依赖问题变得更加复杂。如何平衡在线学习的便利性与儿童的健康发展，是当前教育领域亟需解决的挑战。

5.3 数字产品的“成瘾设计”

数字产品，特别是短视频平台和在线游戏，并非中立的工具，它们的设计理念本身就包含了利用人类心理弱点以最大化用户参与度甚至成瘾性的元素，这被称为“成瘾设计”（Addictive Design）。这些设计策略尤其针对儿童和青少年的认知特点，诱导他们持续使用，加剧了手机依赖的风险。

首先，算法推荐机制是数字产品成瘾设计的核心。短视频平台（如TikTok）通过复杂的算法，精准分析用户的观看历史、互动行为、停留时间等数据，不断学习并推送其最可能感兴趣的内容。这种个性化、无休止的内容流，使得用户难以停止刷屏，因为每一次滑动都可能带来新的刺激和满足感。对于认知控制能力尚不成熟的儿童而言，他们更容易被算法“牵着走”，沉浸在为他们量身定制的数字世界中，难以自拔。有研究指出，数字媒体通过激活多巴胺和奖赏通路，与注意力缺陷多动行为相关，并可能被误诊为ADHD 7。而算法正是通过不断提供新奇刺激，持续激活这些奖赏通路，从而诱导儿童持续使用。

其次，即时反馈机制是游戏和社交媒体成瘾设计的另一大支柱。无论是游戏中获得的成就、虚拟奖励，还是社交媒体上的点赞、评论和分享，这些都提供了即时、可见的积极反馈。这种即时反馈会强化行为，形成“即时反馈-持续使用”的循环。心理学研究表明，反馈在学习过程中扮演重要角色，尤其是即时反馈对基于奖励的学习具有显著的促进作用 5455。数字产品正是利用了这一点，通过高频率的、可变比率的奖励机制（即奖励不是每次都出现，而是随机出现，从而增强了用户的期待和投入），使得儿童不断重复操作，以期获得下一个奖励。这种设计利用了人类大脑对奖励预期的敏感性 56，使手机使用变得难以抑制。

此外，数字产品还采用了多种其他成瘾设计元素：

  • 无限滚动（Infinite Scroll）：内容永无止境，用户无需点击或等待，即可持续获得新内容，消除了任何停止的“断点”。
  • 推送通知（Push Notifications）：通过声音、振动或屏幕提示，不断提醒用户有新消息、新活动或新奖励，打断用户的现实活动，将其注意力拉回数字平台。
  • 社交压力与 FOMO（Fear Of Missing Out）：社交平台鼓励用户不断分享和查看朋友动态，营造出一种“错过即是损失”的氛围，促使用户频繁上线。
  • 游戏化元素（Gamification）：将游戏中的奖励机制（如积分、等级、徽章、排行榜）引入非游戏应用中，刺激用户的竞争欲和成就感，促使他们投入更多时间。

面对数字产品的强大成瘾设计，防沉迷功能的有效性却一直存在争议。各国政府和平台方都出台了青少年防沉迷系统，例如限制使用时长、宵禁、实名认证等。然而，这些措施往往面临技术规避、执行不力或效果有限的挑战。例如，儿童可能通过使用父母的账号、注册多个账号或利用第三方工具绕过限制。关于预防措施和干预策略的文献指出，虽然许多干预措施都包含教育成分并显示出积极效果，但研究报告的普遍不足限制了对这些措施有效性的明确结论 57。此外，有研究提到青少年数字媒体使用障碍在疫情后仍是严重的健康问题，并强调家长、学校以及平台提供商在引导青少年媒体素养和自律使用中的关键作用 58。

儿童的自控力较弱，对数字产品成瘾设计的抵抗力更低。他们的认知控制能力和情绪调节能力尚未完全发育成熟，容易受到即时奖励和外部刺激的影响，难以抵制数字产品的诱惑 59。这种情况下，外部的限制和干预显得尤为重要，但也更具挑战性。正如多项研究反复强调的，互联网使用障碍（包括网络游戏障碍）是一个值得深入研究的临床现象，其发展和维持涉及个体心理、认知、情感与执行功能的交互作用 606162。这意味着，仅仅依靠防沉迷系统可能不足以应对复杂的数字成瘾问题，更需要结合对产品设计的监管，以及对儿童心理韧性的培养和家庭教育的引导。

6. 代价与后果：从个体健康到社会功能的全面冲击

儿童和青少年时期的过度手机使用并非无害，其累积的负面影响正逐渐显现，并对个体健康、心理发展和社会功能构成全面冲击。这些代价不仅体现在短期的不适和效率下降，更可能导致长期的身体疾病、心理障碍和社会适应困难。

6.1 身体健康的累积性损害

过度使用手机对儿童身体健康的影响是多方面的，且具有累积性。从视力问题到骨骼健康，再到代谢紊乱，手机的长时间、不当使用正在悄然侵蚀儿童的身体基础。

首先，视力健康是受手机影响最直接的方面之一。长时间近距离盯着手机屏幕，特别是在光线不足或晃动的环境中，会导致眼睛睫状肌持续紧张，进而引发视疲劳，并加速近视的发生和发展。一项前瞻性队列研究对6至14岁儿童进行了为期两年的跟踪，结果显示，日常使用智能手机时间越长，近视进展越快（每天使用手机5.1±1.2小时的儿童，近视进展显著快于每天使用3.4±1.0小时的儿童，p<0.001）63。相反，增加户外活动时间（1.2±0.6小时/天对2.1±0.8小时/天，p<0.001）和保持更长的屏幕距离（25.8±5.4厘米对31.4±6.2厘米，p<00.001）则与近视进展呈负相关63。这些数据明确指出，手机使用时长和屏幕距离是儿童近视进展的关键预测因素。

其次，颈椎健康也面临严重威胁。儿童和青少年在低头看手机时，颈部会长时间保持前屈姿势，这增加了颈椎的压力，导致“文本颈”（Text Neck）综合征的发生率显著上升。文本颈是一种与频繁和长时间使用移动电子设备时，颈部和头部保持前屈姿势相关的肌肉骨骼疾病64。这种不自然的姿势不仅会导致颈部疼痛、僵硬，还可能引发头痛、肩部不适，甚至影响脊柱的正常生理曲度。尽管目前关于儿童文本颈的康复研究相对较少，但现有研究普遍集中于成人，表明正确的姿势矫正、强化训练和拉伸运动等物理治疗方法对缓解症状有效64。这提示我们需要在儿童中加强预防和早期干预。

再者，代谢健康问题也与过度手机使用间接相关。长时间使用手机往往伴随着静态生活方式的增加，即减少了体育活动和户外运动的时间。有研究显示，儿童的久坐时间过长与体能活动不足，尤其是中等强度到高强度体能活动（MVPA）不足，是相关的65。例如，一项研究发现，10-14岁儿童中，不参加运动的女孩更容易不活跃；而在15-18岁儿童中，不参加运动是导致不活跃的主要因素65。久坐不动的生活方式是儿童肥胖的一个重要危险因素，而肥胖又与代谢综合征的发生密切相关。代谢综合征涉及腹部肥胖、高血压、高血糖、血脂异常等一系列危险因素66。虽然智能手机本身可能用于健康监测（如智能手机数字人体测量可辅助代谢综合征评估），但其过度使用导致的运动不足和睡眠紊乱，是加剧肥胖和代谢综合征风险的间接原因67。一项研究发现，两岁及以下儿童的屏幕观看时间与睡眠时长显著相关，每增加1小时的总屏幕观看时间，睡眠时长平均减少0.26小时，在6个月及以下婴儿中这种影响更为显著（每增加1小时屏幕观看时间，睡眠时长减少0.73小时）68。睡眠不足不仅影响儿童的认知和情绪，也是肥胖和心血管疾病风险的独立危险因素。

此外，长期和过度的手机使用，特别是蓝光暴露，还可能影响儿童的内分泌系统和生长发育。尽管关于手机辐射对儿童健康影响的争议仍在继续，但儿童由于其头骨较薄、大脑发育未成熟等生理特点，被认为可能对电磁辐射更为敏感，因此普遍建议儿童应尽量减少手机使用，并采取预防措施69。

综上所述，过度手机使用对儿童身体健康的损害是多维度、累积性的，涵盖了视力、颈椎、代谢以及可能的内分泌和生长发育。这些健康风险如果不加以重视和干预，将对儿童未来的生活质量产生深远的影响。

6.2 心理发展的潜在风险

儿童和青少年正处于心理发展的关键时期，其情绪、认知和社会功能尚未完全成熟。过度手机使用，特别是形成手机依赖，会对他们的心理健康构成显著且长期的风险。这种依赖性不仅与抑郁、焦虑等常见情绪障碍紧密相关，甚至可能增加自杀行为和意念的风险，同时也会影响他们认知功能的发展。

首先，手机依赖与抑郁、焦虑的关联已在多项研究中得到证实。儿童和青少年时期的手机成瘾行为与较高的抑郁症状和睡眠问题发生率密切相关 70。一项针对韩国青少年的纵向研究发现，抑郁症状会增加手机依赖的风险，提示抑郁可能成为手机依赖的一个重要预测因子 7172。另有研究指出，青少年手机依赖与焦虑水平之间存在显著正相关 73。高风险的手机成瘾者，其焦虑、生理性焦虑、过敏和社交担忧等指标均显著高于低风险者 73。这表明，儿童可能为了逃避或缓解负面情绪而转向手机，但过度使用反而会加剧这些情绪问题，形成恶性循环。

其次，手机依赖对自杀倾向和自杀行为的潜在风险日益受到关注。多项纵向研究强调了成瘾性屏幕使用轨迹与自杀相关结果之间的强关联。一项重要的队列研究发现，在早期青少年时期（11岁起），近三分之一的参与者表现出社交媒体或手机成瘾性使用的增长轨迹。这些高或不断增长的成瘾性使用轨迹与更高的自杀行为和意念风险以及更差的心理健康状况相关 74。例如，社交媒体成瘾性使用的增加轨迹，导致自杀行为的风险比为2.14（95% CI, 1.61-2.85）74。高水平的视频游戏成瘾性使用轨迹也显示出更高的内化症状（T分差异为2.03，95% CI, 1.45-2.61）74。另一项针对9-11岁美国儿童的前瞻性队列研究也显示，总屏幕时间的每增加一小时，两年后自杀行为的风险增加1.09倍（95% CI 1.03-1.14）75。具体而言，短信、视频聊天、观看视频和玩视频游戏的每增加一小时，都与后续自杀行为的更高几率相关 75。这些研究结果明确表明，过度且成瘾性的屏幕使用，尤其是手机，是儿童和青少年自杀风险的重要预测因素。

再者，手机依赖还可能导致其他心理健康问题。例如，研究发现有抑郁症的青少年，其无手机焦虑症（Nomophobia，即对无法使用手机的恐惧）水平更高，并且与较低的地理位置移动和较高的智能手机感应舒适度相关联 76。这意味着，手机依赖不仅表现为对手机的过度使用，还可能引发对手机分离的焦虑。此外，过度使用手机还会导致注意力、自控力、情绪调节能力等认知功能的下降，这对于儿童和青少年的学业表现和人际关系发展都构成负面影响。儿童和青少年更容易受到负面网络体验（如排斥、有害评论、个人数据滥用等）的影响，这些负面体验与较低的生活质量和行为困难相关，尤其是在那些已经存在心理健康问题的青少年中更为普遍 77。

总而言之，儿童手机依赖绝非仅仅是行为习惯问题，它与一系列严重的心理健康风险紧密相连。从常见的抑郁和焦虑，到更危险的自杀倾向和行为，手机依赖正在侵蚀儿童和青少年的心理健康基石。因此，对儿童手机依赖的干预和预防，不仅是改善其行为习惯，更是守护他们心理健康的关键。

6.3 社会功能的适应性弱化

儿童和青少年时期是社会功能发展和适应性技能培养的关键阶段。然而，过度手机使用及其导致的依赖，正在多方面弱化儿童的社会功能适应性，使其在学业、现实社交以及整体社会融入方面面临挑战。

首先，对学业成就的负面影响是手机依赖最显著的代价之一。智能手机的即时娱乐性和信息推送功能，极易分散儿童的注意力，尤其是在学习过程中。研究表明，问题性智能手机使用（PSU）与学业成就呈负相关 78。一项对全球48,490名学生进行的荟萃分析发现，PSU与学业成就之间存在负面关联，效应量虽小但显著（r = -0.110），且这种关联在中小学生群体中更为明显 78。这意味着，手机依赖程度越高的学生，其学业表现往往越差。例如，一项研究指出，重度技术使用与男性（AOR = 0.68）和女性（AOR = 0.66）学生较低的学业表现显著相关 79。此外，手机依赖还会降低学生在校的连接感（school connectedness），这种连接感对于学生的学业投入和整体适应至关重要 79。

其次，现实社交能力的适应性弱化是过度手机使用的另一个严重后果。虽然手机提供虚拟社交平台，但在数字世界中建立的联系往往无法替代面对面互动所带来的深刻情感体验和社交技能锻炼。儿童和青少年将大量时间投入到屏幕社交中，可能会减少与家人和同伴在现实生活中的直接互动，导致其在眼神交流、非语言沟通、情绪理解和共情等方面的能力退化。当他们习惯了通过文字、表情符号进行交流，而非面对面地处理复杂的人际关系时，就可能在现实社交场合感到不适、焦虑甚至逃避。有研究表明，过度使用手机与青少年较低的社交能力和沟通技巧相关，并可能导致更严重的社交焦虑。长期依赖虚拟社交，会使儿童在真实的社交环境中表现出适应不良，例如难以融入集体、缺乏自信，甚至可能因此感到更加孤独和沮丧。

再者，对注意力和执行功能的损害是手机依赖导致社会功能适应性弱化的深层原因。手机的即时刺激和多任务处理模式，可能使儿童难以长时间专注于单一任务，从而影响其注意力的持续性和稳定性。这种注意力缺陷不仅影响学业，也会波及日常生活中的各种活动，例如听课、阅读、完成家务等。有研究指出，数字设备的使用可能对儿童的执行功能产生影响，包括潜在的风险和优势 80。执行功能是社会适应和独立生活的基础，其弱化将使儿童在应对现实生活中的挑战时显得力不从心。例如，有研究发现，智能手机成瘾与注意力缺陷多动症状（Attention Deficit Hyperactivity Symptoms）之间存在显著关联 81。

最后，情绪管理和抗逆力的降低也与手机依赖息息相关。如前所述，儿童可能将手机作为逃避负面情绪的工具，而非积极应对。这种被动的情绪调节方式，使得他们无法有效发展出内在的情绪管理策略和应对机制。当面对挫折、压力或冲突时，缺乏抗逆力的儿童更容易陷入沮丧、焦虑，甚至表现出攻击性或退缩行为，从而进一步影响其社会功能的适应。父母的忽视（parental neglect）与儿童的学业适应不良呈负相关，而学业适应不良又与智能手机依赖呈正相关，这意味着父母忽视可能通过影响儿童的学校适应能力，间接加剧其智能手机依赖 82。这说明，家庭环境与手机依赖对儿童社会功能的适应性弱化之间存在复杂的交互作用。

综上所述，儿童手机依赖并非孤立的行为问题，而是对个体身心健康和未来社会功能发展构成全面挑战的复杂现象。从学业表现下降到现实社交能力退化，再到核心认知功能的损害和情绪调节能力的不足，这些代价都在预示着，若不加以有效干预，儿童在未来社会中的适应能力将面临严峻考验。

7. 干预路径：多主体协同的系统性解决方案

儿童手机依赖是一个复杂的社会问题，其成因涉及生理、心理、家庭和社会的多个层面。因此，有效的干预和预防策略也必须是多主体协同、系统性的解决方案，涵盖家庭、教育和社会三个主要层面，以期从根本上重建儿童与数字设备之间的健康关系。

7.1 家庭层面：重建高质量亲子互动

家庭是儿童成长和发展的首要环境，父母在儿童手机依赖的干预中扮演着不可替代的角色。高质量的亲子互动是预防和解决儿童手机依赖问题的基石。以下是家庭层面可以采取的具体策略：

首先，“替代活动引导”是减少儿童手机使用时长和频率的有效途径。父母应积极引导儿童参与多样化的线下活动，包括亲子游戏、户外运动、阅读、艺术创作等。这些活动不仅能够提供丰富的感官刺激和愉悦体验，满足儿童的探索欲和成就感，还能促进其身体、认知和情感的全面发展。例如，有研究指出，数字干预有助于在儿童和青少年中通过增加体力活动等方式来预防和治疗肥胖 83，而创造性的视频游戏设计也可以通过数字化介导的体育游戏促进青年体育活动以预防肥胖 84。父母可以主动组织家庭户外活动，如徒步、骑行、野餐；鼓励孩子参与球类、游泳等体育项目；或在家中开展棋类游戏、拼图、手工制作等亲子互动游戏。重要的是，这些替代活动应充满乐趣且具有吸引力，让儿童从中获得手机无法提供的真实满足感和成就感，从而自然地减少对手机的依赖。

其次，“规则共商”是建立健康手机使用习惯的关键。家长不应采取单方面强制性的限制措施，而应与孩子一起制定明确、合理且易于执行的家庭手机使用契约。这份契约应包含以下要素：

  • 明确使用时间：规定每天或每周可使用手机的总时长，以及具体的使用时段（例如，饭前、睡前禁止使用）。
  • 限定使用场景：明确哪些场合（如餐桌上、家庭聚会时、卧室里）不能使用手机，以及哪些内容（如特定游戏、社交媒体）可以或不可以使用。
  • 约定惩罚与奖励：当违反规定时，应有相应的后果（如减少使用时间、没收手机一段时间）；当孩子遵守规定或表现出色时，也应给予适当的鼓励和奖励（非物质奖励优先）。
  • 父母以身作则：父母自身也应遵守契约内容，避免在规定禁用时间或场合使用手机，为孩子树立良好的榜样。有研究强调，父母的榜样作用和对数字媒体的态度对儿童屏幕时间有显著影响。

成功家庭干预案例表明，民主型的教养方式，即父母对孩子有高要求、高回应，同时尊重孩子并与其协商，能有效降低儿童的手机依赖程度。在这种教养模式下，孩子更容易理解并内化规则，并发展出自我管理能力。例如，有家庭通过“数字排毒”日、家庭电影夜、无手机餐桌等方式，创造高质量的亲子互动时间，有效减少了全家人的屏幕使用时长，并增强了家庭成员之间的情感联结。研究还发现，父母的“phubbing”（即在社交互动中沉迷于智能手机而忽视他人）行为与学龄前儿童的数字游戏成瘾倾向呈正相关，且会降低儿童的社交技能水平，理解父母phubbing行为对儿童的影响有助于提高认识并采取措施改善亲子关系 85。此外，研究显示父母在照顾孩子时使用移动设备的情况值得关注，但其对亲子互动和监督的影响尚需进一步研究 86。因此，父母减少自身“技术干扰”（technoference），在与孩子互动时放下手机，全心投入，是重建高质量亲子互动的重要一步。

此外，提升父母的数字素养和媒介素养也至关重要。父母需要了解不同数字内容的特点、其潜在的风险和益处，以及如何选择适合孩子年龄和发展阶段的数字产品。学习如何使用家庭网络过滤器、家长控制软件等工具，也能帮助父母更好地管理孩子的数字行为。

通过上述策略，家庭可以在重建高质量亲子互动的基础上，为儿童构建一个既能利用数字资源、又能避免过度依赖的健康成长环境。

7.2 教育层面：数字素养与心理韧性培养

学校作为儿童和青少年社会化的重要场所，在应对手机依赖问题上扮演着不可或缺的角色。除了家庭的努力，教育系统应着力于培养学生的数字素养和心理韧性，并建立合理的数字设备使用规范，以引导学生健康使用手机。

首先，学校在数字使用规范的制定与执行上具有主体责任。这包括但不限于课堂手机管理政策的明确与实施。例如，学校可以规定学生在教学时间内不得使用手机，统一保管或要求学生将手机静音并放入指定区域。对于非教学时间，如课间休息和午餐，学校也应有引导性的规定，鼓励学生进行线下交流和活动，而非沉迷于手机。有效的课堂手机管理不仅能减少学生上课分心，提高学习效率，也能为学生创造一个更专注于学习和现实社交的环境。此外，学校还可以通过定期举办讲座、工作坊等形式，向学生普及过度使用手机的危害，并分享健康使用手机的技巧。

其次，媒介素养教育的普及是培养儿童数字批判性思维的关键。在信息爆炸的数字时代，儿童和青少年每天接触海量的数字信息，但他们往往缺乏有效甄别信息真伪、评估信息价值的能力。媒介素养教育旨在帮助学生理解媒体的运作方式、内容生产的意图，以及数字信息可能带来的影响。具体而言，学校应教授学生：

  • 信息甄别能力：如何判断网络信息的可靠性，识别虚假信息、谣言和网络诈骗。
  • 内容评估能力：如何批判性地看待数字内容，理解其背后的价值观和潜在影响，而非被动接受。
  • 数字伦理和责任：引导学生遵守网络道德，尊重他人隐私，警惕网络欺凌，以及负责任地发布个人信息。
  • 数字公民意识：理解数字世界中的权利和义务，成为积极、负责任的数字公民。

通过媒介素养教育，学生能够更好地理解数字产品的“成瘾设计”原理，从而增强自我保护和抵制诱惑的能力。例如，教导他们认识到算法推荐如何利用他们的兴趣点来延长使用时间，以及即时反馈机制如何刺激多巴胺分泌，有助于他们更理性地看待手机应用。

再者，心理韧性培养是应对手机依赖的内在驱动力。手机依赖往往与个体的情绪调节能力、应对压力方式以及自我价值感缺失有关。学校应将心理健康教育融入日常教学和学生辅导中，通过以下途径提升学生的心理韧性：

  • 情绪管理技能：教授学生识别、表达和调节负面情绪的有效策略，如深呼吸、正念练习、寻求支持等，而非被动地通过手机逃避。
  • 解决问题能力：引导学生在面对学业、人际或生活困境时，主动分析问题、寻找解决方案，培养积极应对而非回避的习惯。
  • 抗逆力训练：通过角色扮演、情景模拟等方式，让学生体验挫折并从中学习，提升他们在逆境中恢复和成长的能力。
  • 发展积极自我概念：通过鼓励学生发展多元兴趣、发挥个人特长、参与志愿服务等，帮助他们从现实生活中获得成就感和价值感，减少对数字世界虚拟认同的依赖。

值得注意的是，认知行为疗法（CBT）在青少年手机依赖干预中已显示出有效性。CBT是一种结构化的心理治疗方法，旨在帮助个体识别并改变导致不良情绪和行为的非理性思维模式和行为习惯。在手机依赖的干预中，CBT可以帮助青少年：

  • 识别触发因素：了解哪些情境、情绪或想法会促使自己过度使用手机。
  • 挑战非理性信念：例如，“没有手机我就无法和朋友交流”、“手机能解决我所有的无聊”等。
  • 发展替代行为：学习和练习健康的应对策略来替代手机使用，如运动、阅读、与朋友面对面交流等。
  • 渐进式行为暴露：逐步减少手机使用时间，并应对由此产生的焦虑或不适。

