The supposed danger of digital media made headlines over the weekend when psychotherapist Nicholas Kardaras published a story in the New York Post called "It’s ‘digital heroin’: How screens turn kids into psychotic junkies." In the op-ed, Kardaras claims that "iPads, smartphones and XBoxes are a form of digital drug." He stokes fears about the potential for addiction and the ubiquity of technology by referencing "hundreds of clinical studies" that show "screens increase depression, anxiety and aggression."
We’ve seen this form of scaremongering before. People are frequently uneasy with new technology, after all. The problem is, screens and computers aren’t actually all that new. There’s already a whole generation — millennials — who grew up with computers. They appear, mostly, to be fine, selfies aside. If computers were "digital drugs," wouldn’t we have already seen warning signs?
No matter. Kardaras opens with a little boy who was so hooked on Minecraft that his mom found him in his room in the middle of the night, in a "catatonic stupor" — his iPad lying next to him. This is an astonishing use of "catatonic," and is almost certainly not medically correct. It’s meant to scare parents.
This style of manipulation is most obvious in Kardaras’ use of statistics: "According to a 2013 Policy Statement by the American Academy of Pediatrics, 8- to 10 year-olds spend 8 hours a day with various digital media while teenagers spend 11 hours in front of screens," he writes. His article takes general aim at screens, but specifically stokes fears about video games and the internet ("I have found it easier to treat heroin and crystal meth addicts than lost-in-the-matrix video gamers or Facebook-dependent social media addicts," he writes). He makes no mention of television, which remains the predominant form of media for children and teens, according to a 2013 policy statement from the American Academy of pediatrics.
Kardaras is the executive director of The Dunes East Hampton luxury addiction recovery center, which Vanity Fair reports costs between $50,000 and $75,000 per month. He’s also the author of a recently published book: Glow Kids: How Screen Addiction is Hijacking Our Kids — And How to Break The Trance. (Kardaras said in an interview with The Verge that The Dunes doesn’t offer therapy for tech addiction, and that his op-ed wasn’t driven by a financial agenda.) But how accurate are Kardaras’ claims? Should we all live in fear that our toddlers will be ravaged by their iPads?
Michael Rich, the director of the Center on Media and Child Health at Boston Children’s Hospital, says that he has seen cases of problematic interactive media use that keep children up at night. But, he adds, "I’ve also had kids who have been found staring wide-eyed and bloodshot at Harry Potter at two in the morning."
Kardaras’ op-ed goes on to warn that exposure to screens can cause "addiction," and he quotes researchers analogizing screen time to heroin and cocaine. "That’s right — your kid’s brain on Minecraft looks like a brain on drugs," he writes. This is, strictly speaking, true — at least, from a neuroimaging standpoint. This is a hoary old trope in science writing, and it’s apparently loosely based on fMRI, which is hardly the most accurate discipline. The brain’s reward center, the ventral striatum, is what makes you feel good when you eat, have sex, take cocaine, or play video games.
Yale psychiatrists Robert Leeman and Marc Potenza write in a 2013 review paper that there are neurobiological and genetic parallels between substance abuse and problematic behaviors, like excessive gambling, shopping, sex, gaming, and internet use. But because these are things pretty much everyone engages in, it’s hard to draw a line between one person’s activity and another person’s addiction.
Kardaras’ loose talk on addiction is what makes his argument so tough to believe. About 1.6 percent of Americans use heroin, but a quarter of them wind up addicted, according to an estimate from the National Institutes of Drug Addiction. Something like 16 percent of cocaine users become dependent on the drug within 10 years of trying it for the first time, say scientists in the journal Neuropsychopharmacology. Digital devices, as well as video games, are far more widespread than either of these drugs. If they were, in fact, comparable, we should be seeing a lot more people displaying "catatonia," with their iPads dropped dramatically beside them.
The tech-as-addiction metaphor is sloppy, though it might not be wrong. The problem is we don’t have a good handle on what qualifies as tech addiction — if it exists at all, how common it is, and what kind of environmental and physiological conditions predispose someone to it.
Substance use disorder — that regular ol’ drug addiction — is a recognized condition in the latest version of the psychiatric Bible, the Diagnostic and Statistical Manual of Mental Disorders; technology abuse disorder is not. Internet gaming disorder is in a special section called "the research appendix," where the DSM’s authors relegate conditions that do not have sufficient evidence for existence — but where more research might be useful. While it’s true, as Kardaras pointed out, that the DSM is not without flaw — it did, after all, list homosexuality as a disorder until 1973 — whether to list internet gaming disorder or internet addiction was hotly debated.