一项针对青少年健康促进干预的随机对照试验发现，结合健康咨询的认知行为疗法（CBT）智能手机应用程序，在短期内能够有效降低青少年抑郁症状，特别是在有抑郁症状高危的青少年中效果显著 87。虽然该研究主要关注抑郁症状，但其结果提示CBT作为一种干预手段在移动健康领域对青少年心理健康具有积极作用。另一项关于产后抑郁症的CBT智能手机应用程序的研究也指出，尽管独立应用程序的疗效有待进一步验证，但应用参与度与治疗反应之间存在剂量-反应关系，表明CBT干预的潜在价值 88。

通过在教育场景中整合数字使用规范、媒介素养教育和心理韧性培养，并借鉴认知行为疗法的有效实践，学校可以为儿童和青少年构建一道坚实的防线，帮助他们驾驭数字世界，健康成长。

7.3 社会层面：技术规范与政策支持

除了家庭和教育层面的干预，社会层面的技术规范与政策支持对于解决儿童手机依赖问题同样至关重要。这包括推动数字产品实行“儿童友好设计”，以及政府在家庭支持和专业服务方面提供政策保障。

首先，数字产品的“儿童友好设计”是减少儿童手机依赖的根本性举措。当前的许多数字产品，特别是游戏和社交媒体应用，其设计中普遍存在“成瘾设计”元素（如算法推荐、即时反馈、无限滚动等），这些元素利用了人类心理弱点，特别是儿童自控力较弱的特点，诱导用户长时间使用。为了保护儿童，政策制定者和行业监管机构应推动数字产品开发商采用“儿童友好设计”原则，具体包括：

  • 优化防沉迷系统：现有的防沉沉迷系统（如时长限制、实名认证、宵禁等）仍存在诸多漏洞和规避方法。未来的防沉迷系统应更加智能和个性化，例如利用人工智能识别儿童绕过限制的行为，并与家长账户联动进行多重验证。同时，应增加“冷静期”设置，强制用户在长时间使用后休息。
  • 内容审核与分级：加强对面向儿童的数字内容审核，确保内容健康、安全，并建立明确的分级制度，引导家长根据儿童年龄选择合适的内容。
  • 弱化成瘾设计元素：鼓励甚至强制数字产品在设计中减少或移除过度利用人类心理弱点以增加用户粘性的设计，例如减少或禁用无限滚动、限制过度即时反馈的频率和强度，或者提供更多用户自主控制的选项。
  • 增强透明度：要求数字产品开发者公开其算法推荐机制和用户数据使用方式，提升家长和监管机构对其产品影响的认知。
  • 积极心理学融入设计：鼓励将积极心理学原则融入数字产品设计中，例如，开发旨在提升幸福感、促进技能学习和社交互动的应用程序，而非仅仅是消耗时间的娱乐产品。例如，有研究呼吁在数字干预工具开发中融入人本设计（human-centered design），使其更易用、有用且符合上下文语境，从而提高心理健康服务的可及性、有效性和公平性 89。

其次，公共政策应在家庭支持方面发挥主导作用。许多家庭在应对儿童手机依赖问题时感到力不从心，缺乏资源和指导。政府可以通过以下政策措施提供支持：

  • 提供亲子活动空间与资源：建设更多免费或低成本的公共亲子活动中心、户外游乐设施、图书馆儿童区等，为家庭提供高质量的替代性娱乐和学习选择，减少儿童对手机的依赖。
  • 推广数字育儿指南与培训：制作和传播科学权威的数字育儿指南，通过社区讲座、线上课程等形式，提升家长的数字素养和育儿技能，帮助他们更好地管理孩子的手机使用。
  • 保障家庭心理健康服务：手机依赖往往与家庭功能失调或儿童心理健康问题相互交织。政府应加大对心理健康服务的投入，包括提供专业的家庭咨询、儿童心理辅导等，帮助家庭应对手机依赖带来的心理困扰。
  • 对低收入和中等收入国家家庭的支持：一项关于育儿应用程序的迭代协同设计研究表明，数字技术结合用户参与设计，可以弥补儿童早期发展（ECD）的差距，尤其是在低收入和中等收入国家。该研究强调了开发本地化、文化适宜的数字育儿工具的重要性，例如开发促进包容、鼓励父亲参与、解决父母心理健康问题、教育儿童文化价值观等内容 90。这提示我们在制定政策时，应考虑到不同家庭背景和文化语境下的差异化需求。

再者，加强专业服务体系建设，提供多元化的干预途径。

  • 健全心理咨询与治疗服务：将儿童手机依赖纳入心理健康服务范畴，培训专业的心理咨询师和治疗师，运用认知行为疗法（CBT）、家庭治疗等有效方法对有严重手机依赖问题的儿童进行干预。目前，行为成瘾（如网络游戏障碍）已被国际疾病分类（ICD-11）收录，这为相关诊断和治疗提供了依据 919293。
  • 医疗机构的早期筛查与干预：儿科医生和社区卫生服务人员应在常规体检中增加对儿童手机使用情况的筛查，识别高风险儿童，并提供初步的指导和转介服务。有研究建议，儿科护士应向儿童和家庭提供有关预防肥胖和睡眠障碍风险的咨询，通过早期识别有网络成瘾风险的儿童 94。
  • 多学科合作：鼓励心理学、教育学、社会学、医学、信息技术等多个领域的专家进行跨学科合作，共同研究儿童手机依赖的深层机制，开发更有效、更具创新性的干预策略。

结合国际经验，例如欧洲等国家在数字素养教育和网络安全方面的实践，以及中国在未成年人防沉迷领域的探索，可以为本土政策制定提供借鉴。例如，有研究表明，提升儿童数字素养对自我管理数字产品使用有重要意义，并发现通过教育、适当的育儿策略和替代活动能有效预防儿童对互联网的过度依赖 95。

总而言之，社会层面的干预需要政府、行业、医疗机构和科研单位的通力合作。通过技术规范引导数字产品向“儿童友好”方向发展，通过政策支持保障家庭和专业服务的可及性，才能为儿童构建一个既能享受数字机遇又能免受数字危害的健康成长环境 96。

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参考文献

1Prevalence of problematic smartphone usage and associated mental health outcomes amongst children and young people: a systematic review, meta-analysis and GRADE of the evidence.PubMed

Sei Yon Sohn, Philippa Rees, Bethany Wildridge, et al.
BMC Psychiatry. 2019 Nov 29;19(1):356. doi: 10.1186/s12888-019-2350-x.
BACKGROUND: Over the past decade, smartphone use has become widespread amongst today's children and young people (CYP) which parallels increases in poor mental health in this group. Simultaneously, media concern abounds about the existence of 'smartphone addiction' or problematic smartphone use. There has been much recent research concerning the prevalence of problematic smartphone use is in children and young people who use smartphones, and how this syndrome relates to mental health outcomes, but this has not been synthesized and critically evaluated. AIMS: To conduct a systematic review and meta-analysis to examine the prevalence of PSU and quantify the association with mental health harms. METHODS: A search strategy using Medical Subject Headings was developed and adapted for eight databases between January 1, 1st 2011 to October 15th 2017. No language restriction was applied. Of 924 studies identified, 41 were included in this review, three of which were cohort studies and 38 were cross sectional studies. The mental health outcomes were self-reported: depression; anxiety; stress; poor sleep quality; and decreased educational attainment, which were synthesized according to an a priori protocol. RESULTS: The studies included 41,871 CYP, and 55% were female. The median prevalence of PSU amongst CYP was 23.3% (14.0-31.2%). PSU was associated with an increased odds of depression (OR = 3.17;95%CI 2.30-4.37;I = 78%); increased anxiety (OR = 3.05 95%CI 2.64-3.53;I = 0%); higher perceived stress (OR = 1.86;95%CI 1.24-2.77;I = 65%); and poorer sleep quality (OR = 2.60; 95%CI; 1.39-4.85, I = 78%). CONCLUSIONS: PSU was reported in approximately one in every four CYP and accompanied by an increased odds of poorer mental health. PSU is an evolving public health concern that requires greater study to determine the boundary between helpful and harmful technology use. Policy guidance is needed to outline harm reduction strategies.

2Is Smartphone Addiction in the Younger Population a Public Health Problem?PubMed

Sofija Loleska, Nada Pop-Jordanova
Pril (Makedon Akad Nauk Umet Odd Med Nauki). 2021 Dec 30;42(3):29-36. doi: 10.2478/prilozi-2021-0032.
Problematic smartphone use and or addiction is defined as a form of behaviour characterized by the compulsive use of a smartphone that results in various forms of physical, psychological, or social harm. Global popularity in the area of the use of smartphones has raised concerns about the negative effects associated with problematic smartphone use, especially in the younger population. Having no consensual definition of smartphone addiction (SA), this behavioural addiction is based on the classic addiction symptomology that was included in DSM-5 criteria for compulsive gambling and substance abuse (APA 2013) This article provides a review of current research related to SA. Articles were found in the PUBMED database using related key words. Statistics confirm the exponential rise of this problem globally, especially in children and adolescents. Therefore, one must make this a high priority among public health issues.

3In Search of Digital Dopamine: How Apps Can Motivate Depressed Patients, a Review and Conceptual Analysis.PubMed

Stephane Mouchabac, Redwan Maatoug, Ismael Conejero, et al.
Brain Sci. 2021 Nov 1;11(11):1454. doi: 10.3390/brainsci11111454.
INTRODUCTION: Depression is highly prevalent and causes considerable suffering and disease burden despite the existence of wide-ranging treatment options. Momentary assessment is a promising tool in the management of psychiatric disorders, and particularly depression. It allows for a real-time evaluation of symptoms and an earlier detection of relapse or treatment efficacy. Treating the motivational and hedonic aspects of depression is a key target reported in the literature, but it is time-consuming in terms of human resources. Digital Applications offer a major opportunity to indirectly regulate impaired motivational circuits through dopaminergic pathways. OBJECTIVE: The main objective of this review was twofold: (1) propose a conceptual and critical review of the literature regarding the theoretical and technical principles of digital applications focused on motivation in depression, activating dopamine, and (2) suggest recommendations on the relevance of using these tools and their potential place in the treatment of depression. MATERIAL AND METHODS: A search for words related to "dopamine", "depression", "smartphone apps", "digital phenotype" has been conducted on PubMed. RESULTS: Ecological momentary interventions (EMIs) differ from traditional treatments by providing relevant, useful intervention strategies in the context of people's daily lives. EMIs triggered by ecological momentary assessment (EMA) are called "Smart-EMI". Smart-EMIs can mimic the "dopamine reward system" if the intervention is tailored for motivation or hedonic enhancement, and it has been shown that a simple reward (such as a digital badge) can increase motivation. DISCUSSION: The various studies presented support the potential interest of digital health in effectively motivating depressed patients to adopt therapeutic activation behaviors. Finding effective ways to integrate EMIs with human-provided therapeutic support may ultimately yield the most efficient and effective intervention method. This approach could be a helpful tool to increase adherence and motivation. CONCLUSION: Smartphone apps can motivate depressed patients by enhancing dopamine, offering the opportunity to enhance motivation and behavioral changes, although longer term studies are still needed.

4Association between screen time and developmental and behavioral problems among children in the United States: evidence from 2018 to 2020 NSCH.PubMed

Guangbo Qu, Wenjing Hu, Jia Meng, et al.
J Psychiatr Res. 2023 May;161:140-149. doi: 10.1016/j.jpsychires.2023.03.014. Epub 2023 Mar 8.
Excessive digital media use has become the common phenomenon among children's lifestyle, and its influences on the plausible accompanying psychological and behavioral problems are gradually investigated. This study aimed to examine the association between screen time and developmental and behavioral problems of children in the United States (US). A secondary analysis based on the data from the 2018 to 2020 National Survey of Children's Health (NSCH) was conducted. Seven types of developmental and behavioral problems and screen time on weekdays of children were collected through parents/caregivers' recall. Logistic regression models were constructed to determine the associations. Overall, 101,350 children aged between 0 and 17 years old were included in this study and 70.3% of preschoolers aged 0-5 years old and 80.2% of children and adolescents aged 6-17 years old had excessive screen time. Excessive screen time was positively associated with behavioral and conduct problem, developmental delay, speech disorder, learning disability, autism spectrum disorders (ASD), and attention deficit hyperactivity disorder (ADHD) and there were significant dose-response relationships. The association between excessive screen time and developmental and behavioral problems was stronger among preschoolers than among children and adolescents. Boys with excessive screen time showed high odds of most types of developmental and behavioral problems. It can be concluded that children with excessive screen time are at high odds of developmental and behavioral problems, especially for preschoolers and boys. Early intervention of digital media use is urgent and essential for children in the US.

5Screen Time And Its Relationship With Attention Deficit Hyperactivity Disorder Among Children Attending A Tertiary Care Hospital.PubMed

Zaeema Ahmer, Marrium Sultan Dar, Muriam Arif, et al.
J Pak Med Assoc. 2023 Sep;73(9):1847-1851. doi: 10.47391/JPMA.8031.
OBJECTIVE: To estimate the frequency of attention deficit hyperactivity disorder and its relationship with screen time and sociodemographic characteristics among children. METHODS: The cross-sectionalstudy was conducted at the National Institute of Child Health, Karachi, in June-July 2022, and comprised children of either gender aged 5-10 years visiting the paediatric outpatient department. Screen time was measured using a pretested questionnaire, while attention deficit hyperactivity disorder was measured using ADHD rating scale IV. The relationship of sociodemographic characteristics and screen time with the disorder was explored through multiple linear regression analysis. Data was analysed using SPSS 20. RESULTS: Of the 247 participants, 126(51%) were boys and 121(49%) were girls. The overall mean age was 7.84±1.87 years. There were 149(60.3%) children at the primary level of education, while 76(30.8%) had no formal education. There were 139(56.3%) children having screen time >2 hours/day with a mean of 3.36±3.14 hours. There were 15(6.1%) children with attention deficit hyperactivity disorderscore >26 with a mean of 11.58±9.27. Boys were more frequently affected by attention deficit hyperactivity disorder compared to girls (p=0.026), and there was a significant positive correlation between screen time and attention deficit hyperactivity disorder (p<0.001). CONCLUSION: The majority of children were found to be spending more than the recommended time on screen. Male gender and screen time were associated with attention deficit hyperactivity disorder.

6Structural and functional correlates of smartphone addiction.PubMed

Juliane Horvath, Christina Mundinger, Mike M Schmitgen, et al.
Addict Behav. 2020 Jun;105:106334. doi: 10.1016/j.addbeh.2020.106334. Epub 2020 Feb 1.
Popularity and availability of smartphones have dramatically increased in the past years. This trend is accompanied by increased concerns regarding potentially adverse effects of excessive smartphone use, particularly with respect to physical and mental health. Recently, the term "smartphone addiction" (SPA) has been introduced to describe smartphone-related addictive behavior and associated physical and psychosocial impairment. Here, we used structural and functional magnetic resonance imaging (MRI) at 3 T to investigate gray matter volume (GMV) and intrinsic neural activity in individuals with SPA (n = 22) compared to a control group (n = 26). SPA was assessed using the Smartphone Addiction Inventory (SPAI), GMV was investigated by means of voxel-based morphometry, and intrinsic neural activity was measured by the amplitude of low frequency fluctuations (ALFF). Compared to controls, individuals with SPA showed lower GMV in left anterior insula, inferior temporal and parahippocampal cortex (p < 0.001, uncorrected for height, followed by correction for spatial extent). Lower intrinsic activity in SPA was found in the right anterior cingulate cortex (ACC). A significant negative association was found between SPAI and both ACC volume and activity. In addition, a significant negative association between SPAI scores and left orbitofrontal GMV was found. This study provides first evidence for distinct structural and functional correlates of behavioral addiction in individuals meeting psychometric criteria for SPA. Given their widespread use and increasing popularity, the present study questions the harmlessness of smartphones, at least in individuals that may be at increased risk for developing smartphone-related addictive behaviors.

7Adverse physiological and psychological effects of screen time on children and adolescents: Literature review and case study.PubMed

Gadi Lissak
Environ Res. 2018 Jul;164:149-157. doi: 10.1016/j.envres.2018.01.015. Epub 2018 Feb 27.
UNLABELLED: A growing body of literature is associating excessive and addictive use of digital media with physical, psychological, social and neurological adverse consequences. Research is focusing more on mobile devices use, and studies suggest that duration, content, after-dark-use, media type and the number of devices are key components determining screen time effects. Physical health effects: excessive screen time is associated with poor sleep and risk factors for cardiovascular diseases such as high blood pressure, obesity, low HDL cholesterol, poor stress regulation (high sympathetic arousal and cortisol dysregulation), and Insulin Resistance. Other physical health consequences include impaired vision and reduced bone density. Psychological effects: internalizing and externalizing behavior is related to poor sleep. Depressive symptoms and suicidal are associated to screen time induced poor sleep, digital device night use, and mobile phone dependency. ADHD-related behavior was linked to sleep problems, overall screen time, and violent and fast-paced content which activates dopamine and the reward pathways. Early and prolonged exposure to violent content is also linked to risk for antisocial behavior and decreased prosocial behavior. Psychoneurological effects: addictive screen time use decreases social coping and involves craving behavior which resembles substance dependence behavior. Brain structural changes related to cognitive control and emotional regulation are associated with digital media addictive behavior. A case study of a treatment of an ADHD diagnosed 9-year-old boy suggests screen time induced ADHD-related behavior could be inaccurately diagnosed as ADHD. Screen time reduction is effective in decreasing ADHD-related behavior. CONCLUSIONS: Components crucial for psychophysiological resilience are none-wandering mind (typical of ADHD-related behavior), good social coping and attachment, and good physical health. Excessive digital media use by children and adolescents appears as a major factor which may hamper the formation of sound psychophysiological resilience.

8Screen time is a predictor of cognitive function in children with attention deficit hyperactivity disorder.PubMed

Han-Yu Dong, Li-Li Wang, Miao-Shui Bai, et al.
Pediatr Res. 2025 Nov;98(5):1884-1891. doi: 10.1038/s41390-025-04026-9. Epub 2025 Mar 26.
BACKGROUND: Screen exposure may affect cognitive function in children with attention deficit hyperactivity disorder (ADHD). We aimed to investigate the relationship between screen time and cognitive function in children with ADHD and explore other risk factors for cognitive function. METHODS: The study included 184 patients with ADHD (aged 6-16 years). Socioeconomic and demographic information was collected. We assessed the core symptoms of ADHD, intelligence quotient (IQ), cognitive function (using the Das-Naglieri cognitive assessment system [DN:CAS] Chinese version), and screen time per day. Multiple linear regression was used to evaluate the factors associated with DN:CAS subscales. RESULTS: A higher full IQ (p < 0.001), shorter screen time per day (p < 0.001), and higher maternal education level (p = 0.029) were predictors of better scores on the DN:CAS full scale. CONCLUSION: IQ, screen time, and maternal education are predictors of cognitive function in children and adolescents with ADHD. Hence, parents should understand the importance of controlling their children's screen time to enhance their cognitive function. IMPACT: IQ, screen time, and maternal education are predictors of cognitive function in children and adolescents with ADHD. Thus, parents should understand the importance of controlling their children's screen time to enhance their cognitive function. Our application of DN:CAS as a cognitive assessment tool is advantageous compared to the Wechsler intelligence test. The DN:CAS Chinese version is a theory-driven assessment kit, developed based on the PASS (planning, attention, simultaneous, and successive) theory assessing cognitive function. The PASS theory is an example of a terminal cognitive processing theory based on the view of functional regions of brain operation and cognitive psychology.

9Internet Addiction and Attention in Adolescents: A Systematic Review.PubMed

Maísa Gelain Marin, Xiomara Nuñez, Rosa Maria Martins de Almeida
Cyberpsychol Behav Soc Netw. 2021 Apr;24(4):237-249. doi: 10.1089/cyber.2019.0698. Epub 2020 Oct 28.
Internet addiction (IA) has been explored worldwide and involves some features that might harm social, psychological, and functional aspects. The vulnerability of adolescents might result in some addictive behaviors, and the Internet is one of them. The aim of this systematic review was to identify empirical studies that have been done to explore instruments that have been used to assess IA and to verify what variables and comorbidities are related to IA in adolescents, including executive functions, such as attention. To accomplish our aim, a systematic search was conducted in the following databases: PubMed, Web of Science, and PsycINFO. Some inclusion and exclusion criteria were used to select the studies and 44 in total were analyzed independently. The results showed that the most used instrument to assess IA is the Young's Internet Addiction Test. A few studies have been developed in the Western world, and most of them have analyzed attention bias in attention-deficit/hyperactivity disorder (ADHD) and non-ADHD groups. Furthermore, other variables have been widely explored in the studies, such as depression, sleeping patterns, body weight, aggressiveness, and other addictive substances.

10Migraine, attention deficit hyperactivity disorder and screen time in children attending a Sri Lankan tertiary care facility: are they associated?PubMed

Udena Ruwindu Attygalle, Gemunu Hewawitharana, Champa Jayalakshmie Wijesinghe
BMC Neurol. 2020 Jul 8;20(1):275. doi: 10.1186/s12883-020-01855-5.
BACKGROUND: Headache and Attention Deficit Hyperactivity Disorder (ADHD) are two relatively common, neuropsychiatric conditions seen in children. Recent studies have shown an association between these two disorders, which are otherwise distinct conditions. This study aims to assess the association between migraine and ADHD, as well as the association between screen-time and these two conditions, among children attending a Sri Lankan tertiary care facility. Possible associations will have important implications in the clinical management of these conditions. METHODS: This was a comparative cross-sectional study of 226 children aged 5-14 years, attending clinics at a tertiary care hospital in Galle, Sri Lanka. Of them, 141 had a diagnosis of migraine and 85 did not have migraine. The presence or absence of ADHD and the use of screen-time among the two groups was analysed. Chi-square test and Mann-Whitney U test was used to assess the associations between these variables. RESULTS: Approximately 5% of the children with migraine had clinically diagnosed ADHD, compared to 3.5% of those without migraine (p = 0.862). The median SNAP-IV scores (inter-quartile range) of the children with migraine and without migraine were 0.60 (0.27-1.00) and 0.44 (0.16-0.80) respectively (p = 0.014). There was no significant difference in screen-time hours per day between children with and without clinically diagnosed ADHD. However, a significant difference in median screen-time (hours per day) was observed between children with and without migraine (2.0 h and 1.0 h respectively; p = 0.012). CONCLUSIONS: Our findings suggest that children with migraine are more likely to show features of hyperactivity/impulsivity and inattentiveness than those without migraine. While no association was found between clinically diagnosed ADHD and screen-time, migraine was associated with longer daily screen use. Screening for ADHD in children diagnosed with migraine may be of benefit. Further studies are required to understand the possible benefits of reducing screen-time in children with migraine.

11Impact of movie and video game elements on tic manifestation in children.PubMed

Gal Raz, Shiri Davidovitch, Mor Halevi, et al.
Eur J Neurol. 2024 Feb;31(2):e16120. doi: 10.1111/ene.16120. Epub 2023 Nov 10.
BACKGROUND AND PURPOSE: Children in developed countries spend a significant portion of their waking hours engaging with audiovisual content and video games. The impact of media consumption on children's health and well-being has been widely studied, including its effects on tic disorders. Previous studies have shown that tic frequency can both increase and decrease during activities like gaming and television watching, resulting in mixed findings. METHODS: To better understand the impact of audiovisual media on tics, we conducted a fine-grained tic manifestation analysis. We focused on the effects of the impact of a movie scene with suspensful elements and a video game designed to heighten anticipation, thought to stimulate phasic and striatal dopamine release. We closely monitored tic frequency throuhghout these experiences based on moment-to-moment tic annotation. The study included 20 participants (19 males aged 7-16) diagnosed with tic disorders (Yale Global Tic Severity Scale≥8), and we tested the replicability of our findings with an independent group of 36 children (15 females, aged 7-15) with tic disorders. RESULTS: During film viewing, we observed significant synchronization in the temporal tic patterns of various individuals despite diversity in their tic profiles. Furthermore, employing a video game developed for our study, we found that tic frequency increases during anticipation of a pending reward. This finding was replicated in a second experiment with an independent cohort. CONCLUSIONS: Our results indicate that tic frequency is affected by media elements in the short-term, and call for further investigation of the long-term impacts of exposure to such tic triggers.

12Bigger, Brighter, Bluer-Better? Current Light-Emitting Devices - Adverse Sleep Properties and Preventative Strategies.PubMed

Paul Gringras, Benita Middleton, Debra J Skene, et al.
Front Public Health. 2015 Oct 13;3:233. doi: 10.3389/fpubh.2015.00233. eCollection 2015.
OBJECTIVE: In an effort to enhance the efficiency, brightness, and contrast of light-emitting (LE) devices during the day, displays often generate substantial short-wavelength (blue-enriched) light emissions that can adversely affect sleep. We set out to verify the extent of such short-wavelength emissions, produced by a tablet (iPad Air), e-reader (Kindle Paperwhite 1st generation), and smartphone (iPhone 5s) and to determine the impact of strategies designed to reduce these light emissions. SETTING: University of Surrey dedicated chronobiology facility. METHODS: First, the spectral power of all the LE devices was assessed when displaying identical text. Second, we compared the text output with that of "Angry Birds" - a popular top 100 "App Store" game. Finally, we measured the impact of two strategies that attempt to reduce the output of short-wavelength light emissions. The first strategy employed an inexpensive commercially available pair of orange-tinted "blue-blocking" glasses. The second strategy tested an app designed to be "sleep-aware" whose designers deliberately attempted to reduce short-wavelength light emissions. RESULTS: All the LE devices shared very similar enhanced short-wavelength peaks when displaying text. This included the output from the backlit Kindle Paperwhite device. The spectra when comparing text to the Angry Birds game were also very similar, although the text emissions were higher intensity. Both the orange-tinted glasses and the "sleep-aware" app significantly reduced short-wavelength emissions. CONCLUSION: The LE devices tested were all bright and characterized by short-wavelength enriched emissions. Since this type of light is likely to cause the most disruption to sleep as it most effectively suppresses melatonin and increases alertness, there needs to be the recognition that at night-time "brighter and bluer" is not synonymous with "better." Ideally future software design could be better optimized when night-time use is anticipated, and hardware should allow an automatic "bedtime mode" that shifts blue and green light emissions to yellow and red as well as reduce backlight/light intensity.

13[The use of social media modifies teenagers' sleep-related behavior].PubMed

S Royant-Parola, V Londe, S Tréhout, et al.
Encephale. 2018 Sep;44(4):321-328. doi: 10.1016/j.encep.2017.03.009. Epub 2017 Jun 8.
OBJECTIVE: Modification of sleep behaviors in teenagers has been observed over the past 30years with a reduction in overall sleep time and an increasing number of teenagers suffering from sleep deprivation. Sleep deprivation is linked to physical problems such as obesity but also to change in performance at school and mood disorders. Changes have been associated with the use of screens, cell phones, Internet and social media. Use of screens has been shown to delay sleep onset and melatonin secretion and stimulation of wake systems by interaction with social media may exacerbate these effects. The links between the use of social media and sleep patterns have not been fully explored. Our study aimed to evaluate the effects of social media on teenagers' sleep and the impact of sleep deprivation. METHODOLOGY: As part of a sleep education program conducted in middle schools, teenagers from 6th to 9th grade were invited to complete an online questionnaire on sleep habits with teacher supervision and after parental consent. Outcome measures were sleep and wake times with estimated sleep duration in school (SP) and rest periods (RP), use of screens (computers, tablets, smartphones and video game consoles), the use of social media and impact on visual analogue scales of sleep quality, mood and daytime functioning. Students were divided into those with clear sleep deprivation (sleep time<6hours in SP) and those whose sleep time was in line with the National Sleep Foundations recommended sleep needs for teenagers (9hours or more). RESULTS: A total of 786 questionnaires were completed and 776 were exploitable. Four schools took part with 408/786 girls (64.2 %) and a mean age of 12.4±1.24. Internet access was almost universal (98.3 %), 85.2 % had cell phones and 42.7 % had a personal computer in their bedroom. Social media was used by 64.6 %. After dinner, 52.6 % spent more than an hour and 14.7 % spent more than 2hours in front of a screen. After bedtime, 51.7 % regularly used electronic devices of which 25.6 % had a screen-based activity (e.g. texts, social media, video games or television). During the night, some teens woke up to continue screen-based activities: 6.1 % in order to play online video games, 15.3 % to send texts and 11 % to use social media. Bedtimes were later in PR compared with PS (22h06±132 vs. 23h54±02; P<0.0001) as were wake times (7h06±36 vs. 10h06±102; P<0.0001). Sleep time was clearly longer in PR (10h12±126 P<0.0001) compared to PS. For students in 6th grade compared to 9th grade in sleep duration in SP decreased (8:55±90 vs. 7:25±93; P<0.0001), whereas sleep duration during RP was stable (10h08±118 vs. 10h08±90 P<0.029). No significant difference was found between girls and boys for sleep duration, sleep quality, performance during the day or mood. Sleep deprivation during the week (6hours or less) was less common in 6th graders 5 % vs. 15 % (P<0.0001). In sleep deprived teens compared to teens sleeping, the recommended ≥9hours, difficulties falling asleep were reported with 33 % vs. 9 % taking over an hour to fall asleep (P<0.0001) and difficulties getting up in the morning were more common (7.05±3.27 vs. 5.74±2.97; P=0.0003). Sleep deprivation had an effect on daytime performance: teenagers deprived of sleep were more likely to report a need to fight sleepiness, (5.93±3.24 vs. 2.84±2.44 P<0.0001) and had reduced energy during the day (6.21±2.86 vs. 7.77±2.07 P<0.0001). A negative effect on mood was evident: in sleep, deprived teenagers irritability (5.28±3.12 vs. 3.30±2.34; P<0.0001) and feelings of sadness (3.97±2.99 vs. 2.59±2.15; P=0.003) were more common. There was a clear association between sleep deprivation and access to screens and social media: sleep deprived teens were at more risk of nocturnal disruption with a higher prevalence of computers (67 % vs. 33 %; P<0.0001), cell phones (99 % vs. 80 %; P=0.0001) and smart phones (85 % vs. 66 %; P=0.0001) in their bedrooms. CONCLUSIONS: Access to social media and especially a cell phone in teenagers' bedrooms is associated with a reduction in sleep time during the school week with negative effects on daily functioning and mood which increases with increasing age. Education about use of social media and sleep for teenagers needs to start early as modifications in sleep and evening use of screens was present on our population from 11years on and to involve parents as setting parent controlled bedtimes has been shown to increase teenage sleep time.

14Sleep characteristics and cardiovascular risk in children and adolescents: an enumerative review.PubMed

Karen A Matthews, Elizabeth J M Pantesco
Sleep Med. 2016 Feb;18:36-49. doi: 10.1016/j.sleep.2015.06.004. Epub 2015 Jun 23.
Cardiovascular risk factors develop in childhood and adolescence. This enumerative review addresses whether sleep characteristics, including sleep duration, continuity, quality, and daytime sleepiness, are associated with cardiovascular risk factors in young people. Thirty-nine studies were identified, which examined the following risk factors: metabolic syndrome, glucose and insulin, lipids, blood pressure, and cardiovascular responses to psychological stressors. Due to the availability of other reviews, 16 longitudinal studies of obesity published in 2011 and later were also included in this report. Excluded from the review were studies of participants with suspected or diagnosed sleep disorders and reports from sleep deprivation experiments. Combining studies, evidence was strongest for obesity, followed by glucose, insulin, blood pressure (especially ambulatory blood pressure), and parasympathetic responses to psychological stressors. There was little evidence for metabolic syndrome cluster, lipids, and blood pressure responses to psychological stressors. The more positive associations were obtained for studies that incorporated objective measures of sleep and that included adolescents. The foundational evidence is almost entirely cross-sectional, except for work on obesity. In summary, available evidence suggests that the associations between sleep characteristics and cardiovascular risk vary by risk factor. It is time to conduct studies to determine antecedent and consequent relationships, and to expand risk factors to include markers of inflammation.

15A Systematic Review of Sleep, Hypertension, and Cardiovascular Risk in Children and Adolescents.PubMed

Aaron D Fobian, Lindsey Elliott, Tinnie Louie
Curr Hypertens Rep. 2018 May 1;20(5):42. doi: 10.1007/s11906-018-0841-7.
PURPOSE OF REVIEW: Many of the risk factors for heart disease have recently been shown to develop during childhood such as left ventricular hypertrophy and fibrous plaque lesions. As risk for cardiovascular disease in children and adolescents has risen, sleep duration has decreased, and inadequate sleep in children and adolescents has been found to be associated with cardiovascular disease risk. The aims of this manuscript are to provide an updated systematic review of the literature assessing sleep, hypertension, and cardiovascular risk and evaluate the strength of the evidence based on the available research. RECENT FINDINGS: A systematic review was conducted using six databases from January 1, 2015 through March 9, 2018. We sought studies which looked at the relationship between sleep duration, sleep timing, or sleep quality and outcome variables of hypertension, inflammation, obesity, glucose or insulin, and lipids in children and adolescents. We found 24 studies which met our criteria. Nine studies included hypertension as an outcome variable; fifteen included obesity; thirteen included glucose or insulin; eight included lipids; and three included measures of inflammation. The existing literature on sleep and cardiovascular disease in children and adolescents is limited and relatively weak. Only one RCT was identified, and the overwhelming majority of studies had a high risk of bias. The strongest evidence of an association with sleep is with obesity, hypertension, and insulin sensitivity. Further research using more standardized methods and objective measures is needed to determine if a causal relationship truly exists between sleep and cardiovascular risk.

16The relationship between maternal alexithymia and cognitive flexibility, children's emotional eating, and childhood obesity.PubMed

Pınar Aydoğan Avşar, Duygu Çalişkan, Merve Türkegün Şengül
Appetite. 2026 Jan 1;216:108258. doi: 10.1016/j.appet.2025.108258. Epub 2025 Aug 6.
OBJECTIVES: Childhood obesity is one of the major health challenges of the 21st century, a chronic and complicated condition that requires medical intervention. The goal of this study was to investigate the emotional eating levels of children with obesity as well as their mothers' alexithymia and cognitive flexibility, which we hypothesized to contribute to childhood obesity. METHODS: This is a cross-sectional, case-control study of age-, sex-, and ethnicity-matched 100 dyads. All mothers completed the Toronto Alexithymia Scale (TAS-20) and the Cognitive Flexibility Inventory (CFI), and the children completed the Emotional Eating Scale-Children (EES-C). In addition, researchers administered a clinical and sociodemographic questionnaire. RESULTS: The childhood obesity group exhibited significantly higher levels of emotional eating and maternal alexithymia, but also significantly lower levels of maternal cognitive flexibility compared to those in the healthy control group. Further analyses revealed a significant association between childhood obesity, maternal alexithymia, and irregular sleep patterns in children. CONCLUSION: Our results indicate that elevated levels of alexithymia in mothers of children diagnosed with obesity may influence childhood obesity. The aims of early interventions in managing pediatric obesity may include evaluations of families and mothers.

17Diet, Physical Activity, and Screen Time to Sleep Better: Multiple Mediation Analysis of Lifestyle Factors in School-Aged Children with and without Attention Deficit Hyperactivity Disorder.PubMed

George C C Hong, Russell Conduit, Jason Wong, et al.
J Atten Disord. 2021 Nov;25(13):1847-1858. doi: 10.1177/1087054720940417. Epub 2020 Jul 14.
OBJECTIVE: This study examined the mediation roles of multiple lifestyle factors in school-aged children. Structural equation modeling (SEM) tested how lifestyle factors play mechanism roles one another in the impact of ADHD to seek theoretical and intervention insights. METHOD: An online survey assessed children's lifestyle factors including diet, physical activity, screen time, sleep difficulties, and having ADHD diagnosis. A multi-country sample from English speaking nations included 309 caregivers. Multiple regression and SEM were planned to identify significant correlates and mediators of ADHD in explaining lifestyle differences. RESULTS: Preliminary multiple regression showed only sleep quality was significantly different between children with and without ADHD. Significant triple mediation effects suggested diet, physical activity, and screen time mediated the ADHD impact on sleep quality. CONCLUSION: Researchers and practitioners may incorporate the findings to develop intervention models for children with ADHD attending to the mediational roles of lifestyle factors to improve sleep quality.

18Social implications of children's smartphone addiction: The role of support networks and social engagement.PubMed

Jennifer Ihm
J Behav Addict. 2018 Jun 1;7(2):473-481. doi: 10.1556/2006.7.2018.48. Epub 2018 Jun 5.
Background and aims Most studies have regarded smartphone addiction as a condition stemming from individuals' psychological issues, so research has rarely examined it in relation to a lack of social resources and its social impacts. However, this study reinterprets smartphone addiction as a social problem stemming from a lack of offline social networks and resulting in a decline of social engagement. Methods This study drew on a survey of 2,000 children in Korea consisting of 991 males and 1,009 females with an average age of 12 years old. Using the STATA 14 structural equation modeling program, this study examined the relationships between children's lack of social networks, smartphone addiction, and social engagement. Results Social network variables, such as formal organizational membership, quality of relationship with parents, size of the peer group, and peer support, decrease smartphone addiction. Simply having good relationships and reciprocal feelings with peers do not have any influence on the smartphone addiction. The more the children become addicted to smartphones, the less they participate in social engagement. Discussion and conclusions This study provides a new understanding of smartphone addiction by focusing on its social aspects, augmenting prior studies that have addressed psychological factors. Findings suggest that children's lack of social networks may inhibit comfortable social interactions and feelings of support in the offline environment, which can heighten their desire to escape to smartphones. These children, unlike non-addicts, may not take advantage of the media to enrich their social lives and increase their level of social engagement.

19Factors affecting the anxiety levels of adolescents in home-quarantine during COVID-19 pandemic in Turkey.PubMed

Şenay Kılınçel, Oğuzhan Kılınçel, Gürkan Muratdağı, et al.
Asia Pac Psychiatry. 2021 Jun;13(2):e12406. doi: 10.1111/appy.12406. Epub 2020 Aug 11.
BACKGROUND: The long-term closing of schools and home-quarantine during the COVID-19 pandemic cause negative effects on the physical and mental health of young people. Studies evaluating the mental health of adolescents during the pandemic are limited in the literature. AIM: In our study, it was aimed to determine the results of home-quarantine measures taken for adolescents during the pandemic and the affecting factors. METHOD: This study was conducted as an online cross-sectional self-report questionnaire and included children aged between 12 and 18 years. The data were obtained from the children of volunteer families via Facebook family groups, and Google Forms questionnaires sent by the child psychiatry clinic to their smartphones. Sociodemographic form, State-Trait anxiety scale, and UCLA loneliness survey were used as data collection tools. RESULTS: We examined the data of 745 adolescents. The average age of the study group was 16.83 ± 1.66 years, and 69.5% were females. It was determined that 88.2% of the adolescents followed the developments in the COVID-19 process and obtained most information from the television. State anxiety was related to "Former psychiatric referral" by 4.39-fold, "Having a COVID positive patient in the family or your surroundings" by 3.81-fold, and "The most common medium for obtaining COVID-related information" by 2.41-fold. CONCLUSIONS: Closure of schools and home-quarantine during pandemic causes anxiety and loneliness in young people. The identification of risky groups helps to properly support these individuals by various social connections, including healthcare professionals, families, and schools.

20Canadian Adolescents' Internalized Symptoms in Pandemic Times: Association with Sociodemographic Characteristics, Confinement Habits, and Support.PubMed

Kristel Tardif-Grenier, Isabelle Archambault, Véronique Dupéré, et al.
Psychiatr Q. 2021 Sep;92(3):1309-1325. doi: 10.1007/s11126-021-09895-x. Epub 2021 Mar 25.
Adolescence is a time of increased risk for developing symptoms of anxiety and depression, especially for girls. The stress and social isolation experienced during confinement add new threats to already vulnerable adolescents' daily lives. This study is aimed at determining which sociodemographic characteristics (age, family composition, achievement), confinement habits (schedule, new hobby, sleep duration, cellphone and computer use, sports, schoolwork), and sources of support (parents and teachers) are associated with more or less internalized symptoms in Canadian adolescents. Differences between boys and girls are also investigated. Between April 8 and 30 (2020) and through an online survey, 895 Canadian adolescents (74% girls) aged between 12 and 17 years (M = 14.7) were recruited. Path analysis was performed to identify significant associations between sociodemographic characteristics, confinement habits, support variables, and internalized symptoms. Independent samples t-tests and invariance tests were conducted to compare boys and girls. Results suggest that certain confinement habits (time spent using cellphones, doing sports and schoolwork, finding a new hobby) and support variables (parents working outside the home) were significantly and negatively associated with internalized symptoms. Regarding the sex differences, girls used their cellphones more and invariance test results showed that all associations between predictors and symptoms were statistically similar for boys and girls. This study's results help understand better adolescents' experience in confinement. It sheds light on the habits likely to characterize those who are less at risk of experiencing distress, making it possible to better support adolescents during this challenging period.

21Parental neglect and short-form video application addiction in Chinese adolescents: The mediating role of alexithymia and the moderating role of refusal self-efficacy.PubMed

Fang Li, Gang Wang, Dan Zhu, et al.
Child Abuse Negl. 2023 Sep;143:106345. doi: 10.1016/j.chiabu.2023.106345. Epub 2023 Jul 12.
BACKGROUND: The phenomenon of short-form video application addiction among Chinese adolescents is noteworthy. More research has focused on the influencing factors of internet addiction, but research on specifically exploring the antecedents and influencing mechanisms of short-form video application addiction (a subcategory of internet addiction) among adolescents is insufficient. OBJECTIVES: This study aimed to investigate the relation between parental neglect and short-form video application addiction among Chinese adolescents and examine the mediating effect of alexithymia and the moderating role of refusal self-efficacy. METHODS: A total of 1203 Chinese adolescents were assigned to complete scales regarding parental neglect, alexithymia, refusal self-efficacy and short-form video application addiction. RESULTS: Parental neglect was positively related to short-form video application addiction among Chinese adolescents, and alexithymia mediated this link. Furthermore, refusal self-efficacy moderated the direct connection between parental neglect and short-form video application addiction. Specifically, the link between parental neglect and short-form video application addiction became weaker as adolescents' refusal self-efficacy increased. CONCLUSION: The experiences of parental neglect are closely related to higher levels of short-form video application addiction among Chinese adolescents. Parental neglect is associated with higher level of short-form video application addiction through stronger alexithymia, and the relationship between parental neglect and short-form video application addiction is attenuated when adolescents have high refusal self-efficacy.

22Parental Phubbing and Child Social-Emotional Adjustment: A Meta-Analysis of Studies Conducted in China.PubMed

Jinghui Zhang, Chuanmei Dong, Yue Jiang, et al.
Psychol Res Behav Manag. 2023 Oct 19;16:4267-4285. doi: 10.2147/PRBM.S417718. eCollection 2023.
INTRODUCTION: Parental phubbing refers to the act of parents using mobile phones in the presence of their children instead of engaging with them. With increasing smartphone use in many households, parental phubbing is a potential threat to children's healthy development. This meta-analysis synthesized the existing evidence on the impact of parental phubbing on children's social-emotional development to examine the effect sizes and identify the moderators. METHODS: Following the PRISMA guidelines, we conducted a systematic search across multiple electronic databases (Web of Science, EBSCO, ProQuest, Springer, and China National Knowledge Infrastructure) from 2012 to May 2023. Our search included both English and Chinese literature, encompassing published journal articles as well as thesis. To assess the risk of bias, we utilized the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Publication bias was evaluated using funnel plot interpretation and Egger's regression intercept. RESULTS: Our comprehensive search identified 42 studies with 56,275 children and 59 effect sizes. A random-effects meta-analysis revealed that parental phubbing was positively associated with children's internalizing problems ( = 0.270; 95% CI [0.234, 0.304]) and externalizing problems ( = 0.210; 95% CI [0.154, 0.264]), while negatively correlated with children's self-concept ( = -0.206; 95% CI [-0.244, -0.168]) and social-emotional competence ( = -0.162; 95% CI [-0.207, -0.120]). Furthermore, the parental phubbing group moderated the association between parental phubbing and internalizing problems, when both parents engage in phubbing, there is a stronger association with children's externalizing problems compared to when only one parent is engaging in phubbing. DISCUSSION: The findings of this meta-analysis provide strong evidence supporting the detrimental effects of parental phubbing on child social-emotional adjustment. Consequently, parents, researchers, and the government must collaborate to mitigate parental phubbing and promote the healthy development of children's social-emotional abilities.

23Parents' Phubbing and Problematic Mobile Phone Use: The Roles of the Parent-Child Relationship and Children's Self-Esteem.PubMed

Wei Hong, Ru-De Liu, Yi Ding, et al.
Cyberpsychol Behav Soc Netw. 2019 Dec;22(12):779-786. doi: 10.1089/cyber.2019.0179. Epub 2019 Nov 20.
An increasing number of mobile phone users check their phones at any time and place, even during in-person interactions. Such behaviors that interrupt social interactions have been described as phubbing. The present study focused on phubbing behaviors within the context of parent-child households and aimed to examine the associations among parents' phubbing, the parent-child relationship, children's self-esteem, and problematic mobile phone use (PMPU) by adolescents. The structural equation model results based on the data collected from 1,721 secondary students revealed that parents' phubbing was not only directly associated with children's PMPU but also indirectly associated with PMPU through the mediating roles of the parent-child relationship and children's self-esteem after gender and age were controlled. These findings suggest a possible underlying mechanism for the relationship between parents' phubbing and children's PMPU, and could thus inform interventions to prevent or decrease PMPU among adolescents. Limitations and implications are discussed.

24Parental Phubbing, Self-Esteem, and Suicidal Ideation among Chinese Adolescents: A Longitudinal Mediational Analysis.PubMed

Xingchao Wang, Yuran Qiao
J Youth Adolesc. 2022 Nov;51(11):2248-2260. doi: 10.1007/s10964-022-01655-9. Epub 2022 Jul 13.
Parental phubbing refers to a phenomenon in which parents are distracted by their smartphones when they interact with their children. It has become a common concern and linked to adolescents' internalizing and externalizing behavior problems. However, much remains unclear about reciprocal associations among parental phubbing, self-esteem, and suicidal ideation and the potential mechanisms underlying these associations. To address these gaps, the current study tested bidirectional relationships among parental phubbing, self-esteem, and suicidal ideation, as well as the mediating role of self-esteem. In addition, the present study examined whether these relationships varied by extraversion, gender, and perceived economic stress across three time points using a cross-lagged design. A total of 2407 Chinese adolescents (50.23% girls, M = 12.75, SD = 0.58 at baseline) participated in the study. The results showed that parental phubbing was associated with self-esteem as well as with suicidal ideation, and there were bidirectional relationships between self-esteem and suicidal ideation. Self-esteem significantly mediated the association between parental phubbing and suicidal ideation. Extraversion moderated the link between parental phubbing and suicidal ideation as well as self-esteem and suicidal ideation during the first year. Gender and perceived economic stress did not play a moderating role. The results indicate that parental phubbing is a new risk factor for adolescents' suicidal ideation. Parents concerned about adolescents' self-esteem and suicidal ideation should focus on minimizing the frequency of smartphone use and teach adolescents some social skills to seek more sources of social support.