"Well over 250 publications exist on internet gaming disorder, also referred to as gaming or internet use disorder, gaming or internet addiction, gaming or internet dependence, pathological or problematic gaming, etc.," Nancy Petri, a committee member for the DSM, and Charles O’Brien the chair of the committee wrote in Addiction in 2013. But, as the dispute over terminology hints, there wasn’t much standardization on these studies; nor did the qualifications for problematic behavior remain the same between the studies. "Given substantial differences related to classification, it is not surprising that information on the prevalence, course, treatment and biomarkers associated with internet gaming disorder is inconclusive," they write.
This is of course less attention-grabbing than a scary bedtime story about a six-year-old with bloodshot eyes sitting upright and unresponsive in his bed next to an iPad — which is probably why the Post didn’t run it. One has to sell the paper after all. But the way the article discusses addiction is meant to incite panic, and parents should be wary of anyone trying to panic them. "I don’t think this is a helpful approach, this panic and addiction fears," says Boston Children Hospital’s Rich.
Kardaras isn't the first one inciting fear about the ill-effects of technology on our — and our childrens’ — minds. Others have done the same before him. British scientist and media-maker Susan Greenfield made waves by claiming that 500 peer-reviewed papers showed that technology harmed the brain. When Oxford University psychologist Dorothy Bishop actually analyzed the papers, there were 395, and only a small proportion were peer-reviewed papers that actually supported Greenfield’s conclusions.
Other reviews of the literature didn’t find consistently positive or negative effects of media on children. "The content delivered by electronic media is far more influential than the media themselves," write the authors of a review in the under-the-radar, but apparently peer-reviewed (according to their website) journal Future of Children.
And it’s just as easy to cherry-pick results that highlight the positive aspects of technology on kids’ brains. Just this week, after all, research presented at an international anesthesiology conference suggests that iPads are just as effective as conventional sedatives at keeping kids calm right before surgery. Another study published by a research team at the University of Texas in 2012 demonstrated that virtual reality training — with a digital device — helped boost social skills and cognition in young adults with autism. In March, an international team of researchers published an analysis of more than 3,000 children between the ages of six and 11 living in European Union countries. They found that, all else being equal, gamers had a higher chance than non-gamers of performing better at school and a lower chance of experiencing problems with their peers.
Kardaras, the author of New York Post article, references hundreds of studies he claims to cite in his book and on his webpage. This is an impressive rhetorical trick, though his number is somewhat less than the number the DSM committee came up with three years ago. (Presumably, there would be more studies and not fewer in the intervening years.) Citing that many studies makes him sound authoritative, while disincentivizing anyone who might want to dispute him — not all of us have Bishop’s determination. When we took a look at his webpage, we saw that it does include some peer-reviewed studies. But it also references law enforcement speculation that the massacre by Adam Lanza at the Sandy Hook Elementary School "was the result of his video game psychosis."
It’s true that there is research linking the overuse of electronics to mental health disorders. But the arrow of causation still isn’t clear, says David Hill, chair of the American Academy of Pediatrics Council on Communications and Media. No one has been able to tell whether excessive screen time can cause mental health disorders, or whether people with underlying disorders are more predisposed to problematic use of interactive media.
At any rate, Kardaras didn’t contribute his conclusions to the scientific body of evidence whatsoever. Searching a database of the academic literature for "Nicholas Kardaras", "Nick Kardaras", and "N Kardaras" doesn’t turn up a single peer-reviewed publication about tech addiction, internet addiction, or psychology. That means that while the claims given weight by a ‘PhD’ following Kardaras’ name are out there to frighten parents, he’s never submitted them for other scientists and clinicians to evaluate.
In an interview with The Verge, Kardaras didn’t dispute that he hasn’t published in the peer-reviewed literature. Instead, he said that he wanted to reach the broadest audience possible by publishing in the popular press. But Rich worries that disseminating information having to do with mental health this way stirs up hysteria, and clouds our ability to deal with it. "This kind of hysteria doesn’t lead to that kind of thoughtful, evidence-based, mindful use of these tools that, after all, we all have to use," Rich says.
Both Rich and Hill agree with Kardaras’ recommendation that parents should take an active role in their children’s media use. But while parents should be alert to whether screen time is displacing other activities, they also need to realize that screens are becoming an unavoidable part of a child’s environment — in school, with friends, even on the street, where billboards are increasingly replaced by digital screens. Children will be exposed to them.
"I think that the approach we should take to it is to understand that all of us have changed the way we live because of the way we use these devices, but we also have to be aware that they are just tools. They are neutral. What we do with them, and what we demonstrate for our children, and what we let our children do with them is what determines the outcome," Rich says.
"Just as we need to learn to drive a car safely, we need to learn how to drive the internet safely. Again, this is another tool that increases our freedom, increases our ability to do things, but also has great potential danger. But we don’t get in cars thinking oh, I could get addicted."