25Self-concept clarity and appearance-based social comparison to idealized bodies.PubMed

Jeanne J Carter, Lenny R Vartanian
Body Image. 2022 Mar;40:124-130. doi: 10.1016/j.bodyim.2021.12.001. Epub 2021 Dec 17.
Exposure to images of idealized bodies in the media has been shown to increase body dissatisfaction among women. One of the mechanisms through which exposure influences body dissatisfaction is appearance-based comparison with the people in the images. The present study tested the hypothesis that individuals low in self-concept clarity (i.e., individuals who lack a clear sense of their own identity) would be more likely to compare themselves to images of thin models, and would consequently experience greater body dissatisfaction. White female participants (N = 489) were exposed to either images featuring idealized bodies or neutral control images, and then indicated the extent to which they compared their appearance to that of the targets and reported their level of body dissatisfaction. A moderated-mediation model showed that the effect of exposure condition on body dissatisfaction via appearance comparison to the targets depended on the participant's level of self-concept clarity. Those with lower self-concept clarity engaged in greater comparison when exposed to idealized images relative to control images, leading to greater post-exposure body dissatisfaction. These findings suggest that low self-concept clarity might increase vulnerability to the negative effects of exposure to idealized media images.

26Impact of parenting styles on adolescents' self-esteem and internalization of values in Spain.PubMed

Isabel Martínez, José Fernando García
Span J Psychol. 2007 Nov;10(2):338-48. doi: 10.1017/s1138741600006600.
The relationship of parenting styles with adolescents' outcomes was analyzed within a sample of Spanish adolescents. A sample of 1456 teenagers from 13 to 16 years of age, of whom 54.3% were females, reported on their parents' child-rearing practices. The teenagers' parents were classified into one of four groups (authoritative, authoritarian, indulgent, or neglectful). The adolescents were then contrasted on two different outcomes: (1) priority given to Schwartz's self-transcendence (universalism and benevolence) and conservation (security, conformity, and tradition) values and (2) level of self-esteem (appraised in five domains: academic, social, emotional, family and physical). The results show that Spanish adolescents from indulgent households have the same or better outcomes than adolescents from authoritative homes. Parenting is related with two self-esteem dimensions--academic and family--and with all the self-transcendence and conservation values. Adolescents of indulgent parents show highest scores in self-esteem whereas adolescents from authoritarian parents obtain the worst results. In contrast, there were no differences between the priority given by adolescents of authoritative and indulgent parents to any of the self-transcendence and conservation values, whereas adolescents of authoritarian and neglectful parents, in general, assign the lowest priority to all of these values.

27Family functioning mediates the association between parental depression and low self-esteem in adolescents.PubMed

Susann Krug, Hans-Ulrich Wittchen, Roselind Lieb, et al.
J Affect Disord. 2016 Oct;203:184-189. doi: 10.1016/j.jad.2016.06.008. Epub 2016 Jun 4.
BACKGROUND: The negative impact of parental depression on offsprings' development has been repeatedly documented. There is however little research on the potential pathways contributing to this association. The present study examined the relationship between parental depressive disorders, family functioning and adolescents' self-esteem. METHODS: A community-based sample of 1040 participants aged 14-17 years and their parents was assessed including direct and indirect information on parental psychopathology based on the Munich-Composite International Diagnostic Interview (M-CIDI). Family functioning and youth self-esteem were assessed by self-report questionnaires using the McMaster Family Assessment Device (FAD) in parents and the "Aussagen-Liste zum Selbstwertgefühl" in adolescents. RESULTS: Findings from multiple regression analyses indicated positive associations between parental depressive disorders and dimensions of dysfunctional family functioning as well as between dysfunctional familial affective involvement and youth's positive self-esteem. The relationship between parental depression and self-esteem was partly mediated by familial affective involvement. LIMITATIONS: Associations may be underestimated, since incidence for depressive disorders spans to the third decade of life. Consensus diagnoses for parental depressive disorders were based on direct and indirect information for maximum use of available data, neglecting familial load, chronicity of parental depressive disorders or comorbid conditions. Thus, specificity of the findings for the family transmission of depressive disorders remains yet to be determined. CONCLUSIONS: Findings contribute to understanding of the pathways on how parental depression impairs offsprings' view of themselves, and to consider family functioning as a possible target for preventive interventions.

28Smartphones through children's eyes: perceived benefits and educational considerations.PubMed

Mirari Gaztañaga, Nahia Idoiaga-Mondragon, Idoia Legorburu Fernandez, et al.
Front Psychol. 2025 Jun 19;16:1596595. doi: 10.3389/fpsyg.2025.1596595. eCollection 2025.
INTRODUCTION: Smartphones have become central to everyday life, especially among children and adolescents. While they provide opportunities for communication, learning, and entertainment, growing concerns persist regarding their association with negative outcomes such as anxiety, depression, and reduced social and cognitive development. Despite the prevalence of these concerns, children's own perspectives are often overlooked in debates about smartphone regulation and education. METHODS: This mixed-methods study involved a total of 642 children from the Basque Country. Data collection combined quantitative and qualitative approaches to explore children's perceptions of smartphone use. Participants shared their experiences and opinions through structured questionnaires and open-ended responses, allowing for both statistical analysis and thematic exploration. RESULTS: Children identified four main benefits of smartphone use: (1) maintaining social connections and contacting parents in emergencies, (2) accessing information, (3) reducing boredom, and (4) engaging in multimedia entertainment. Ownership status influenced perceived benefits: those with personal devices highlighted communication and academic uses, while those using parents' devices focused on entertainment. The study also examined the role of smartphone education in schools and family discussions, revealing significant correlations with children's reported benefits. DISCUSSION: Findings underscore the importance of incorporating children's voices into digital policy and educational strategies. The study highlights the need for early digital education programs that promote balanced and responsible use. Additionally, it identifies boredom as a potentially constructive driver for creative and emotional development. Adopting a child-centered framework for understanding smartphone use can foster more effective and empathetic approaches to digital wellbeing.

29Is the relationship between problematic mobile phone use and mental health problems mediated by fear of missing out and escapism?PubMed

Nevra Atış Akyol, Derya Atalan Ergin, Anna K Krettmann, et al.
Addict Behav Rep. 2021 Oct 8;14:100384. doi: 10.1016/j.abrep.2021.100384. eCollection 2021 Dec.
INTRODUCTION: Individuals with problematic mobile phone use often report mental health problems, however, little is known about factors which mediate this association. Therefore, the aim of this study was to examine the mediating role of fear of missing out (FoMO) and escapism in an attempt to explain the relationship between problematic mobile phone use and mental health problems. METHOD: A total of 235 undergraduate students in Turkey participated in this study. These participants completed a set of questionnaires to measure fear of missing out, problematic mobile phone use, escapism, depression, anxiety, stress, and worry severity. RESULTS: Participants with a high level of problematic mobile phone use also had a high level of mental health problems, FoMO, and escapism. The association between problematic mobile phone use and mental health problems was not mediated by FoMO and escapism. CONCLUSION: Personal characteristics such as emotional regulation and self-regulation need to be examined in future studies in order to determine their potential mediating role in explaining the association between problematic mobile phone use and mental health problems.

30Correlation of negative emotion, fatigue level and internet addiction in college students: implication for coping strategies.PubMed

Shanshan Gu, Xue Min, Jing Xu, et al.
BMC Psychiatry. 2024 Apr 9;24(1):264. doi: 10.1186/s12888-024-05711-5.
BACKGROUND: Internet addiction has an important influence on the development of physical and mental health of college students. The purpose of this study is to evaluate the current status and the correlation between college students' negative emotion, fatigue level and Internet addiction disorder, and to provide reference for the care and management of college students. METHODS: We conducted a questionnaire survey on a cluster sample of college students from October to November 15, 2022. Internet addiction scale, fatigue assessment scale and positive and negative emotion scale were used for survey. Pearson correlation analysis and mediating effect test were performed to analyze the correlation and effects. RESULTS: A total of 1546 valid questionnaires were collected. The incidence of internet addiction in college student was 20.38%. The total score of internet addiction was 52.94 ± 12.47, the total fatigue score was 69.27 ± 3.19, the score of positive emotion of college students was 31. 41 ± 5.09, and the negative emotion score was 18.54 ± 5.68. The total score of internet addiction were positively correlated with score of negative emotion (all P < 0. 05). The total score of internet addiction scale of college students were positively correlated and each factor score of with the score of fatigue severity (all P < 0. 05). Fatigue played an intermediary role in the prediction of negative emotion and internet addiction of college students, with an intermediary role of-0.433, accounting for 76.35% of the total effect. CONCLUSION: The college students' positive emotion may be strengthened to reduce their fatigue level and negative emotion so as to reduce internet addiction.

31Adverse Childhood Experiences and Building Resilience With the JoyPop App: Evaluation Study.PubMed

Angela MacIsaac, Aislin R Mushquash, Shakira Mohammed, et al.
JMIR Mhealth Uhealth. 2021 Jan 4;9(1):e25087. doi: 10.2196/25087.
BACKGROUND: The effects of adverse childhood experiences (ACEs) on mental health, self-regulatory capacities, and overall resilience are well-known. Given such effects, ACEs may play a role in how individuals adjust to challenges later in life. Of interest in this study is the transition to university, a time of heightened stress when adapting to circumstances is required and when those with ACEs may need additional in-the-moment support to exercise resilience. A smartphone app may provide a worthwhile and readily accessible medium for a resilience intervention, provided behavioral outcomes are adequately evaluated. OBJECTIVE: This study evaluates the impact of an innovative, smartphone app-based resilience intervention. The JoyPop app was designed to promote resilience through the use of self-regulatory skills such as emotion regulation and executive functioning. Among a sample of first-year undergraduate students, we explored whether use of the app would be associated with positive changes in resilience and related outcomes, and whether these benefits were influenced by level of childhood adversity. METHODS: Participants (N=156) were requested to use the JoyPop app for 4 weeks, at least twice daily. Changes in resilience, emotion regulation, executive functioning, and depression were assessed after 2 and 4 weeks of app usage using multilevel modeling. RESULTS: The sample of 156 participants included 123 females and 33 males, with a mean age of 19.02 years (SD 2.90). On average participants used the app on 20.43 of the possible 28 days (SD 7.14). App usage was associated with improvements in emotion regulation (χ=44.46; P<.001), such that it improved by 0.25 points on the 18-point scale for each additional day of app usage, and symptoms of depression (χ=25.12; P<.001), such that depression symptoms were reduced by .08 points on the 9-point scale with each additional day of app usage. An interaction between ACEs and days of app usage existed for emotion regulation, such that participants with more adversity evidenced a faster rate of change in emotion regulation (P=.02). CONCLUSIONS: Results highlight that daily incorporation of an app-based resilience intervention can help youth who have experienced adversity to improve emotion regulation skills and experience reductions in depression. The JoyPop app represents an important step forward in the integration of resilience intervention research with a technology-based medium that provides in-the-moment support.

32The Relationship between Mother's Smartphone Addiction and Children's Smartphone Usage.PubMed

Bomi Kim, So Ra Han, Eun-Jin Park, et al.
Psychiatry Investig. 2021 Feb;18(2):126-131. doi: 10.30773/pi.2020.0338. Epub 2021 Feb 2.
OBJECTIVE: As smartphone use is becoming more common, the age of initial exposure to devices is becoming younger. Young children's screen use is influenced by various factors; it is more directly dependent on family environment than school-aged children. Our study aimed to examine the effect of mother's smartphone addition on their child's smartphone use. METHODS: Participants were from the Kids Cohort for Understanding of internet addiction Risk factors in early childhood (K-CURE) study. Adult smartphone addiction self-diagnosis scale was used to evaluate smartphone addiction degree of mother. Child's smartphone use was assessed by parental questionnaire. Using logistic regression analysis, we examine the association between mother's smartphone addiction and child's smartphone use. RESULTS: After adjusting for other factors, mother's smartphone addiction is related with early smartphone exposure of children. Highrisk group's children was exposed to smartphone earlier than low risk group (adjusted OR, 0.418; p=0.021). Contrary to expectation, there is no correlation between mother's smartphone addiction and child's smartphone use time. CONCLUSION: Our study explain that mother's smartphone addiction can affect early smartphone exposure on children. Based on our findings, further study might explore the effect of early smartphone exposure on children.

33Associations between Parent Attitudes and on- and off-Screen Behaviours of Preschool Children in Singapore.PubMed

Michael Yong Hwa Chia, John Komar, Terence Buan Kiong Chua, et al.
Int J Environ Res Public Health. 2022 Sep 13;19(18):11508. doi: 10.3390/ijerph191811508.
The research aims were to examine the relationships between parent and child digital media use and to describe the characteristics of the top and bottom quartiles of child digital media use in meeting the 24 h integrated guidelines for sleep, physical activity, and sedentary behaviour. Parent-reported on- and off-screen habits and quality of life of children were collected from 1481 parents of preschool children aged 2-5 years in 2019. Significant relationships were detected between parent and child digital media use (weekday, = 0.274; weekend, = 0.421, < 0.05) with no sex difference in daily child digital media use ( > 0.05). Age of first exposure to fixed screens, daily digital media use, and physical play durations were significantly different between heavy (child-TQ) and light (child-BQ) child users of digital media ( < 0.05). Parental perceived importance of child digital media use and parental awareness and practice of guidelines for child digital media use differed significantly between parents of child-TQs and parents of child-BQs ( < 0.05). The number of 24 h movement guidelines met between child-TQs and child-BQs differed ( < 0.05). Parents voiced serious concerns for child digital media use, including addiction (75-76%), poor eyesight (73%), access to inappropriate content (73-74%), a lack of parent-child interaction (65%), poor sleep (49-55%), and a lack of physical activity (55-59%), but these findings did not translate to parental enforcement of the guidelines. Parent education on how to get the best digital media use outcomes for preschool children is recommended.

34Exposure and Use of Mobile Media Devices by Young Children.PubMed

Hilda K Kabali, Matilde M Irigoyen, Rosemary Nunez-Davis, et al.
Pediatrics. 2015 Dec;136(6):1044-50. doi: 10.1542/peds.2015-2151. Epub 2015 Nov 2.
BACKGROUND AND OBJECTIVES: Research on children's use of mobile media devices lags behind its adoption. The objective of this study was to examine young children's exposure to and use of mobile media devices. METHODS: Cross-sectional study of 350 children aged 6 months to 4 years seen October to November 2014 at a pediatric clinic in an urban, low-income, minority community. The survey was adapted from Common Sense Media's 2013 nationwide survey. RESULTS: Most households had television (97%), tablets (83%), and smartphones (77%). At age 4, half the children had their own television and three-fourths their own mobile device. Almost all children (96.6%) used mobile devices, and most started using before age 1. Parents gave children devices when doing house chores (70%), to keep them calm (65%), and at bedtime (29%). At age 2, most children used a device daily and spent comparable screen time on television and mobile devices. Most 3- and 4-year-olds used devices without help, and one-third engaged in media multitasking. Content delivery applications such as YouTube and Netflix were popular. Child ownership of device, age at first use, and daily use were not associated with ethnicity or parent education. CONCLUSIONS: Young children in an urban, low-income, minority community had almost universal exposure to mobile devices, and most had their own device by age 4. The patterns of use suggest early adoption, frequent and independent use, and media multitasking. Studies are urgently needed to update recommendations for families and providers on the use of mobile media by young children.

35The association of mobile touch screen device use with parent-child attachment: a systematic review.PubMed

Rebecca Hood, Juliana Zabatiero, Stephen R Zubrick, et al.
Ergonomics. 2021 Dec;64(12):1606-1622. doi: 10.1080/00140139.2021.1948617. Epub 2021 Jul 26.
Mobile touch screen devices (smartphones and tablet computers) have become an integral part of many parents' and children's lives, with this interaction linked to physical, mental and social outcomes. Despite the known importance of parent-child attachment, evidence on the association between device use and attachment was yet to be reviewed. Following protocol pre-registration, databases were searched, papers screened, and methodological quality assessed. Three papers met the inclusion criteria, and reported some negative associations between duration of parent/child smartphone use and attachment outcomes. A narrative synthesis on two groups of related papers found child time using any screen technology (including television viewing), and child 'problematic' internet, mobile phone, gaming and social media use, was negatively associated with attachment outcomes. Currently there is limited direct evidence on any association between time parents or children spend using these devices and parent-child attachment to support time guidelines for families and professionals working with families. Many parents and children regularly spend time using smartphones and tablet computers. This systematic review found limited evidence evaluating associations between child/adolescent or parent time using devices and parent-child attachment. Until quality evidence exists, practitioners should be alert to potential impacts of device use on family relationships and child outcomes.

36Domestication of Information and Communication Technologies into Family Systems: A Conceptual Framework Evaluating Family Health.PubMed

Remesh Krishnan Purushothaman Nair, Nancy Mengi, Santhosh Adhikarathil Jose
Soc Work. 2024 Oct 1;69(4):356-366. doi: 10.1093/sw/swae033.
As the world undergoes its fourth industrial revolution, digital media are becoming more prevalent in both rural and urban communities. This shift has had a profound impact on our daily lives, transforming the way we live, work, and communicate. Although technology now plays a crucial role in our daily routine, it can lead to interference in human relationships, a phenomenon referred to as technoference. This interference has significant consequences, particularly in parent-child relationships, as it can adversely affect children's emotional and behavioral development and the mental health and overall functioning of parents. Thus, for children to grow up healthy and for families to be harmoniously balanced, all the family subsystems need to be aligned in a healthy manner. This study conceptualizes how family health is affected when technological devices are brought as a subsystem into a family system. The researchers developed a conceptual multidimensional framework based on several interrelated theoretical concepts, and this framework is presented in three sequential frames for better comprehension, to identify how the interference, in particular, impacts the various dimensions of a healthy family system and contributes to dysfunctional family functioning and mental health issues in both parents and children.

37Connections between Parental Phubbing and Electronic Media Use in Young Children: The Mediating Role of Parent-Child Conflict and Moderating Effect of Child Emotion Regulation.PubMed

Xiaocen Liu, Shuliang Geng, Tong Lei, et al.
Behav Sci (Basel). 2024 Feb 6;14(2):119. doi: 10.3390/bs14020119.
In this digital age, where parental attention is often diverted by digital engagement, the phenomenon of "parental phubbing," defined as parents ignoring their children in favor of mobile devices, is scrutinized for its potential impact on child development. This study, utilizing questionnaire data from 612 parents and Structural Equation Modeling (SEM) with moderated mediation, examines the potential association between parental phubbing and young children's electronic media use. The findings revealed a correlation between parental phubbing and increased electronic media use in children. Parent-child conflict, informed by instances of parental phubbing, was identified as a partial mediator in this relation. Notably, children's emotion regulation emerged as a moderating factor, with adept regulation linked to reduced adverse effects of parental phubbing and improved relational harmony. These findings underscore the importance of parental awareness of their digital behaviors and the benefits of fostering robust parent-child relationships and supporting children's emotional regulation to nurture well-adjusted "digital citizens" in the contemporary media landscape.

38Reciprocal Relationship Between Parental Technoference and Adolescent Problematic Mobile Phone Use: The Longitudinal Mediating Roles of Paternal and Maternal Attachment.PubMed

Zhaoyang Xie, Cheng Xu, Ningning Feng, et al.
Fam Process. 2025 Sep;64(3):e70058. doi: 10.1111/famp.70058.
Parental technoference, which refers to the interference of parent-child interactions by technology, has been demonstrated to be a risk factor for adolescent Problematic Mobile Phone Use (PMPU). From the perspective of family systems theory, the impact of adolescent PMPU on parental technoference seems also plausible. The present research investigated the bidirectional predictive association between parental technoference and adolescent PMPU through the mediating roles of paternal and maternal attachment using a two-wave cross-lagged design. A total of 1664 Chinese adolescents (61.24% female; M = 16.86 ± 0.77) were surveyed at Time 1 (January 2023) and Time 2 (August 2023). Results showed that Time 1 parental technoference predicted Time 2 adolescent PMPU and Time 1 adolescent PMPU predicted Time 1 parental technoference. Furthermore, both paternal attachment and maternal attachment had longitudinal mediating effects on the reciprocal association between parental technoference and adolescent PMPU. Finally, there was no difference between boys and girls in the longitudinal relationship among parental technoference, paternal and maternal attachment, and adolescent PMPU. The findings reveal the interdependent connections between parental and child usage of electronic devices, highlighting the roles of paternal and maternal attachment separately. The findings contribute to a family-based solution for preventing and intervening in adolescent PMPU.

39The Relationship Between Parental Phubbing and Preschoolers' Behavioral Problems: The Mediation Role of Mindful Attention Awareness.PubMed

Antonio Puligheddu, Annamaria Porru, Andrea Spano, et al.
Children (Basel). 2025 Aug 2;12(8):1022. doi: 10.3390/children12081022.
UNLABELLED: Phubbing, a relatively new phenomenon in the field of digital risks, refers to the act of ignoring someone in favor of focusing on a smartphone during face-to-face interactions. Parental phubbing, a specific form of this behavior, is a prevalent negative parenting practice that can affect parent-child relationships and child development. However, the impact of parental phubbing on the emotional and behavioral development of preschool children remains unclear. This study aims to explore the relationship between parental phubbing and preschoolers' behavioral problems, as well as test whether parents' mindful attention awareness (MAA) acts as a mediator between them. METHOD: A questionnaire was administered to 138 Italian parents (mean age = 38.5, SD = 6.2) of 138 kindergarten preschoolers (mean age = 3.9, SD = 1.03). Questionnaires included the Generic Scale of Phubbing (GSP), the Mindful Attention Awareness Scale (MAAS), and the Strengths and Difficulties Questionnaire (SDQ). RESULTS: Analyses revealed a significant negative correlation between the MAAS and SDQ total scores, a positive correlation between the GSP total score and the SDQ total score, and a negative correlation between the GSP total score and the MAAS total score. The mediation analysis did not show a direct effect of GSP on SDQ, suggesting that parental phubbing did not directly predict children's behavioral difficulties. Nevertheless, the indirect effect measured by bootstrapping was significant, indicating that parental MAA fully mediated the relationship between parental phubbing and preschoolers' problematic behaviors. CONCLUSIONS: Although further research is needed, parental mindfulness may influence phubbing behaviors in parents providing valuable insights for early interventions aimed at reducing problem behaviors in young children.

40Patterns of proximity and maternal-infant engagement in a neonatal intensive care unit.PubMed

Christine Neugebauer, Wonjung Oh, Ann M Mastergeorge
Infant Ment Health J. 2025 Jan;46(1):30-45. doi: 10.1002/imhj.22147. Epub 2024 Dec 8.
Mother-infant relationship development is influenced by maternal presence, proximity, and the frequency and duration of engagement. Proximity and dyadic engagement can be challenging when an infant is hospitalized in a neonatal intensive care unit (NICU). This study examined patterns of maternal proximity and engagement in a NICU in the Southwestern United States and identified thematic categories of alternate activities to engagement. Trained observers conducted 52 h of NICU observations, documenting maternal presence, patterns of proximity, engagement, nonengagement, and alternate activities to nonengagement and focused engagement. Results include data from 88 mother-infant dyads. Of the time mothers were in proximity to their infants, 83% of these instances occurred without active engagement. In contrast, focused dyadic engagement was noted in 97% of these observations, while unfocused engagement was recorded in 65% of instances. Mothers in proximity but not actively engaged were most often observed using a smartphone, a trend that was also observed when mothers were in unfocused engagement during nurturing social contexts. While it is expected that occasional interruptions to mother-infant interaction in the NICU will occur, more studies are needed to determine the implications of both brief and prolonged disruptions during dyadic interactions on interaction quality in the NICU.

41Tuning into the real effect of smartphone use on parenting: a multiverse analysis.PubMed

Kathryn L Modecki, Samantha Low-Choy, Bep N Uink, et al.
J Child Psychol Psychiatry. 2020 Aug;61(8):855-865. doi: 10.1111/jcpp.13282. Epub 2020 Jul 7.
BACKGROUND: Concerns have been raised regarding the potential negative impacts of parents' smartphone use on the parent-child relationship. A scoping literature review indicated inconsistent effects, arguably attributable to different conceptualizations of parent phone use and conflation of phone use with technological interference. METHODS: Based on a sample of n = 3, 659 parents collected in partnership with a national public broadcaster, we conducted a multiverse analysis. We explored 84 different analytic choices to address whether associations were weak versus robust, and provide clearer direction for measurement, theory, and practice. Effects were assessed in relation to p values, effect sizes, and AIC; we further conducted a meta-analytic sensitivity check. RESULTS: Direct associations between smartphone use and parenting were relatively weak and mixed. Instead, the relation between use and parenting depended on level of technological interference. This pattern was particularly robust for family displacement. At low levels of displacing time with family using technology, more smartphone use was associated with better (not worse) parenting. CONCLUSIONS: Our results indicate fragility in findings of risks for parental smartphone use on parenting; there were few concerns in this regard. Rather, at low levels of technological interference, more phone use was associated with higher parenting quality. Scholars should avoid generalized narratives of family risk and seek to uncover real effects of smartphone use on family outcomes across diverse households and contexts.

42Unveiling the pathway: Exploring how neglectful parenting and peer alienation contribute to mobile phone dependency in children.PubMed

Sangwon Kim, Yanghee Lee
Child Abuse Negl. 2025 Sep;167:107609. doi: 10.1016/j.chiabu.2025.107609. Epub 2025 Jul 23.
BACKGROUND: Growing dependency on mobile phones among children has become a pressing global concern, with Korean children showing similar trends. Given the evident physical and psychological implications of mobile phone dependency, it is crucial to comprehensively explore the underlying factors that contribute to children's dependent mobile phone use. OBJECTIVE: To address this issue, this study aimed to test the pathways leading to mobile phone dependency among first-year middle school students and elucidate the underlying influencing mechanism. METHODS: Nationally representative data targeting 1st-grade students (n = 2002), collected by the Korean Children and Youth Panel Survey (KCYPS), was used. A total of 1937 responses (48.8 % female), reporting owning mobile phone were analyzed to examine the hypothesized model. Measures of neglectful parenting, peer alienation, self-esteem, social withdrawal, and mobile phone dependency were included in the model. Structural Equation Modeling was conducted using Mplus 8.7. RESULT: The findings demonstrated that unmet needs in relationships with parents and peers may contribute to mobile phone dependency, with self-esteem and social withdrawal serving as mediators. CONCLUSION: These findings suggest that interventions focusing on relational support systems within families and peer networks could be crucial in diversifying pathways leading to mobile phone dependency. Addressing self-esteem and social withdrawal within these strategies is particularly important. Intervention strategies should be considered to mitigate these influences in or to provide insights into promoting healthier technology use among children.

43The impact of parenting style, temperament and character on problematic internet and smartphone use among non-clinical female adolescents.PubMed

Sadettin Burak Açikel, Nur Çetin
Turk J Med Sci. 2024 Jun 11;55(2):488-500. doi: 10.55730/1300-0144.5993. eCollection 2025.
BACKGROUND/AIM: It is known that various temperament and character dimensions, and parenting styles could be associated with problematic internet and smartphone use. This study aimed to examine the association between temperament, character, and parenting styles and problematic smartphone and internet use in nonclinical female teenagers. MATERIALS AND METHODS: 244 nonclinical female adolescent were included the study. Young's Internet Addiction Test Short Form, Smartphone Addiction Scale, Junior Temperament and Character Inventory and Parenting Style Scale were used for collecting data. RESULTS: Problematic smartphone use was significantly negatively correlated with cooperativeness character type, strictness/supervision, and acceptance/involvement subscales of the parenting style scale. A significant correlation was found between problematic internet use and acceptance/involvement, strictness/supervision subscales of Parenting Style Scale. In ANOVA analysis, it was found that the authoritative parenting style was associated with less problematic use, and the neglectful, authoritarian, and indulgent parenting styles were associated with increased problematic use. A negative correlation was found between the cooperativeness character style and problematic smartphone use. CONCLUSION: According to our results, parenting style is more important for problematic internet and smartphone use among female adolescents than temperament and character.

44Association between Children's Difficulties, Parent-Child Sleep, Parental Control, and Children's Screen Time: A Cross-Sectional Study in Japan.PubMed

Yusuke Arai, Daimei Sasayama, Kazuhiro Suzuki, et al.
Pediatr Rep. 2023 Nov 8;15(4):668-678. doi: 10.3390/pediatric15040060.
Children's screen time may affect their growth and development. However, differences in the impact of various psychiatric and psychological factors on children's screen time is a research gap. This study aimed to explore the differences in the influence of related factors affecting children's screen time based on their sleep, difficulties, and parental control among Japanese elementary and junior high school students. A cross-sectional survey was conducted among parents in Japan. Data on screen time duration, parent-child background, strengths and difficulties, sleep variables, and parental control types were collected from 225 households. A regression analysis revealed that high Strengths and Difficulties Questionnaire (SDQ) scores (β = 0.166, = 0.008), sleep duration (β = -0.281, < 0.001), and parental control (β = -0.204, = 0.001) were significantly related to children's screen time. Additionally, it was found that parents' late bedtimes affect children's screen time by mediating children's sleep duration. This study, together with previous research, provides comprehensive insights into design interventions to decrease the screen time of children in the Japanese context.

45Peer relationship and adolescent smartphone addiction: The mediating role of self-esteem and the moderating role of the need to belong.PubMed

Pengcheng Wang, Meng Zhao, Xingchao Wang, et al.
J Behav Addict. 2017 Dec 1;6(4):708-717. doi: 10.1556/2006.6.2017.079. Epub 2017 Dec 19.
Background and aims Adolescent smartphone addiction has received increased attention in recent years, and peer relationship has been found to be a protective factor in adolescent smartphone. However, little is known about the mediating and moderating mechanisms underlying this relation. The aim of this study was to investigate (a) the mediating role of self-esteem in the association between student-student relationship and smartphone addiction, and (b) the moderating role of the need to belong in the indirect relationship between student-student relationship and adolescent smartphone addiction. Methods This model was examined with 768 Chinese adolescents (mean age = 16.81 years, SD = 0.73); the participants completed measurements regarding student-student relationship, self-esteem, the need to belong, and smartphone addiction. Results The correlation analyses indicated that student-student relationship was significantly negatively associated with adolescent smartphone addiction, and the need to belong was significantly positively associated with adolescent smartphone addiction. Mediation analyses revealed that self-esteem partially mediated the link between student-student relationship and adolescent smartphone addiction. Moderated mediation further indicated that the mediated path was weaker for adolescents with lower levels of the need to belong. Discussion and conclusion High self-esteem could be a protective factor against smartphone addiction for adolescents with a strong need to belong as these students appeared to be at elevated risk of developing smartphone addiction.

46Parent-adolescent relationships, peer relationships, and adolescent mobile phone addiction: The mediating role of psychological needs satisfaction.PubMed

Qiufeng Gao, Haiyan Zheng, Ruimei Sun, et al.
Addict Behav. 2022 Jun;129:107260. doi: 10.1016/j.addbeh.2022.107260. Epub 2022 Jan 24.
INTRODUCTION: Prior studies have shown that parent-adolescent relationships and peer relationships may be important factors associated with adolescent mobile phone addiction (MPA). The present study aims to further explore the direct effects of parent-adolescent and peer relationships on adolescent MPA as well as the indirect effects through the mediating roles of autonomy, competence, and relatedness needs satisfaction. METHODS: Our sample consisted of 1766 Chinese adolescents (53.10% male; M = 13.33, SD = 1.94, range from 10 to 18 years) who completed questionnaires regarding parent-adolescent relationships, peer relationships, psychological needs satisfaction, and MPA. SPSS 24.0 was used to analyze correlations among variables and Mplus 7.4 was used to test the structural equation model in this study. RESULTS: (1) positive parent-adolescent relationships were negatively associated with adolescent MPA, while peer relationships did not show a significant association with MPA; (2) autonomy and competence needs satisfaction significantly mediated the effects of parent-adolescent and peer relationships on MPA, while the mediating role of relatedness need satisfaction between parent-adolescent and peer relationships and MPA was not significant; (3) the mediating effect of competence need satisfaction between peer relationships and MPA was significantly stronger than that between parent-adolescent relationships and MPA. CONCLUSIONS: This study explored the different mechanisms by which parent-adolescent and peer relationships influence adolescent MPA. These discoveries may contribute to intervention and prevention programs for adolescent MPA.

47Children's Eating Habits, Physical Activity, Sleep, and Media Usage before and during COVID-19 Pandemic in Poland.PubMed

Edyta Łuszczki, Anna Bartosiewicz, Iwona Pezdan-Śliż, et al.
Nutrients. 2021 Jul 17;13(7):2447. doi: 10.3390/nu13072447.
The COVID-19 pandemic has caused huge changes in people's lifestyle, health, and social relationships. This situation has had an impact on children and adolescents, affecting their health, intellectual, physical, and emotional development. The survey aimed to compare eating behaviors, level of physical activity (PA), hours of sleep, and screen time among Polish children and adolescents aged 6-15 years before and during the COVID-19 pandemic. We obtained self-reported data from 1016 participants at two measurement points before and during the COVID-19 lockdown in Poland to examine the influence of the lockdown and the distance learning on PA, dietary habits, sleep, and media usage of children and adolescents aged 6-15 years. The study identified dietary differences and changes in daily activity patterns (reduced sleep duration with higher sleep quality and reduced physical activity). Additionally, the increase in general media usage was observed during the pandemic alongside a reduction in smartphone usage. Together, the findings indicate increased sleep, physical activity, and reduced media usage and screen time among Polish children and adolescents during the COVID-19 pandemic.

48Parental Mental Health and Children's Behaviors and Media Usage during COVID-19-Related School Closures.PubMed

Seong Ju Kim, Sangha Lee, Hyojin Han, et al.
J Korean Med Sci. 2021 Jun 28;36(25):e184. doi: 10.3346/jkms.2021.36.e184.
BACKGROUND: Coronavirus disease 2019 (COVID-19) is different from previous disasters in that it continues to the present and has affected all aspects of family life. During epidemics, psychosocial support is not less important than infection control. During COVID-19-related school closures, prolonged partial closures of schools could have detrimental social and health consequences for children and may increase the burden on the family. Based on a community sample in Korea, this study identified parental concerns, children's media usage, other various factors and examined whether parental stress level or depression were positively associated with problem behaviors, media exposure, and sleep problems of the primary school children during school closure under COVID-19. METHODS: Participants were 217 parents residing in Suwon, South Korea, who had primary school children and responded to a web-based questionnaire on parental concerns from school closure under COVID-19, subjective stress, depression, whether having received mental health services, and family characteristics; children's sleep patterns, problem behaviors, media usage during the online-only class period, and changes in activity level following the pandemic. RESULTS: During school closure, children gained body weight, spent less time in physical activities and more in media usage. Besides online learning content (97.2%), YouTube was highly used content (87.6%), and games followed (78.3%). Parental subjective stress index was highly associated with parental depression (Pearson correlation 0.439, < 0.001), children's sleep problems (0.283, < 0.001), tablet time (0.171, = 0.012) and behavior problems (0.413, < 0.001). Parental depression was associated with children's sleep problems (0.355, < 0.001), TV time (0.153, = 0.024), tablet time (0.159, = 0.019), and behavior problems (0.524, < 0.001). Parents who previously received mental services seemed to be more concerned about the problems their children already have getting worse because of COVID-19 than the disease itself. Children's sleep problem was associated with tablet (0.172, = 0.011) and smartphone time (0.298, < 0.001), but not its frequency. CONCLUSION: During COVID-19-related school closures, many parents and children had various difficulties relating to mental health. Ongoing monitoring of mental health of high-risk groups and multiple support systems may need to be expanded to cover those parents having difficulty in caring for their children.

49Musculoskeletal complaints and associated factors in school children aged between 6 and 13 years in Istanbul during the COVID-19 pandemic: A cross-sectional study.PubMed

Ozden Ozyemisci Taskiran, Mahir Topaloglu, Esra Giray, et al.
Work. 2023;74(3):811-821. doi: 10.3233/WOR-220263.
BACKGROUND: Following the first COVID-19 cases in Turkey, face-to-face education was ceased after March 16, 2020 until the end of the educational year (i.e. June 19, 2020) and education was substituted remotely due to confinement. OBJECTIVE: This study aims to investigate the frequency of musculoskeletal complaints in school-age children and associated risk factors including reduced physical activity, increased screen time and poor ergonomics conditions in school-age children during the pandemic. METHODS: This cross-sectional study included parents or guardians of 960 students aged between 6-13 years old with a non-randomized sampling. A survey was administered consisting of 65 items related with sociodemographic characteristics of the children and family, online education hours, technological device(s) used, screen time, type of physical activity, presence of musculoskeletal problems and poor ergonomics conditions such as incorrect sitting posture. RESULTS: Logistic regression results demonstrated that age, excess weight gain, total daily screen time, smartphone use, incorrect sitting posture were associated with musculoskeletal complaints. CONCLUSION: The long-term closure of schools due to the pandemic may have led to an increase in musculoskeletal complaints in 6-13 years old children, based on the factors identified in this study, which were excess weight gain, increased screen time and incorrect sitting posture. These findings might help education and health authorities to develop strategies to improve musculoskeletal health of children especially in emergencies such as the pandemic.

50Evaluating the optimised font size and viewing time of online learning in young children: a multicentre cross-sectional study.PubMed

L U Ma, Xi Yu, Ling Gong, et al.
BMJ Paediatr Open. 2023 Apr;7(1). doi: 10.1136/bmjpo-2022-001835.
OBJECTIVES: Near viewing distance (VD) and longer viewing times are associated with myopia. This study aimed to identify the font size and viewing time that guarantee the appropriate VD and pixels per degree (PPD) for children's online learning. DESIGN: This cross-sectional study comprised two experiments. In experiment A, participants read text in five font sizes on three backlit displays (a personal computer, a smartphone and a tablet), an E-ink display and paper for 5 min per font size. In experiment B, participants watched videos for 30 min on three backlit displays. SETTING: The Peking University People's Hospital in Beijing (China) and the School of Ophthalmology and Optometry, Wenzhou Medical University (Zhejiang Province, China). PARTICIPANTS: Thirty-five participants completed experiment A. Ten of them participated in experiment B. PRIMARY AND SECONDARY OUTCOME MEASURES: VDs were measured by Clouclip. The corresponding PPD was calculated. RESULTS: In experiment A, font size and display type significantly affected VD (F=149.44, p<0.001, ES (Effect size)=0.77; F, p<0.001, ES=0.37). VDs were >33 cm for all five font sizes on the PC, the tablet and paper and for 18-pt on the smartphone and 16-pt on E-ink. PPD for 16-pt on the PC, 14-pt on the tablet and all five font sizes on the phone were >60. In experiment B, VD increased over the four previous 5 min periods but decreased slightly on tablets and PCs in the fifth 5 min period. PPD was >60. CONCLUSION: Children demonstrated different VDs and PPDs based on font size and display type. To ensure a 33 cm VD and 60 PPD, the minimum font size for online reading should be 18-pt on smartphones, 16-pt on PCs and E-ink, 10.5-pt on tablets and 9-pt on paper. More attention should be given to children's VD with continuous video viewing of more than 25 min. TRIAL REGISTRATION NUMBER: ChiCTR2100049584.

51[Psychopathological consequences of confinement].PubMed

A Mengin, M C Allé, J Rolling, et al.
Encephale. 2020 Jun;46(3S):S43-S52. doi: 10.1016/j.encep.2020.04.007. Epub 2020 Apr 22.
The psychological effects of isolation have already been described in the literature (polar expeditions, submarines, prison). Nevertheless, the scale of confinement implemented during the COVID-19 pandemic is unprecedented. In addition to reviewing the published studies, we need to anticipate the psychological problems that could arise during or at a distance from confinement. We have gone beyond the COVID-19 literature in order to examine the implications of the known consequences of confinement, like boredom, social isolation, stress, or sleep deprivation. Anxiety, post-traumatic stress disorder, depression, suicidal or addictive behaviours, domestic violence are described effects of confinement, but the mechanisms of emergence of these disorders and their interrelationships remain to be studied. For example, what are the mechanisms of emergence of post-traumatic stress disorders in the context of confinement? We also remind the reader of points of vigilance to be kept in mind with regard to eating disorders and hallucinations. Hallucinations are curiously ignored in the literature on confinement, whereas a vast literature links social isolation and hallucinations. Due to the broad psychopathological consequences, we have to look for these various symptoms to manage them. We quickly summarize the diagnostic and therapeutic approaches already in place, such as telemedicine, which is undergoing rapid development during the COVID-19 crisis.

52How mental health care should change as a consequence of the COVID-19 pandemic.PubMed

Carmen Moreno, Til Wykes, Silvana Galderisi, et al.
Lancet Psychiatry. 2020 Sep;7(9):813-824. doi: 10.1016/S2215-0366(20)30307-2. Epub 2020 Jul 16.
The unpredictability and uncertainty of the COVID-19 pandemic; the associated lockdowns, physical distancing, and other containment strategies; and the resulting economic breakdown could increase the risk of mental health problems and exacerbate health inequalities. Preliminary findings suggest adverse mental health effects in previously healthy people and especially in people with pre-existing mental health disorders. Despite the heterogeneity of worldwide health systems, efforts have been made to adapt the delivery of mental health care to the demands of COVID-19. Mental health concerns have been addressed via the public mental health response and by adapting mental health services, mostly focusing on infection control, modifying access to diagnosis and treatment, ensuring continuity of care for mental health service users, and paying attention to new cases of mental ill health and populations at high risk of mental health problems. Sustainable adaptations of delivery systems for mental health care should be developed by experts, clinicians, and service users, and should be specifically designed to mitigate disparities in health-care provision. Thorough and continuous assessment of health and service-use outcomes in mental health clinical practice will be crucial for defining which practices should be further developed and which discontinued. For this Position Paper, an international group of clinicians, mental health experts, and users of mental health services has come together to reflect on the challenges for mental health that COVID-19 poses. The interconnectedness of the world made society vulnerable to this infection, but it also provides the infrastructure to address previous system failings by disseminating good practices that can result in sustained, efficient, and equitable delivery of mental health-care delivery. Thus, the COVID-19 pandemic could be an opportunity to improve mental health services.

53Understanding Mobile Health and Youth Mental Health: Scoping Review.PubMed

Xiaoxu Ding, Kelli Wuerth, Brodie Sakakibara, et al.
JMIR Mhealth Uhealth. 2023 Jun 16;11:e44951. doi: 10.2196/44951.
BACKGROUND: A total of 75% of people with mental health disorders have an onset of illness between the ages of 12 and 24 years. Many in this age group report substantial obstacles to receiving quality youth-centered mental health care services. With the rapid development of technology and the recent COVID-19 pandemic, mobile health (mHealth) has presented new opportunities for youth mental health research, practice, and policy. OBJECTIVE: The research objectives were to (1) synthesize the current evidence supporting mHealth interventions for youths who experience mental health challenges and (2) identify current gaps in the mHealth field related to youth's access to mental health services and health outcomes. METHODS: Guided by the methods of Arksey and O'Malley, we conducted a scoping review of peer-reviewed studies that used mHealth tools to improve youth mental health (January 2016-February 2022). We searched MEDLINE, PubMed, PsycINFO, and Embase databases using the following key terms: (1) mHealth; (2) youth and young adults; and (3) mental health. The current gaps were analyzed using content analysis. RESULTS: The search produced 4270 records, of which 151 met inclusion criteria. Included articles highlight the comprehensive aspects of youth mHealth intervention resource allocation for targeted conditions, mHealth delivery methods, measurement tools, evaluation of mHealth intervention, and youth engagement. The median age for participants in all studies is 17 (IQR 14-21) years. Only 3 (2%) studies involved participants who reported their sex or gender outside of the binary option. Many studies (68/151, 45%) were published after the onset of the COVID-19 outbreak. Study types and designs varied, with 60 (40%) identified as randomized controlled trials. Notably, 143 out of 151 (95%) studies came from developed countries, suggesting an evidence shortfall on the feasibility of implementing mHealth services in lower-resourced settings. Additionally, the results highlight concerns related to inadequate resources devoted to self-harm and substance uses, weak study design, expert engagement, and the variety of outcome measures selected to capture impact or changes over time. There is also a lack of standardized regulations and guidelines for researching mHealth technologies for youths and the use of non-youth-centered approaches to implementing results. CONCLUSIONS: This study may be used to inform future work as well as the development of youth-centered mHealth tools that can be implemented and sustained over time for diverse types of youths. Implementation science research that prioritizes youths' engagement is needed to advance the current understanding of mHealth implementation. Moreover, core outcome sets may support a youth-centered measurement strategy to capture outcomes in a systematic way that prioritizes equity, diversity, inclusion, and robust measurement science. Finally, this study suggests that future practice and policy research are needed to ensure the risk of mHealth is minimized and that this innovative health care service is meeting the emerging needs of youths over time.

54Left-shifting prism adaptation boosts reward-based learning.PubMed

Selene Schintu, Michael Freedberg, Zaynah M Alam, et al.
Cortex. 2018 Dec;109:279-286. doi: 10.1016/j.cortex.2018.09.021. Epub 2018 Oct 12.
Visuospatial cognition has an inherent lateralized bias. Individual differences in the direction and magnitude of this bias are associated with asymmetrical D2/3 dopamine binding and dopamine system genotypes. Dopamine level affects feedback-based learning and dopamine signaling asymmetry is related to differential learning from reward and punishment. High D2 binding in the left hemisphere is associated with preference for reward. Prism adaptation (PA) is a simple sensorimotor technique, which modulates visuospatial bias according to the direction of the deviation. Left-deviating prism adaptation (LPA) induces rightward bias in healthy subjects. It is therefore possible that the right side of space increases in saliency along with left hemisphere dopaminergic activity. Right-deviating prism adaptation (RPA) has been used mainly as a control condition because it does not modulate behavior in healthy individuals. Since LPA induces a rightward visuospatial bias as a result of left hemisphere modulation, and higher dopaminergic activity in the left hemisphere is associated with preference for rewarding events we hypothesized that LPA would increase the preference for learning with reward. Healthy volunteers performed a computer-based probabilistic classification task before and after LPA or RPA. Consistent with our predictions, PA altered the preference for rewarded versus punished learning, with the LPA group exhibiting increased learning from reward. These results suggest that PA modulates dopaminergic activity in a lateralized fashion.

55Learning new words via feedback-Association between feedback-locked ERPs and recall performance-An exploratory study.PubMed

Christine Albrecht, Ruben van de Vijver, Christian Bellebaum
Psychophysiology. 2023 Oct;60(10):e14324. doi: 10.1111/psyp.14324. Epub 2023 May 5.
Feedback learning is thought to involve the dopamine system and its projection sites in the basal ganglia and anterior cingulate cortex (ACC), regions associated with procedural learning. Under certain conditions, such as when feedback is delayed, feedback-locked activation is pronounced in the medial temporal lobe (MTL), which is associated with declarative learning. In event-related potential research, the feedback-related negativity (FRN) has been linked to immediate feedback processing, while the N170, possibly reflecting MTL activity, has been related to delayed feedback processing. In the current study, we performed an exploratory investigation on the relation between N170 and FRN amplitude and memory performance in a test for declarative memory (free recall), also exploring the role of feedback delay. To this end, we adapted a paradigm in which participants learned associations between non-objects and non-words with either immediate or delayed feedback, and added a subsequent free recall test. We indeed found that N170, but not FRN amplitudes, depended on later free recall performance, with smaller amplitudes for later remembered non-words. In an additional analysis with memory performance as dependent variable, the N170, but not the FRN amplitude predicted free recall, modulated by feedback timing and valence. This finding shows that the N170 reflects an important process during feedback processing, possibly related to expectations and their violation, but is distinct from the process reflected by the FRN.

56The role of state uncertainty in the dynamics of dopamine.PubMed

John G Mikhael, HyungGoo R Kim, Naoshige Uchida, et al.
Curr Biol. 2022 Mar 14;32(5):1077-1087.e9. doi: 10.1016/j.cub.2022.01.025. Epub 2022 Feb 2.
Reinforcement learning models of the basal ganglia map the phasic dopamine signal to reward prediction errors (RPEs). Conventional models assert that, when a stimulus predicts a reward with fixed delay, dopamine activity during the delay should converge to baseline through learning. However, recent studies have found that dopamine ramps up before reward in certain conditions even after learning, thus challenging the conventional models. In this work, we show that sensory feedback causes an unbiased learner to produce RPE ramps. Our model predicts that when feedback gradually decreases during a trial, dopamine activity should resemble a "bump," whose ramp-up phase should, furthermore, be greater than that of conditions where the feedback stays high. We trained mice on a virtual navigation task with varying brightness, and both predictions were empirically observed. In sum, our theoretical and experimental results reconcile the seemingly conflicting data on dopamine behaviors under the RPE hypothesis.

57Prevention and Health Promotion Interventions for Young People in the Context of Digital Well-Being: Rapid Systematic Review.PubMed

Michelle Colder Carras, Dahlia Aljuboori, Jing Shi, et al.
J Med Internet Res. 2024 Dec 18;26:e59968. doi: 10.2196/59968.
BACKGROUND: Increasing digital technology and media use among young people has raised concerns about problematic use and negative consequences. The formal recognition of a technology addiction (eg, gaming disorder) requires an understanding of the landscape of interventions designed to prevent this disorder and related technology addictions. OBJECTIVE: We conducted a rapid systematic review to investigate the current evidence on approaches to prevent problematic technology use and promote digital well-being, defined as the healthy use of digital media and technology and the absence of problems resulting from excessive use. METHODS: We used a pragmatic and rapid approach to systematically review and synthesize recent literature with a focus on contextual factors that can aid in understanding translatability, making trade-offs appropriate for rapid reviews per the Cochrane Collaboration guidelines. We searched multiple databases, including gray literature, for primary studies and systematic reviews of prevention interventions targeting children, adolescents, and youth. We extracted data on study characteristics, quality, and translatability and synthesized evidence through narrative description and vote counting of controlled trials. Data are openly available on our Open Science Framework website. RESULTS: We found 6416 citations, of which 41 (0.64%) were eligible for inclusion (6 reviews and 35 primary studies of 33 interventions). Most interventions (26/33, 79%) combined intervention approaches and included an education component. Synthesis through vote counting showed benefits for all forms of digital well-being. Both included meta-analyses reported small positive effects on reductions of screen time. However, study reporting was overall lacking, impairing the ability to draw conclusions. CONCLUSIONS: As digital technology use increases, interventions to prevent problematic technology use and promote digital well-being continue to proliferate. Understanding context factors that influence healthy technology use and understanding the limitations of the current evidence are vital for informing future research. This review demonstrates positive findings for the effectiveness of prevention interventions and describes factors that may contribute to translation and implementation. Future research would benefit from following appropriate reporting guidelines, reporting both the benefits and harms of interventions, and including greater detail on factors informing translation. TRIAL REGISTRATION: PROSPERO CRD42023444387; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=444387.

58[Not Available].PubMed

Hanna Wiedemann, Jan-Ole Cloes, Kerstin Paschke, et al.
Prax Kinderpsychol Kinderpsychiatr. 2024 Nov;73(7):604-626. doi: 10.13109/prkk.2024.73.7.604.
New Media and Addiction in Youth New media, such as digital games, social media, and video streaming services, have emerged as fundamental channels for socialization and leisure activities among young people. Platforms such as TikTok, Fortnite, and YouTube do not only provide entertainment, enjoyment, and opportunities for social connection, but also carry the risk of excessive use. Particularly vulnerable youth, who turn to media to escape real-world problems and conflicts, can quickly become trapped in a vicious cycle, resulting in problematic usage habits with significant psychosocial consequences. This review presents the current state of research on Digital Media Use Disorders (DMUD) in youth. It outlines diagnostic criteria, presents recent data on epidemiology, etiology, and treatment approaches, and discusses implications for prevention. DMUD in youth remains a serious health issue in the aftermath of the pandemic. Parents and schools play a crucial role in guiding children and adolescents towards media literacy and self-regulated use of digital media. But also game and platform providers, who often employ manipulative mechanisms that prevent a self-regulated use, need to be held accountable. The introduction of the European Digital Services Act represents a crucial step in this direction.

59Digital Media and Developing Brains: Concerns and Opportunities.PubMed

John S Hutton, Jessica Taylor Piotrowski, Kara Bagot, et al.
Curr Addict Rep. 2024;11(2):287-298. doi: 10.1007/s40429-024-00545-3. Epub 2024 Mar 4.
PURPOSE OF REVIEW: The incorporation of digital technologies and their use in youth's everyday lives has been increasing rapidly over the past several decades with possible impacts on youth development and mental health. This narrative review aimed to consider how the use of digital technologies may be influencing brain development underlying adaptive and maladaptive screen-related behaviors. RECENT FINDINGS: To explore and provide direction for further scientific inquiry, an international group of experts considered what is known, important gaps in knowledge, and how a research agenda might be pursued regarding relationships between screen media activity and neurodevelopment from infancy through childhood and adolescence. While an understanding of brain-behavior relationships involving screen media activity has been emerging, significant gaps exist that have important implications for the health of developing youth. SUMMARY: Specific considerations regarding brain-behavior relationships involving screen media activity exist for infancy, toddlerhood, and early childhood; middle childhood; and adolescence. Transdiagnostic frameworks may provide a foundation for guiding future research efforts. Translating knowledge gained into better interventions and policy to promote healthy development is important in a rapidly changing digital technology environment.

60Integrating psychological and neurobiological considerations regarding the development and maintenance of specific Internet-use disorders: An Interaction of Person-Affect-Cognition-Execution (I-PACE) model.PubMed

Matthias Brand, Kimberly S Young, Christian Laier, et al.
Neurosci Biobehav Rev. 2016 Dec;71:252-266. doi: 10.1016/j.neubiorev.2016.08.033. Epub 2016 Aug 30.
Within the last two decades, many studies have addressed the clinical phenomenon of Internet-use disorders, with a particular focus on Internet-gaming disorder. Based on previous theoretical considerations and empirical findings, we suggest an Interaction of Person-Affect-Cognition-Execution (I-PACE) model of specific Internet-use disorders. The I-PACE model is a theoretical framework for the processes underlying the development and maintenance of an addictive use of certain Internet applications or sites promoting gaming, gambling, pornography viewing, shopping, or communication. The model is composed as a process model. Specific Internet-use disorders are considered to be the consequence of interactions between predisposing factors, such as neurobiological and psychological constitutions, moderators, such as coping styles and Internet-related cognitive biases, and mediators, such as affective and cognitive responses to situational triggers in combination with reduced executive functioning. Conditioning processes may strengthen these associations within an addiction process. Although the hypotheses regarding the mechanisms underlying the development and maintenance of specific Internet-use disorders, summarized in the I-PACE model, must be further tested empirically, implications for treatment interventions are suggested.

61Efficacy and Neural Mechanisms of Mindfulness Meditation Among Adults With Internet Gaming Disorder: A Randomized Clinical Trial.PubMed

Haosen Ni, Huabin Wang, Xuefeng Ma, et al.
JAMA Netw Open. 2024 Jun 3;7(6):e2416684. doi: 10.1001/jamanetworkopen.2024.16684.
IMPORTANCE: The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), recently identified internet gaming disorder (IGD) as a condition warranting more research, and few empirically validated treatments exist. Mindfulness meditation (MM) has multiple health benefits; however, its efficacy in treating IGD and potential neural mechanisms underlying MM treatment of the disorder remain largely unknown. OBJECTIVE: To explore the efficacy of MM used to treat adults with IGD and to identify neural mechanisms underlying MM. DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial was performed from October 1 to November 30, 2023, at Hangzhou Normal University in Hangzhou, China. Adults (aged ≥18 years) who met at least 6 of the 9 DSM-5-TR proposed criteria for IGD were recruited to receive either MM or progressive muscle relaxation (PMR). Data analysis was performed on December 1, 2023. INTERVENTION: Participants underwent MM training (an 8-session meditation program that focuses on attention and acceptance) and PMR training (an 8-time program for body relaxation) delivered in groups that met 2 times each week for 4 weeks. MAIN OUTCOMES AND MEASURES: This per-protocol analysis included only participants who finished the pretest assessment, 8 training sessions, and posttest assessment. The main outcomes were addiction severity (measured with the DSM-5-TR proposed criteria for IGD and with Internet Addiction Test scores), gaming craving (measured with Questionnaire for Gaming Urges scores), and blood oxygen level-dependent signals assessed with cue-craving tasks on fMRI. Behavioral and brain measurements were compared using analysis of variance. Functional connectivity (FC) among identified brain regions was measured to test connectivity changes associated with MM. RESULTS: This study included 64 adults with IGD. A total of 32 participants received MM (mean [SD] age, 20.3 [1.9] years; 17 women [53%]) and 32 received PMR (mean [SD] age, 20.2 [1.5] years; 16 women [50%]). The severity of IGD decreased in the MM group (pretest vs posttest: mean [SD], 7.0 [1.1] vs 3.6 [0.8]; P < .001) and in the PMR group (mean [SD], 7.1 [0.9] vs 6.0 [0.9]; P = .04). The MM group had a greater decrease in IGD severity than the PMR group (mean [SD] score change for the MM group vs the PMR group, -3.6 [0.3] vs -1.1 [0.2]; P < .001). Mindfulness meditation was associated with decreased brain activation in the bilateral lentiform nuclei (r = 0.40; 95% CI, 0.19 to 0.60; P = .02), insula (r = 0.35; 95% CI, 0.09 to 0.60; P = .047), and medial frontal gyrus (MFG; r = 0.43; 95% CI, 0.16 to 0.70; P = .01). Increased MFG-lentiform FC and decreased craving (pretest vs posttest: mean [SD], 58.8 [15.7] vs 33.6 [12.0]; t = -8.66; ƞ2 = 0.30; P < .001) was observed after MM, and changes in MFG-lentiform FC mediated the relationship between increased mindfulness and decreased craving (mediate effect, -0.17; 95% CI, -0.32 to -0.08; P = .03). CONCLUSIONS AND RELEVANCE: In this study, MM was more effective in decreasing addiction severity and gaming cravings compared with PMR. These findings indicate that MM may be an effective treatment for IGD and may exert its effects by altering frontopallidal pathways. TRIAL REGISTRATION: Chinese Clinical Trial Registry Identifier: ChiCTR2300075869.

62Internet Gaming Disorder in Children and Adolescents.PubMed

Douglas A Gentile, Kira Bailey, Daphne Bavelier, et al.
Pediatrics. 2017 Nov;140(Suppl 2):S81-S85. doi: 10.1542/peds.2016-1758H.
The American Psychiatric Association recently included Internet gaming disorder (IGD) as a potential diagnosis, recommending that further study be conducted to help illuminate it more clearly. This paper is a summary of the review undertaken by the IGD Working Group as part of the 2015 National Academy of Sciences Sackler Colloquium on Digital Media and Developing Minds. By using measures based on or similar to the IGD definition, we found that prevalence rates range between ∼1% and 9%, depending on age, country, and other sample characteristics. The etiology of IGD is not well-understood at this time, although it appears that impulsiveness and high amounts of time gaming may be risk factors. Estimates for the length of time the disorder can last vary widely, but it is unclear why. Although the authors of several studies have demonstrated that IGD can be treated, no randomized controlled trials have yet been published, making any definitive statements about treatment impossible. IGD does, therefore, appear to be an area in which additional research is clearly needed. We discuss several of the critical questions that future research should address and provide recommendations for clinicians, policy makers, and educators on the basis of what we know at this time.

63The association between smartphone use and myopia progression in children: a prospective cohort study.PubMed

Jing Li
BMC Pediatr. 2025 May 13;25(1):378. doi: 10.1186/s12887-025-05715-4.
BACKGROUND: The increasing myopia of children has sparked speculations on whether the use of smartphones can accelerate this rate. This study aims to identify possible predictors for myopic progression in children with smartphones over a period of two years. METHODS: This prospective cohort study recruited 523 children aged 6 to 14 years. A comprehensive eye examination was performed at baseline and at 6, 12, and 24 months, which included spherical equivalent refractive error (with cycloplegia) and axial length. Smartphones usage patterns were traced using mobile usage monitoring app. Outdoor activities, sleep duration, and parental history of myopia were documented with structured questionnaires. Data on myopic progression associated with smartphone use are presented with multivariate regression analyses. RESULTS: It demonstrated that daily usage of smartphones was positively associated with the progression of myopia (5.1 ± 1.2 vs. 3.4 ± 1.0 h, p < 0.001). Increased time of outdoor activity (1.2 ± 0.6 vs. 2.1 ± 0.8 h/day, p < 0.001) and longer distances of screens (25.8 ± 5.4 vs. 31.4 ± 6.2 cm, p < 0.001) were inversely related to myopic progression. Of importance is that children whose parents experienced myopia exhibited higher progression rates compared to those who did not (65.5% vs. 44.4%, p < 0.001). CONCLUSION: This study indicated that daily duration of smartphones use, time of outdoor activity, distance of screen, and parental myopia are predictors of childhood myopic progression.

64Physiotherapy in Text Neck Syndrome: A Scoping Review of Current Evidence and Future Directions.PubMed

Joanna Piruta, Wojciech Kułak
J Clin Med. 2025 Feb 19;14(4):1386. doi: 10.3390/jcm14041386.
Musculoskeletal disorders associated with excessive smartphone use represent a significant health issue. Text neck syndrome is one such disorder within that group, increasingly affecting individuals worldwide across various age groups. The phenomenon of text neck may occur in individuals who frequently and for prolonged periods adopt a forward-flexed neck and head position while looking at the screens of mobile electronic devices. Various therapeutic methods are used in the treatment of text neck syndrome. However, there is no consensus on text neck rehabilitation, which poses a challenge for physiotherapists. The aim of this study is to analyze the phenomenon of text neck, with a particular emphasis on current scientific reports regarding the rehabilitation of text neck syndrome. The scoping review was conducted to determine the physiotherapy methods currently used in the treatment of individuals with text neck, assess their impact on symptom reduction, and identify existing knowledge gaps and limitations in the current literature on the rehabilitation of text neck syndrome. A scoping review was conducted on the treatment of text neck syndrome based on electronic databases: PubMed, ResearchGate, Physiotherapy Evidence Database (PEDro), and the Cochrane Library. The databases were searched up to 1 December 2024. The inclusion criteria comprised studies investigating physiotherapy interventions for individuals with text neck, published between 2018 and 2024 and written in English. A total of fifteen papers were reviewed, focusing on various methods used in text neck rehabilitation, including postural correction exercises, stabilization exercises, strengthening and stretching exercises, Pilates, PNF (Proprioceptive Neuromuscular Facilitation), kinesiology taping, Bowen therapy, and manual therapy. Nearly all studies were conducted in the adult population (93%), with the majority of studies taking place in India (60%). In summary, all studies suggest that appropriate physiotherapeutic interventions can provide significant benefits, including pain reduction, posture correction, and improved range of motion in the cervical spine. The best outcomes appear to be achieved by combining various therapeutic techniques. However, further high-quality research is needed to strengthen the evidence and offer reliable recommendations for clinical practice. Additionally, there is limited research on physiotherapy for text neck in the pediatric population, presenting a potential area for future studies.

65Sensor-based physical activity, sedentary time, and reported cell phone screen time: A hierarchy of correlates in youth.PubMed

Pedro B Júdice, João P Magalhães, Gil B Rosa, et al.
J Sport Health Sci. 2021 Jan;10(1):55-64. doi: 10.1016/j.jshs.2020.03.003. Epub 2020 Mar 16.
BACKGROUND: Evidence on correlates relies on subjective metrics and fails to include correlates across all levels of the ecologic model. We determined which correlates best predict sensor-based physical activity (PA), sedentary time (ST), and self-reported cell phone screen time (CST) in a large sample of youth, while considering a multiplicity of correlates. METHODS: Using sensor-based accelerometry, we assessed the PA and ST of 2179 youths. A χ automatic interaction detection algorithm was used to hierarchize the correlates associated with too much ST (> 50th percentile), insufficient moderate-to-vigorous PA (MVPA) (<60 min/day), and prolonged CST (≥2 h/day). RESULTS: Among youth 10-14 years old, the correlates for being inactive consisted of being a girl, not having sport facilities in the neighborhood, and not perceiving the neighborhood as a safe place, whereas in the youth 15-18 years old, the correlate for being inactive was not performing sports (9.7% chance of being active). The correlates for predicting high ST in the younger group was not performing sports (55.8% chance for high ST), and in the older group, the correlates were not owning a pet, perceiving the neighborhood as safe, and having inactive parents (63.7% chance for high ST). In the younger group, the greatest chances of having high CST were among those who were in the last elementary school years, who were girls, and who did not have friends in the neighborhood (73.1% chance for high CST), whereas in the older group, the greatest chance for having high CST was among those who were girls and had a TV in the bedroom (74.3% chance for high CST). CONCLUSION: To counteract ST and boost MVPA among youths, a specific focus on girls, the promotion of sport participation and facilities, neighborhood safety, and involvement of family must be prioritized.

66ObMetrics: A Shiny app to assist in metabolic syndrome assessment in paediatric obesity.PubMed

Álvaro Torres-Martos, Francisco Requena, Guadalupe López-Rodríguez, et al.
Pediatr Obes. 2025 Aug;20(8):e70016. doi: 10.1111/ijpo.70016. Epub 2025 May 5.
OBJECTIVE: To introduce ObMetrics, a free and user-friendly Shiny app that simplifies the calculation, data analysis, and interpretation of Metabolic Syndrome (MetS) outcomes according to multiple definitions in epidemiological studies of paediatric populations. We illustrate its usefulness using ethnically different populations in a comparative study of prevalence across cohorts and definitions. METHODS: We conducted a case study using data from two ethnically diverse paediatric populations: a Hispanic-American cohort (N = 1759) and a Hispanic-European cohort (N = 2411). Using ObMetrics, we computed MetS classifications (Cook, Zimmet, Ahrens) and component-specific z-scores for each participant to compare prevalences. RESULTS: The analysis revealed significant heterogeneity in MetS prevalence across different definitions and cohorts. According to Cook, Zimmet, and Ahrens's definitions, MetS prevalence in children with obesity was 25%, 12%, and 48%, respectively, in the Hispanic-European cohort, and 38%, 27%, and 66% in the Hispanic-American cohort. Calculating component-specific z-scores in each cohort also highlighted ethnic-specific differences in lipid metabolism and blood pressure. By automating these complex calculations, ObMetrics considerably reduced analysis time and minimised the potential for errors. CONCLUSION: ObMetrics proved to be a powerful tool for paediatric research, generating detailed reports on the prevalence of MetS and its components based on various definitions and reference standards. Our case study further provides valuable insights into the challenges of characterising metabolic health in paediatric populations. Future efforts should focus on developing unified consensus guidelines for paediatric MetS. Meanwhile, ObMetrics enables earlier identification and targeted intervention for high-risk children and adolescents.

67Differences in metabolic syndrome severity and prevalence across nine waist circumference measurements collected from smartphone digital anthropometrics.PubMed

Austin J Graybeal, Caleb F Brandner, Abby T Compton, et al.
Clin Nutr ESPEN. 2024 Dec;64:390-399. doi: 10.1016/j.clnesp.2024.10.158. Epub 2024 Oct 30.
BACKGROUND & AIMS: Given the technological advances in 3D smartphone (SP) anthropometry, this technique presents a unique opportunity to improve metabolic syndrome (MetS) screening through optimal waist circumference (WC) landmarking procedures. Thus, the purpose of this study was to evaluate the associations between individual MetS risk factors and nine independent WC sites collected using tape measurement or SP anthropometrics and to determine the differences in MetS severity and prevalence when using these different WC measurement locations. METHODS: A total of 130 participants (F:74, M:56; age: 27.8 ± 11.1) completed this cross-sectional evaluation. Using traditional tape measurement, WC was measured at the lowest rib (WC), superior iliac crest (WC), and between the WC and WC (WC). Additionally, WC measurements were automated using a SP application at six sites along the torso. MetS risk factors were used to calculate MetS severity (MetS) and prevalence. Associations were evaluated using multiple linear regression, the effect of each WC site on MetS was analyzed using mixed-models ANCOVA, and differences in MetS prevalence using WC as the current standard were determined using sensitivity, specificity, chi-squared tests, and odds ratios. RESULTS: The reference SP-WC (SP) and WC demonstrated the largest associations (all p < 0.001) with HDL cholesterol (SP: -0.48; WC: -0.49), systolic (SP: 0.32; WC: 0.30) and diastolic blood pressure (SP: 0.34; WC: 0.32), and fasting blood glucose (SP: 0.38; WC: 0.37). SP and WC were the only WC without significantly different MetS; yet demonstrated lower MetS and sensitivity (SP: 77.8 %; WC: 74.1 %) relative to WC, the conventional (or standard) WC measure. CONCLUSIONS: Compared to the current standard, SP and WC protocols are more highly associated with individual MetS risk factors and produce different MetS and diagnoses; highlighting the need for new MetS WC protocols. Given the surge in remote/mobile healthcare, SP may be an alternative to traditional methods in this context but requires further investigation before implementation.

68Screen viewing behavior and sleep duration among children aged 2 and below.PubMed

Bozhi Chen, Rob M van Dam, Chuen Seng Tan, et al.
BMC Public Health. 2019 Jan 14;19(1):59. doi: 10.1186/s12889-018-6385-6.
BACKGROUND: Few studies have investigated the association between screen viewing (SV) and sleep duration among young children. This study aims to examine the association between total and device-specific SV and sleep duration among children aged 2 and below. METHODS: We conducted a cross-sectional study of 714 Singaporean children aged 2 years and below. Parents were recruited during routine well-child clinic visits from two national polyclinics. In Singapore, all parents visit well-child clinics with their children at regular intervals for routine check-ups and vaccinations. Socio-demographic characteristics, duration of total and device-specific SV, and sleep duration were reported by parents via interviewer-administered questionnaires. Multiple linear regression analysis was used to assess associations between various types of SV and sleep duration, adjusted for socio-demographic variables. Due to significant interaction between SV and age, stratified analyses for children aged less than 6 months and those aged 7-24 months were performed. RESULTS: The prevalence of daily SV among children was 53.1%; 28.3% in children up to 6 months and 73.8% in children aged 7 to 24 months. TV viewing was reported for 44.3% of all children and mobile device SV for 30.1%. Children's average sleep duration was 13.9 (SD = 3.5) hours daily and younger children had longer sleep duration than older ones (up to 6 months: mean = 15.6 h, SD = 3.9; 7-24 months: mean = 12.4 h, SD = 2.2; P < 0.01). In the regression analysis among all children, each 1 h per day increment in total SV was significantly associated with 0.26 h shorter sleep duration with similar significant associations for TV (β = - 0.28 h, 95%CI: -0.50, - 0.06) and mobile devices (β = - 0.35 h, 95%CI: -0.61, - 0.09). Stratified analysis revealed significantly greater reductions in sleep with higher SV among children aged 6 months and below (β = - 0.73 h, 95%CI: -1.12, - 0.34), while associations were weaker in older children (β = - 0.13 h, 95% CI: -0.24, - 0.01). CONCLUSIONS: This study provides evidence for a substantial association between longer SV and shorter sleep duration among very young children. These associations appeared stronger among children aged 6 months and below as compared with those aged 7 to 24 months. Further studies are warranted to confirm our findings.

69Mobile phones: are children at higher risk?PubMed

Norbert Leitgeb
Wien Med Wochenschr. 2008;158(1-2):36-41. doi: 10.1007/s10354-007-0447-1.
The use of mobile phones by children has in recent years been increasing, the onset starting earlier and earlier. This has led to concern about whether children might be at higher risk and whether mobile phone use should even be forbidden. Advice from highly reputed committees on both national and international levels is contradictory and on the whole more confusing than helpful to worried parents and physicians, but this can be explained. It is shown here that different opinions derived from the same database reflect the different way in which uncertainty of knowledge is dealt with. Based on the assessments of the international committee and established knowledge on children's development it can be concluded that existing exposure limits do in fact provide reasonable safety. Compared to adults, however, children do in fact need to be considered at a relatively higher potential risk, depending on their phase of development. If adults are advised to minimise their exposure, this is even more justified for children. However, circular reasoning must be avoided: the uncertainty-triggered application of precaution must not be misinterpreted as evidence for definite risk.

70Smartphone addiction and victimization predicts sleep problems and depression among children.PubMed

Fong-Ching Chang, Chiung-Hui Chiu, Ping-Hung Chen, et al.
J Pediatr Nurs. 2022 May-Jun;64:e24-e31. doi: 10.1016/j.pedn.2022.01.009. Epub 2022 Jan 31.
BACKGROUND: In this study we examined the phenomena of smartphone addiction, online harassment, and school bullying/victimization to predict the prospective influence these could have on the onset and persistence of sleep problems and depression among children. METHODS: Responses from 2155 fifth-grade children recruited from 30 primary schools in Taipei were assessed, and a follow-up was performed in the 6th grade. Self-administered questionnaires were collected for each year. FINDINGS: Children who reported smartphone addictions, online harassment, and school bullying/victimization coupled with an increase in those factors were more likely to experience the onset and persistence of sleep problems. In addition, children who reported smartphone addiction, online harassment, school bullying/victimization, and poor sleep quality were more likely to experience the onset and persistence of depression. IMPLICATIONS: School nurses or pediatric nurses should be able to assess children's Internet use and risks to understand potential influences on sleep quality and mental status and provide recommendations for children, parents and schools.

71Longitudinal Cross-Lagged Analysis Between Mobile Phone Dependence, Friendships, and Depressive Symptoms Among Korean Adolescents.PubMed

Chung Choe, Seunghee Yu
Cyberpsychol Behav Soc Netw. 2022 Jul;25(7):450-457. doi: 10.1089/cyber.2022.0015. Epub 2022 May 25.
This study examined reciprocal longitudinal effects between mobile phone dependence, friendships, and depressive symptoms using 3-year longitudinal data from the Korean Children and Youth Panel Survey. An autoregressive cross-lagged model was applied to a sample of 1,737 adolescents. Results suggested that unidirectional relationships exist between the three variables: friendships reduce mobile phone dependence ( = -0.068, = 0.058; = -0.118, < 0.001) and depressive symptoms increase mobile phone dependence ( = 0.082, = 0.001; = 0.128, < 0.001); however, mobile phone dependence does not affect friendships and depressive symptoms. In addition, this study provided evidence of the negative bidirectional relationship between friendships and depressive symptoms. We suggest that, to prevent or treat adolescents' mobile phone dependence, a practical approach regarding friendships and depressive symptoms is needed.

72Predicting Smartphone Addiction Trajectories in Korean Adolescents: A Longitudinal Analysis of Protective and Risk Factors Based on a National Survey from 2018 to 2020.PubMed

Kyung-Yi Do, Chun-Bae Kim
Asia Pac J Public Health. 2024 Sep;36(6-7):550-557. doi: 10.1177/10105395241259243. Epub 2024 Jun 20.
This longitudinal study aimed to identify the role of psychosocial factors affecting smartphone addiction (SA) among Korean adolescents and predict the trajectory of SA based on the Korean Children and Youth Panel Survey (KCYPS) 2018 to 2020. The dependent variable was SA score as measured by the Korean Smartphone Addiction Propensity Scale (SAPS), and the independent variables were psychosocial factors (attention, grit, life satisfaction, self-esteem, aggression, depression, social withdrawal and physical symptom). Generalized estimating equation (GEE) analysis (adjusted for covariates) results indicated that attention (B = -0.346, < .001), grit (B = -0.402, < .001), life satisfaction (B = -0.150, < .001), and self-esteem (B = -0.099, < .001) were protective factors for reducing SA score. Conversely, aggression (B = 0.222, < .001) and depression (B = 0.067, = .005) were predicted to be risk factors for increasing SA score. A better understanding of the relationship between behavioral addiction and psychosocial development factors in adolescence will assist in the development of more effective prevention and treatment strategies.

73Smartphone Addiction and Anxiety in Adolescents - A Cross-sectional Study.PubMed

Kitai Kim, Jeong Yee, Jee Eun Chung, et al.
Am J Health Behav. 2021 Sep 30;45(5):895-901. doi: 10.5993/AJHB.45.5.9.
The overuse of smartphones affects physical, social, and psychological well-being. However, research on smartphone addiction and anxiety disorders is scarce. Therefore, the objective of this study was to investigate the association between anxiety and smartphone addiction risk in Korean adolescents. This study used a cross-sectional survey method. We used the Revised Children's Manifest Anxiety Scale to assess anxiety symptoms and we used the Korean Smartphone Addiction Proneness Scale index to evaluate the degree of high-risk or at-risk for smartphone addiction. Analyses were performed for 1733 adolescents, including 771 boys and 962 girls. The high-risk or at-risk group for smartphone addiction accounted for 20.1% (p < .0001). Total anxiety scale score, as well as physiological anxiety, oversensitivity, and social concern categories were statistically different among levels of smartphone addiction risk (all p < .0001). Multivariate analysis showed that poor self-reported health level, higher risk of smartphone addiction, having fewer close friends, caffeine drink consumption, female sex, and alcohol use were associated with greater anxiety. Management of smartphone addiction seems to be essential for proper psychological health. There is an urgent need to develop a way to prevent smartphone addiction on a social level.

74Addictive Screen Use Trajectories and Suicidal Behaviors, Suicidal Ideation, and Mental Health in US Youths.PubMed

Yunyu Xiao, Yuan Meng, Timothy T Brown, et al.
JAMA. 2025 Jul 15;334(3):219-228. doi: 10.1001/jama.2025.7829.
IMPORTANCE: Increasing child and adolescent use of social media, video games, and mobile phones has raised concerns about potential links to youth mental health problems. Prior research has largely focused on total screen time rather than longitudinal addictive use trajectories. OBJECTIVES: To identify trajectories of addictive use of social media, mobile phones, and video games and to examine their associations with suicidal behaviors and ideation and mental health outcomes among youths. DESIGN, SETTING, AND PARTICIPANTS: Cohort study analyzing data from baseline through year 4 follow-up in the Adolescent Brain Cognitive Development Study (2016-2022), with population-based samples from 21 US sites. EXPOSURES: Addictive use of social media, mobile phones, and video games using validated child-reported measures from year 2, year 3, and year 4 follow-up surveys. MAIN OUTCOMES AND MEASURES: Suicidal behaviors and ideation assessed using child- and parent-reported information via the Kiddie Schedule for Affective Disorders and Schizophrenia. Internalizing and externalizing symptoms were assessed using the parent-reported Child Behavior Checklist. RESULTS: The analytic sample (n = 4285) had a mean age of 10.0 (SD, 0.6) years; 47.9% were female; and 9.9% were Black, 19.4% Hispanic, and 58.7% White. Latent class linear mixed models identified 3 addictive use trajectories for social media and mobile phones and 2 for video games. Nearly one-third of participants had an increasing addictive use trajectory for social media or mobile phones beginning at age 11 years. In adjusted models, increasing addictive use trajectories were associated with higher risks of suicide-related outcomes than low addictive use trajectories (eg, increasing addictive use of social media had a risk ratio of 2.14 [95% CI, 1.61-2.85] for suicidal behaviors). High addictive use trajectories for all screen types were associated with suicide-related outcomes (eg, high-peaking addictive use of social media had a risk ratio of 2.39 [95% CI, 1.66-3.43] for suicidal behaviors). The high video game addictive use trajectory showed the largest relative difference in internalizing symptoms (T score difference, 2.03 [95% CI, 1.45-2.61]), and the increasing social media addictive use trajectory for externalizing symptoms (T score difference, 1.05 [95% CI, 0.54-1.56]), compared with low addictive use trajectories. Total screen time at baseline was not associated with outcomes. CONCLUSIONS AND RELEVANCE: High or increasing trajectories of addictive use of social media, mobile phones, or video games were common in early adolescents. Both high and increasing addictive screen use trajectories were associated with suicidal behaviors and ideation and worse mental health.

75Screen time and suicidal behaviors among U.S. children 9-11 years old: A prospective cohort study.PubMed

Jonathan Chu, Kyle T Ganson, Fiona C Baker, et al.
Prev Med. 2023 Apr;169:107452. doi: 10.1016/j.ypmed.2023.107452. Epub 2023 Feb 17.
Suicide is a leading cause of death among adolescents. Emerging literature has described relationships between excessive screen time and suicidal behaviors, though findings have been mixed. The objective of this study is to determine the prospective associations between screen time and suicidal behaviors two-years later in a national (U.S.) cohort of 9-11-year-old-children. We analyzed prospective cohort data from the Adolescent Brain Cognitive Development (ABCD) Study (N = 11,633). Logistic regression analyses were estimated to determine the associations between baseline self-reported screen time (exposure) and suicidal behaviors (outcome) based on the Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS-5) at two-year-follow-up. Participants reported an average of 4.0 h of total screen time per day at baseline. At two-year-follow-up, 1.38% of the sample reported at least one suicidal behavior. Each additional hour of total screen time was prospectively associated with 1.09 higher odds of suicidal behaviors at 2-year-follow-up (95% CI 1.03-1.14), after adjusting for covariates. For specific screen time modalities, each additional hour of texting (aOR 1.36, 95% CI 1.06-1.74), video chatting (aOR 1.30, 95% CI 1.03-1.65), watching videos (aOR 1.21, 95% CI 1.04-1.39), and playing video games (aOR 1.18, 95% CI 1.01-1.38) was associated with higher odds of subsequent suicidal behaviors. Higher screen time is associated with higher odds of reporting suicidal behaviors at two-year-follow-up. Future research should seek to identify how specific screen time experiences may influence suicidal behaviors.

76Nomophobia, Psychopathology, and Smartphone-Inferred Behaviors in Youth With Depression: Longitudinal Study.PubMed

Tianyi Zhang, Andres Camargo, Lianne Schmaal, et al.
JMIR Form Res. 2025 Feb 19;9:e57512. doi: 10.2196/57512.
BACKGROUND: Smartphones have become an indispensable part of people's lives, and the fear of being without them, what has been termed "no mobile phone phobia" (nomophobia), is a growing phenomenon. The rise of problematic smartphone use highlights the urgent need to explore the intricate relationship between smartphones and human behavior. However, the connections between nomophobia, mental health indicators, smartphone use patterns, and daily activities remain largely underexplored. OBJECTIVE: This study aimed to explore the relationship between young adults with depression and smartphones and investigate nomophobia by analyzing data obtained from a pilot study of depression in a youth cohort. Exploring nomophobia can enhance our understanding of the dynamics between young adults and smartphone use, potentially empowering them to manage and regulate their smartphone use more effectively. METHODS: During an 8-week period, data collected via smartphone sensors, such as locations and screen status, were gathered from a cohort of 41 individuals diagnosed with major depressive disorder. In addition to passive-sensing smartphone data, the study collected ecological momentary assessments and psychometric measures, including the Nomophobia Questionnaire, which formed the basis of our investigation. We explored statistical associations among smartphone-derived behavioral features, psychometric indicators, and nomophobia. In addition, we used behavioral and psychometric data to develop regression models demonstrating the prediction of nomophobia levels. RESULTS: Our findings revealed that the level of nomophobia was positively associated with depression and negative affect, lower geolocation movements, and higher comfort with smartphone sensing. The exploratory predictive linear regression models demonstrated the feasibility of predicting an individual's Nomophobia Questionnaire score based on their smartphone sensing data. These models effectively used input features derived from both a combination of smartphone sensing data and psychometric measures and from smartphone sensing data alone. CONCLUSIONS: Our work is the first to explore the relationship between nomophobia and smartphone sensor data. It provides valuable insights into the predictors of nomophobia level, contributing to the understanding of the relationship between smartphones and human behavior and paving the way for future studies.

77Children's and adolescents' negative internet experiences and the association with quality of life and behavioural difficulties: a cross-sectional study.PubMed

Deborah Prkno, Nico Grafe, Marian S Schulz, et al.
BMJ Paediatr Open. 2025 Apr 17;9(1):e003135. doi: 10.1136/bmjpo-2024-003135.
BACKGROUND: Numerous studies have assessed cyberbullying victimisation and perpetration in children. However, the internet poses risks beyond cyberbullying. This study explores the prevalence of eight different negative online experiences and their associations with sociodemographic characteristics, media use, behavioural difficulties and quality of life in children and adolescents. METHODS: The sample included 622 participants aged 10-17 years who provided information on negative internet experiences (exclusion, financial loss, disturbing content, hurtful comments, tracking, misuse of personal data, threat, other harmful experiences), media use, symptoms of problematic smartphone use (PSU) (Smartphone Addiction Proneness Scale), behavioural difficulties (Strengths and Difficulties Questionnaire), quality of life (KIDSCREEN-27 Health-Related Quality of Life Questionnaire for Children and Young People and their Parents) and sociodemographic characteristics (age, sex, type of school, maternal education, family income). Poisson regressions were performed to evaluate associations. RESULTS: Negative internet experiences were prevalent in 31% of participants. Individual factors (older age, female sex, family income), media usage characteristics (high media use, PSU symptoms) and mental health factors (poor quality of life, behavioural difficulties) were associated with a higher frequency of self-reported negative internet experiences. In contrast, type of school and maternal education were not significantly associated with negative internet experiences. CONCLUSION: Our study indicates that negative internet experiences are highly prevalent in adolescents, particularly those struggling with mental health issues. This underlines the importance of preventive measures. Longitudinal studies are needed to disentangle the potential interdependence of mental health and negative internet experiences.

78Problematic smartphone use and academic achievement: A systematic review and meta-analysis.PubMed

Adrian Paterna, Manuel Alcaraz-Ibáñez, Jose M Aguilar-Parra, et al.
J Behav Addict. 2024 Apr 26;13(2):313-326. doi: 10.1556/2006.2024.00014. Print 2024 Jun 26.
BACKGROUND AND AIMS: The present study aimed to synthesize existing quantitative evidence on the relationship between problematic smartphone use (PSU) and academic achievement with a focus on quantifying its magnitude and examining its potential moderators. METHODS: Eligible studies were searched for up to February 10, 2023 in six different databases (i.e., MEDLINE, Current Contents Connect, PsycINFO, Web of Science, SciELO, and Dissertations & Theses Global). Studies were considered eligible if they provided information derived from self-report instruments that allowed statistical calculation of the relationship between PSU and academic achievement. Pooled effect sizes (r) were computed using a random-effects model. Meta-regressions were conducted to test the influence of study-level moderators on the relationship of interest. Influence analyses and a three-parameter selection model (3PSM) were conducted to examine the robustness of the results and publication bias, respectively. RESULTS: A total of 33 effect sizes from 29 studies (n = 48,490) were retrieved. Results showed a small effect size (r = -0.110), which tended to be larger in samples consisting of students from elementary and middle schools. DISCUSSION AND CONCLUSIONS: Findings from the present study contribute to the understanding of a potential determinant of decreased academic achievement by providing evidence that PSU may be one of them.

79Problem Technology Use, Academic Performance, and School Connectedness among Adolescents.PubMed

Hugues Sampasa-Kanyinga, Hayley A Hamilton, Gary S Goldfield, et al.
Int J Environ Res Public Health. 2022 Feb 18;19(4):2337. doi: 10.3390/ijerph19042337.
BACKGROUND: Little is known about the association between problem technology use in adolescents and school-related outcomes. The purpose of this study was to determine the prevalence of problem technology use and examine its association with academic performance and school connectedness in a sample of students across Ontario, Canada. METHODS: Self-reported data from a sample of 4837 students in grades 9 to 12 (mean age: 15.9 years; 49.5% females) were cross-sectionally analyzed. Ordered logistic regression models were adjusted for important covariates. RESULTS: We found that 35.8% of students used their screen device for at least 5 h a day and about 18.6% had moderate-to-serious symptoms of problem technology use, a prevalence that was higher in females (22.4%) than males (14.9%). Heavy technology use was differentially associated with lower academic performance and lower levels of school connectedness in males and females. Having moderate-to-serious symptoms of problem technology use was associated with lower academic performance among males (AOR = 0.68, 95% CI = 0.53-0.87) and females (AOR = 0.66, 95% CI = 0.52-0.84). It was also associated with less school connectedness in both males (AOR = 0.65, 95% CI = 0.50-0.86) and females (AOR = 0.63, 95% CI = 0.51-0.78). CONCLUSION: Excessive use and problem technology use are highly prevalent among secondary school students, and they are associated with lower academic performance and lower levels of school connectedness.

80Digital Device Usage and Childhood Cognitive Development: Exploring Effects on Cognitive Abilities.PubMed

Vicente Javier Clemente-Suárez, Ana Isabel Beltrán-Velasco, Silvia Herrero-Roldán, et al.
Children (Basel). 2024 Oct 27;11(11):1299. doi: 10.3390/children11111299.
UNLABELLED: The increasing ubiquity of digital devices in childhood had outpaced the understanding of their effects on cognitive development, creating a significant research gap regarding their long-term impact. OBJECTIVE: The present narrative overview explored the complex relationship between digital device usage and cognitive development in childhood. METHODS: We conducted a comprehensive literature search across multiple databases, including PubMed, Embase, Scopus, and Web of Science, to critically assess cognitive domains such as attention, memory, executive functions, problem-solving skills, and social cognition. Incorporating over 157 peer-reviewed studies published between 2001 and 2024, we used strict inclusion and exclusion criteria to ensure scientific rigor. RESULTS: The review integrated empirical findings with established theoretical frameworks, particularly from cognitive development and media psychology, to highlight both the advantages and risks of early, frequent exposure to technology. The potential for digital devices to enhance cognitive skills, such as multitasking and information processing, was weighed against risks such as cognitive overload, diminished attention spans, and impaired social skills. We also examined psychological and behavioral outcomes, including identity formation, emotional regulation, and maladaptive behaviors associated with excessive screen time. Additionally, we identified strategies to mitigate negative effects, emphasizing structured digital engagement and parental involvement to support healthy cognitive and psychological growth. Our findings provided actionable recommendations for parents, educators, and policymakers, promoting optimal digital practices that enhanced cognitive development while safeguarding against potential harms. CONCLUSIONS: The review offered essential insights for stakeholders in child development, education, and policy-making, highlighting the need for balanced integration of digital tools in childhood learning environments.

81Exploring the Relationship of Smartphone Addiction on Attention Deficit, Hyperactivity Symptoms, and Sleep Quality Among University Students: A Cross-Sectional Study.PubMed

Ibrahim Zeyrek, Muhammed Fatih Tabara, Mahmut Çakan
Brain Behav. 2024 Nov;14(11):e70137. doi: 10.1002/brb3.70137.
BACKGROUND: The prevalence of smartphone usage is steadily rising, leading to the potential development of addiction due to problematic use. This study examined the relationship between smartphone addiction, self-perceived attention deficit and hyperactivity symptoms, and sleep quality among 443 university students at Bingöl University. METHODS: Participants completed several questionnaires, including the Smartphone Addiction Scale-Short Version, the Pittsburgh Sleep Quality Index, and the Adult ADHD Self-Report Scale. RESULTS: This study examined 443 participants, with a mean age of 20.97 ± 3.29, of whom 72.7% (n = 322) were female. Results showed that the majority of participants primarily used smartphones (94.8%, n = 420) for social media browsing (49.9%, n = 221). Factors such as smoking, preference for smartphone screens, and prolonged screen exposure significantly affected sleep quality. Smartphone addiction rates were notable, with 50.4% (n = 61) of males and 47.2% (n = 152) of females being affected; this addiction was associated with poorer sleep quality. Correlations were found between age, sleep duration, and scores on smartphone addiction, sleep quality, and attention deficit scales. Linear regression analysis revealed that age, attention deficit scores, and sleep quality scores significantly influenced levels of smartphone addiction. CONCLUSIONS: These findings contribute valuable insights into the impact of smartphone addiction on attention and sleep in university students.

82The Relationship Between Parental Neglect, School Adjustment, and Smartphone Dependence in Korean Adolescents: Verification Using Multivariate Latent Growth Modeling.PubMed

Sung Man Bae
Child Psychiatry Hum Dev. 2024 Oct;55(5):1250-1258. doi: 10.1007/s10578-022-01485-7. Epub 2022 Dec 28.
The Social bonding theory assumes that social ties are closely associated with maladaptive behavior, and this theory may be applied to explain the smartphone dependence in adolescence. The purpose of this study was to verify how school adjustment mediated the relationship between the parental neglect and smartphone dependence. The data from Korean Children and Youth Panel Survey were utilized in this study. Participants were 2280 students in the 2nd year of middle school [male 1152, female 1128; 13.89 years (SD = 0.34)] who were followed up for four years. We conducted a Multivariate Latent Growth Modeling (LGM) to verify the relationships between variables. In addition, mediating effect was analyzed using the Bootstrapping Test. Findings indicated that parental neglect was negatively associated with school adjustment in the first wave, and school adjustment showed a greater decrease as parental neglect indicated a greater increase. In addition, school adjustment was negatively associated with smartphone dependence in the first wave, and smartphone dependence showed a greater decrease as school adjustment indicated a greater increase. Mediating effect indicated that parental neglect indirectly influences smartphone dependence fully mediating school adjustment. In conclusion, parental neglect indirectly influences smartphone dependence by interfering with school adjustment. In addition, reducing the negative effects of parental neglect on school adaptation may be an effective strategy to prevent smartphone dependence in adolescence.

83[Strategies and effects of digital interventions in overweight and obesity treatments in children and adolescents-a systematic review].PubMed

Sabine Pawellek, Alexandra Ziegeldorf, Hagen Wulff
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2022 May;65(5):624-634. doi: 10.1007/s00103-022-03512-3. Epub 2022 Mar 23.
BACKGROUND: Rising obesity prevalence in childhood and adolescence are characterized by unhealthy lifestyles such as low physical activity due to high media use. Recent studies use the accessibility of this target group through digital media, whereby technologies represent new approaches in the intervention design of weight reduction. However, the question arises as to which digital combinations and methodological program concepts condition effective body mass index (BMI) changes. AIM: To gain insights into effective program design and media use; digital intervention strategies for BMI reduction in overweight and obese children and adolescents will be analyzed and evaluated. METHODS: A systematic review was conducted in the databases MEDLINE via PubMed, Science Direct, and Web of Science to analyze studies from 2016 to 2021 on changes in BMI and BMI z‑score of overweight and obese 6‑ to 18-year-olds. Methodological study quality was assessed according to the Cochrane Risk of Bias guidelines. RESULTS: From 3974 studies, seven articles describing the use of fitness wristbands, smartphones, and computer-based programs were identified. All media achieved BMI reductions, with smartphone interventions via calls and messages causing the most significant changes. DISCUSSION: Smartphones as providers of digital programs (e.g., apps) offer effective approaches to obesity reduction. Based on the data, the selection and combination of several media as well as the relevance of family involvement and the methodological foundation of the measures are confirmed. Due to the young age of the participants, media interventions must be made accessible to the target group.

84Fostering Innovation in Prevention and Treatment of Obesity in Youth: Digitally Mediated Physical Play as an Exemplar.PubMed

Melissa A Kalarchian, Jessica Hammer, Adela Kapuścińska
Obesity (Silver Spring). 2021 Mar;29(3):475-477. doi: 10.1002/oby.23113. Epub 2021 Feb 4.
Novel approaches to obesity prevention among youth are needed. Accordingly, the Office of Women's Health, Department of Health and Human Services, sponsored a challenge to create an interactive video game for obesity prevention. Our team took a theory-based, evidence-informed approach to increasing physical activity in girls. Our approach-digitally mediated physical play-allowed us to include computing-based strategies that promote activity without keeping players in front of a screen. Our prize-winning prototype app, Frolic, helps girls choose the perfect game to play in any context, engaging parents for support. The app is used to highlight some opportunities and challenges for interdisciplinary collaboration. However, much work remains to be done to deploy innovative digital obesity interventions and fully capture the contributions of these tools. In order to accelerate advances, funding is needed for projects that combine engineering design principles with traditional obesity research paradigms.

85The association of parental phubbing behavior with digital game use in preschool children.PubMed

Erdal Görkem Gavcar, Ahmet Buber, Hande Senol
Bull Menninger Clin. 2024 Fall;88(4):336-359. doi: 10.1521/bumc.2024.88.4.336.
The term "phubbing" is a combination of the words "phone" and "snubbing" and is explained as preferring the virtual environment to real communication by engaging with a smartphone during social interaction. Our study included 191 children aged 3-6 attending preschool education. The parents of the children were contacted via an online survey to provide information about their sociodemographic, general phubbing, digital game addiction tendencies, and social skills scale scores. The results showed a positive correlation between parental phubbing level and children's digital game addiction tendencies. Furthermore, the regression analysis revealed that parental phubbing was an increasing factor in children's tendency toward digital game addiction and a decreasing factor in children's social skill levels. In addition, we found that children's social skills may play a mediating role in the relationship between parental phubbing level and digital game addiction tendencies. Understanding the effects of parents' phubbing behaviors on children can help raise awareness and take measures to improve parent-child relationships.

86Mobile device use when caring for children 0-5 years: A naturalistic playground study.PubMed

Elsa Mangan, Justine E Leavy, Jonine Jancey
Health Promot J Austr. 2018 Dec;29(3):337-343. doi: 10.1002/hpja.38. Epub 2018 Mar 5.
ISSUE ADDRESSED: Over the past decade, mobile device use has increased significantly. Adults are now using their mobile device whilst undertaking a range of work and social activities. This naturalistic study aimed to understand parents/carers' use of mobile devices and their associated beliefs about mobile device use whilst caring for children aged five and younger in playgrounds. METHODS: A mixed methods approach was used to collect quantitative and qualitative data from parents/carers. Data were collected by observations (n = 50) and interviews (n = 25) in playgrounds on the North Coast of New South Wales, Australia. RESULTS: Of the 50 observed parents/carers, 76% (n = 38) used their mobile device, with usage time extending to 17.2 minutes of the 20 minute observation period. Text-/type-related mobile device use was most often used (69.6%), followed by voice-related (23.7%) and camera-related mobile device use (6.7%). The 25 interviewed parents/carers beliefs on mobile device use were centred on three themes: diversity of mobile device use, child relationships and mobile device use and the physical environment and mobile device use. CONCLUSION: This study adds to the limited research into parent/carer mobile device use, which has become an integral part of peoples' lifestyle. However, research is required to better understand how parent/carer mobile device use may impact on child supervision and interaction. SO WHAT?: Mobile device use is increasing. We need to better understand its public health impact.

87Adolescent Health Promotion Interventions Using Well-Care Visits and a Smartphone Cognitive Behavioral Therapy App: Randomized Controlled Trial.PubMed

Shinichiro Nagamitsu, Ayako Kanie, Kazumi Sakashita, et al.
JMIR Mhealth Uhealth. 2022 May 23;10(5):e34154. doi: 10.2196/34154.
BACKGROUND: Adolescent health promotion is important in preventing risk behaviors and improving mental health. Health promotion during adolescence has been shown to contribute to the prevention of late onset of the mental health disease. However, scalable interventions have not been established yet. OBJECTIVE: This study was designed to test the efficacy of two adolescent health promotion interventions: a well-care visit (WCV) with a risk assessment interview and counseling and self-monitoring with a smartphone cognitive behavioral therapy (CBT) app. Our hypothesis was that participants who had received both WCV and the CBT app would have better outcomes than those who had received only WCV or those who had not received any intervention. We conducted a prospective multi-institutional randomized controlled trial. METHODS: Participants were 217 adolescents aged 13-18 years. They were randomly divided into two intervention groups (WCV group and WCV with CBT app group) and a nonintervention group. WCV comprised a standardized physical examination along with a structured interview and counseling for youth risk assessment, which was designed with reference to the Guideline for Health Supervision of Adolescents of Bright Futures. A smartphone-based CBT program was developed based on the CBT approach. The CBT app comprised a 1-week psychoeducation component and a 1-week self-monitoring component. During the CBT program, participants created several self-monitoring sheets based on the CBT model with five window panels: event, thoughts, feelings, body response, and actions. The primary outcome was the change in scores for depressive symptoms. Secondary outcomes included changes in scores for self-esteem, quality of life, self-monitoring, and an adolescent health promotion scale. These outcomes were evaluated at baseline and at 1, 2, and 4 months after baseline. The exploratory outcome was the presence of suicidal ideation during the observation period. Intervention effects were estimated using mixed effect models. RESULTS: In total, 94% (204/217) of the participants completed the 4-month evaluation. Both intervention groups showed a significant effect in the form of reduced scores for depressive symptoms at 1 month in high school students; however, these effects were not observed at 2 and 4 months. The intervention effect was significantly more predominant in those scoring above cutoff for depressive symptoms. There was significantly less suicidal ideation in the intervention groups. As for secondary outcomes, there was significant increase in health promotion scale scores at the 4-month follow-up among junior high school students in the WCV group. Moreover, the CBT app was significantly effective in terms of obtaining self-monitoring skills and reducing depressive symptoms. CONCLUSIONS: Although adolescent health promotion interventions may have short-term benefits, the frequency of WCV and further revision of the CBT app should be considered to evaluate long-term effectiveness. TRIAL REGISTRATION: University Hospital Medical Information Network Clinical Trials Registry UMIN 000036343; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000041246.

88Efficacy of a Standalone Smartphone Application to Treat Postnatal Depression: A Randomized Controlled Trial.PubMed

Pedro F Zuccolo, André R Brunoni, Tatiane Borja, et al.
Psychother Psychosom. 2024;93(6):412-424. doi: 10.1159/000541311. Epub 2024 Oct 23.
INTRODUCTION: Smartphone app interventions based on cognitive-behavioral therapy (CBT) are promising scalable alternatives for treating mental disorders, but the evidence of their efficacy for postpartum depression is limited. We assessed the efficacy of Motherly, a standalone CBT-based smartphone app, in reducing symptoms of postpartum depression. METHODS: Women aged 18-40 with symptoms of postpartum depression were randomized either to intervention (Motherly app) or active control (COMVC app). The primary outcome was symptoms of depression measured by the Edinburgh Postnatal Depression Scale (EPDS) at post-treatment. Secondary outcomes were anxiety symptoms, parental stress, quality of sleep, behavioral activation, availability of response-contingent positive reinforcement, and clinical improvement at post-treatment and 1-month follow-up. Exploratory analyses were performed to investigate if app engagement was associated with treatment response. RESULTS: From November 2021 to August 2022, 1,751 women volunteered, of which 264 were randomized, and 215 provided primary outcome data. No statistically significant differences were found between groups at post-treatment: intervention: mean (SD): 12.75 (5.52); active control: 13.28 (5.32); p = 0.604. There was a statistically significant effect of the intervention on some of the secondary outcomes. Exploratory analyses suggest a dose-response relationship between Motherly app engagement and outcomes. CONCLUSION: Our standalone app intervention did not significantly reduce postnatal depression symptoms when compared to active control. Exploratory findings suggest that negative findings might be associated with insufficient app engagement. Consistent with current literature, our findings suggest that standalone app interventions for postpartum depression are not ready to be implemented in clinical practice.

89Designing the Future of Children's Mental Health Services.PubMed

Aaron R Lyon, Alex R Dopp, Stephanie K Brewer, et al.
Adm Policy Ment Health. 2020 Sep;47(5):735-751. doi: 10.1007/s10488-020-01038-x.
Advancements in evidence-based psychosocial interventions, digital technologies, and implementation strategies (i.e., health services research products) for youth mental health services have yet to yield significant improvement in public health outcomes. Achieving such impact will require that these research products are easy to use, useful, and contextually appropriate. This paper describes how human-centered design (HCD), an approach that aligns product development with the needs of the people and settings that use those products, can be leveraged to improve youth mental health services. We articulate how HCD can advance accessibility, effectiveness, and equity, with specific consideration of unique aspects of youth mental health services.

90Parenting app to support socio-emotional and cognitive development in early childhood: iterative codesign learnings from nine low-income and middle-income countries.PubMed

Mafruha Alam, Ian B Hickie, Adam Poulsen, et al.
BMJ Open. 2023 May 16;13(5):e071232. doi: 10.1136/bmjopen-2022-071232.
OBJECTIVE: Many children in low-income and middle-income countries are disadvantaged in achieving early developmental potential in childhood as they lack the necessary support from their surroundings, including from parents and caregivers. Digital technologies, such as smartphone apps, coupled with iterative codesign to engage end-users in the technology-delivered content development stages, can help overcome gaps in early child development (ECD). We describe the iterative codesign and quality improvement process that informs the development of content for the , localised for nine countries in Asia and Africa. DESIGN: Between 2021 and 2022, an average of six codesign workshops in each country were conducted in Afghanistan, Indonesia, Kyrgyzstan, Uzbekistan, Cameroon, the Democratic Republic of the Congo, Ethiopia, Kenya and Namibia.A total of 174 parents and caregivers and 58 in-country subject matter experts participated and provided feedback to refine and inform the cultural appropriateness of the app and its content. Detailed notes from the workshops and written feedback were coded and analysed using established thematic techniques. RESULTS: Four themes emerged from the codesign workshops: local realities, barriers to positive parenting, child development and lessons learnt about the cultural context. These themes, as well as various subthemes, informed content development and refinement. For example, childrearing activities were requested and developed to promote inclusion of families from diverse backgrounds, encourage best parenting practices, increase engagement of fathers in ECD, address parents' mental well-being, educate children about cultural values and help bereaved children with grief and loss. Also, content that did not align with the laws or culture of any country were removed. CONCLUSIONS: The iterative codesign process informed the development of a culturally relevant app for parents and caregivers of children in the early years. Further evaluation is required to assess user experience and impact in real world settings.

91Current Advances in Behavioral Addictions: From Fundamental Research to Clinical Practice.PubMed

Matthias Brand, Stephanie Antons, Beata Bőthe, et al.
Am J Psychiatry. 2025 Feb 1;182(2):155-163. doi: 10.1176/appi.ajp.20240092. Epub 2024 Dec 11.
Gambling disorder is the only behavioral addiction recognized as a clinical disorder in DSM-5, and Internet gaming disorder is included as a condition requiring further research. ICD-11 categorizes gambling and gaming disorders as disorders due to addictive behaviors. Additional behavioral addictions may include compulsive sexual behavior disorder, compulsive buying-shopping disorder, and problematic use of social media. This narrative review summarizes the current state of knowledge regarding these five (potential) disorders due to addictive behaviors. All five (potential) disorders are clinically relevant and prevalent. Behavioral addictions frequently co-occur with other mental and behavioral problems, such as depression, anxiety, and attention deficit hyperactivity disorder. Validated diagnostic instruments exist, with empirical support varying across conditions. No medications have approved indications from regulatory bodies for behavioral addictions, and cognitive-behavioral therapy has the most empirical support for efficacious treatment. Given that behavioral addictions are prevalent, frequently co-occur with psychiatric disorders, may often go undiagnosed and untreated, and have been linked to poorer treatment outcomes, active screening and treatment are indicated. Public health considerations should be expanded, and impacts of modern technologies should be investigated more intensively. Treatment optimization involving pharmacotherapy, psychotherapy, neuromodulation, and their combination warrants additional investigation.

92Adolescent Internet gaming addiction and personality characteristics by game genre.PubMed

Dongil Kim, JeeEun Karin Nam, Changmin Keum
PLoS One. 2022 Feb 10;17(2):e0263645. doi: 10.1371/journal.pone.0263645. eCollection 2022.
With the emergence of a new concept called 'Internet Gaming Disorder' in DSM-5 and ICD-11, related research is underway around the globe. However, not enough literature on Internet gaming addiction has considered the diversity in game genres. Internet gaming addiction may take on a different form according to the particular characteristics of a game being played. To better understand adolescent Internet gaming addiction, this study sought to identify the differences in Internet gaming addiction and personality characteristics based on the game genre played. A total of 3,217 elementary and middle school students across Korea participated in the survey that included the Maladaptive Game Use Scale and the Adolescent Personality Questionnaire. ANOVA analysis revealed that Internet gaming addiction and personality characteristics varied according to the game genre played. In particular, post-hoc tests showed that Real-Time Strategy (RTS) and First-Person Shooter (FPS) game users have higher levels of tolerance, withdrawal, and neglect of everyday life compared to other genres such as Role-Playing Game (RPG), Racing, and Arcade/Shooting. Also, Internet gamers users of particular genres showed significantly lower self-esteem (Arcade/Shooting), conscientiousness (Racing), empathy (RPG), and sense of community (Racing and RTS) scores than comparison group. The implications of the study results were discussed with a special emphasis on Internet gaming addiction interventions.

93Internet Gaming Disorder in Children and Associated Factors and Parents' Opinions.PubMed

Sumbule Koksoy Vayisoglu, Meryem Mutlu, Emine Oncu
J Addict Nurs. 2022;33(4):E26-E35. doi: 10.1097/JAN.0000000000000425. Epub 2021 Sep 17.
OBJECTIVE: The aim of this study is to determine internet gaming disorder (IGD) prevalence in primary grade students and the associated factors and parents' opinions about their children's gaming habits. MATERIALS AND METHODS: This cross-sectional study was conducted between April 1, 2019, and June 1, 2019. In this study, 805 children's and parents' forms were analyzed. Participation rate was 94.5%. Data were collected using "Digital Gaming-Children's Form," "Digital Gaming-Parents' Form," and the "Internet Gaming Disorder Scale-Short Form (IGDS9-SF)." Data were analyzed using descriptive statistics and significance tests. RESULTS: The mean age of the students was 11.24 ± 1.243 years; 42.7% were male. The children's mean IGDS9-SF score was 16.83 ± 6.53. There were only 91 students with a score equal to or above the cutoff point of 36. The mean IGDS9-SF scores varied according to gender, grade level, family environment, and employment status of the father. Analysis of the students' gaming characteristics and mean IGDS9-SF scores showed that their mean IGDS9-SF scores varied depending on computer/phone/tablet gaming status, type of game played, type of connection, mode of connection, frequency of conflicts with parents, and whether families received help to regulate gaming behavior. CONCLUSION: It is essential for a family to have information about games and talk to their children about the games they play to provide appropriate supervision. Providing families and children with counseling about digital games, IGD symptoms, and considerations by nurses during home visits can play an important role in preventing IGD.

94Investigation of the correlation between internet addiction, obesity risk and sleep disorder in children.PubMed

Şulenur Duran, Dilek Küçük Alemdar
J Pediatr Nurs. 2023 Nov-Dec;73:e409-e417. doi: 10.1016/j.pedn.2023.10.009. Epub 2023 Oct 19.
AIM: This study was performed with the aim of investigating the correlation and the effective factors between internet addiction, obesity risk and sleep disorders in children. MATERIAL AND METHOD: The sample for this descriptive and relational search type study comprised the parents of 458 children aged 7-10 years attending a primary school in Turkey. Data were collected the Parent and Child Descriptive Information Form, Family Child Internet Addiction Scale (FCIAS), Family Nutrition and Physical Activity Tool (FNPAT) and Sleep Disturbance Scale for Children (SDSC). RESULTS: There was a statistically significant, positive and weak correlation between the Body Mass Index (BMI) and FCIAS scores of children (p < 0.001). There was a statistically significant, negative and very weak correlation between FNPAT total score with FCIAS total score (p = 0.007). There was a statistically significant, positive and moderate correlation between SDSC total score and FCIAS total score (p < 0.001). According to regression analysis, FCIAS was a determinant at significant levels for FNPAT and SDSC (p < 0.05). CONCLUSION: There was a relationship between internet addiction and obesity and sleep quality. As a result of the study, the increase in internet use was determined to negatively impact physical activity and health nutrition behavior, and to increase sleep disturbance. IMPLICATIONS FOR PRACTICE: Pediatric nurses are recommended to give counseling to children and families about preventing obesity and the risk of sleep disorders by identifying children at risk in terms of internet addiction in the early period.

95Preventive Interventions for Internet Addiction in Young Children: Systematic Review.PubMed

Yansen Theopilus, Abdullah Al Mahmud, Hilary Davis, et al.
JMIR Ment Health. 2024 Aug 30;11:e56896. doi: 10.2196/56896.
BACKGROUND: In this digital age, children typically start using the internet in early childhood. Studies highlighted that young children are vulnerable to internet addiction due to personal limitations and social influence (eg, family and school). Internet addiction can have long-term harmful effects on children's health and well-being. The high risk of internet addiction for vulnerable populations like young children has raised questions about how best to prevent the problem. OBJECTIVE: This review study aimed to investigate the existing interventions and explore future directions to prevent or reduce internet addiction risks in children younger than 12 years. METHODS: The systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched for relevant literature from 4 research databases (Scopus, Web of Science, PubMed, and PsycINFO). We included 14 primary studies discussing the interventions to prevent or reduce internet addiction risks in young children and their efficacy outcomes. RESULTS: The preventive interventions identified were categorized into four approaches as follows: (1) children's education, (2) parenting strategy, (3) strategic physical activity, and (4) counseling. Ten interventions showed promising efficacy in preventing or reducing internet addiction risks with small-to-medium effect sizes. Interventions that enhance children's competencies in having appropriate online behaviors and literacy were more likely to show better efficacy than interventions that force children to reduce screen time. Interventions that shift children's focus from online activities to real-world activities also showed promising efficacy in reducing engagement with the internet, thereby preventing addictive behaviors. We also identified the limitations of each approach (eg, temporariness, accessibility, and implementation) as valuable considerations in developing future interventions. CONCLUSIONS: The findings suggest the need to develop more sustainable and accessible interventions to encourage healthy online behaviors through education, appropriate parenting strategies, and substitutive activities to prevent children's overdependence on the internet. Developing digital tools and social support systems can be beneficial to improve the capability, efficiency, and accessibility of the interventions. Future interventions also need to consider their appropriateness within familial context or culture and provide adequate implementation training. Last, policy makers and experts can also contribute by making design guidelines to prevent digital product developers from making products that can encourage overuse in children.

96Global Perspectives on Children's Digital Opportunities: An Emerging Research and Policy Agenda.PubMed

Sonia Livingstone, Dafna Lemish, Sun Sun Lim, et al.
Pediatrics. 2017 Nov;140(Suppl 2):S137-S141. doi: 10.1542/peds.2016-1758S.
Diverse international perspectives show that children can benefit greatly from digital opportunities. Despite widespread optimism about the potential of digital technologies, especially for information and education, the research reveals an insufficient evidence base to guide policy and practice across all continents of the world, especially in middle- and low-income countries. Beyond revealing pressing and sizeable gaps in knowledge, this cross-national review also reveals the importance of understanding local values and practices regarding the use of technologies. This leads us to stress that future researchers must take into account local contexts and existing inequalities and must share best practices internationally so that children can navigate the balance between risks and opportunities. This article documents the particular irony that while the world's poorer countries look to research to find ways to increase access and accelerate the fair distribution of digital educational resources, the world's wealthier countries look to research for guidance in managing excessive screen time, heavily commercial content, and technologies that intrude on autonomy and privacy. We conclude by recommending that digital divides should be carefully bridged with contextual sensitivity to avoid exacerbating existing disparities; that the provision of technological resources is complemented by a focus on skills enhancement, for teachers as well as students; that a keen eye is needed to ensure the balance of children's protection and participation rights, with protection now including data abuses as well as safety considerations; and that we forge collaborations among all stakeholders in seeking to enhance children's digital opportunities worldwide.