child & youth Ment ental al He Heal alth th Se Series ries Today’s topic : Technology Overuse: Helping Patients and Families to Reconnect and Unplug Speaker: Michael Cheng, Psychiatrist, CHEO Thu, Apr 20, 2017
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Technology Overuse: Helping Patients and Families to Reconnect and Unplug CHEO MH Rounds Thu, Apr 20, 2017, 1200-1300 hrs Dr. Michael Cheng, Psychiatrist, www.drcheng.ca Children’s Hospital of Eastern Ontario (CHEO)
Schedule 1200-1245 Talk (45-min.) 1245-1300 Questions (15-min.)
When I was a kid … • My parents wouldn’t get us an Atari, because my parents thought that it would rot my brain … • For years, I resented them for that … • And now … • Every day I am telling parents to cut back on their kids’ technology …
Objectives • By the end of this session, participants will be able to: • List the elements for mental wellness, • List ways in which technology overuse impairs this, • List strategies to • Reconnect children/youth to healthier attachments such as parents and nature • Disconnect children/youth from technology overuse
Objectives • Note • This presentation is a “Part 2” that complements earlier “Part 1” lectures on technology given by Dr’s Gandy and Cheng. • Whereas previous sessions focused on the evidence that technology overuse causes problems, this session will focus more directly on clinical interventions with the patients that we see.
Now that I’m an adult… • Now I’ve become my parents … • Every day, I tell parents to reduce their kids recreational screen time …
Let’s start with a case… • Dave is a 16-yo teenager • Referred to see you for inattention, irritability, and depression Image: Boggett Photography
Case • Your assessment with Ryan shows … • Depressed mood • Sensory sensitivities • 7.5 hrs a day on video games! Image: Boggett Photography
Q. What is the secret to happiness, i.e mental wellness? a) The latest first person shooter video game b) Lots of money c) Lots of friends d) A sense of belonging (including secure attachments), meaning, hope and purpose
Q. What is the secret to happiness, i.e mental wellness? a) The latest first person shooter video game b) Lots of money c) Lots of friends d) A sense of belonging (including secure attachments), meaning, hope and purpose
What Do People Need for Wellness? • Purpose in daily life, e.g. education, employment, care giving, cultural activities • Hope for the future • Belonging and connectedness within one’s family, community and culture • Sense of meaning in one’s life First Nations Mental Wellness Continuum Framework, 2014
In normal development, people connect to things which give hope, meaning, belonging and purpose such as … Nature Deep connections to people, in particular family Other meaningful things such as community, culture, spirituality, etc...
At a brain level, studies show that these healthy connections provide optimal amounts of dopamine/adrenaline and oxyt ytocin Nature exposure dopamine / adrenaline Secure attachment to people oxytocin Other meaningful things such as community, culture, spirituality, etc... NEED REFERENCES
If someone is depressed, then at some level, they have been disconnected from that which would provide purpose, belonging, hope and meaning … Nature Deep connections to people, in particular family Other meaningful things such as community, culture, spirituality, etc...
Such as overconnection to technology, peers and values that don’t bring meaning… Nature Technology Deep connections to people, in particular family Peers Other meaningful things such as community, culture, spirituality, Hedonism, materialism, consumerism … etc...
Getting back to our case
Epidemiology
How common is technology overuse? • The average American teenager has 7.5 hrs/day of recreational screens (Pew Internet Study, 2011)
Pathophysiology
How does technology overuse impact the brain? • Today’s technology is far more addictive and immersive than early video games • MRI brain studies confirm this • The human brain is not designed for the level of sensory stimulation that today’s modern video games provide • As a result, sensory overload makes the brain feel it is under threat, at a sub-cortical, polyvagal level • It triggers your body’s alarm that something is not quite right…
Screens give us “easy dopamine” When your brain gets used to “easy dopamine”, its harder to do things “Easy dopamine” , i.e. that provide less dopamine, that are provides lots of ‘boring’ like: dopamine, adrenaline • Going for a walk with little effort • Homework • Face to face contact • Driving • Looking at your child …
Screens are overstimulating: Part 1 • This is the type of sensory stimulation our brains are designed to handle • Numerous studies confirm nature provides optimal sensory experience, leading us to have optimal brain waves and feel calm, relaxed, refreshed • Nature sounds are more soothing than even other things thought relaxing, e.g. classical music Image: Boggett Photography
Screens are overstimulating: Part 2 • Although it gives our brains a rush of adrenaline / dopamine, it is actually not calming nor refreshing, and can trigger fight/flight responses • Especially in those with brain conditions, e.g. seizure disorders, sensory processing issues, issues that affect filtering such as psychosis, or anxiety • Multi-tasking just makes this worse … Image credit: Fair Use Policy
With excess screen use … • With excess screen use over time, the body is under chronic alarm, i.e. stress • Blood flow shifts from frontal (developed brain) to the more primitive parts of the brain • Thus, one can see problems with regulation, attention, creativity, social behaviour • Body makes cortisol, a stress hormone • High cortisol impairs memory (from hippocampus), disturbs sleep, disturbs concentration, causes weight gain • Electronic Screen Syndrome (ESS) • Signs of an overloaded brain can mimic any psychiatric disorder • E.g. inattention • E.g. mood/anxiety problems Dunckley, 2014
Clinical Presentation
Excessive screen time has been associated with numerous issues including • Impaired function • School, work and relationships • Preoccupation with technology • Physical symptoms • Insomnia • Physical complaints, including repetitive strain syndrome in texting or video gaming • Neurovegetative symptoms • Mood problems • Attention problems • Hallucinations • REFERENCES
Assessment
Digital Media History • Ask parents / youth together, and separately • What types of technologies does your child use? • How many hours a day on weekdays? Weekends? • What’s the worst thing that has happened online? • Done anything that you’ve regretted, e.g. sexting, posting certain comments, etc.? • Any cyberbullying? • Ask parents • Any rules around the technology use? • Any conflicts that arise from the use?
Activities / Attachments • Ask parents / youth • “Walk me through a typical day… How do you spend your day?” • “What are the activities that you spend time on every day?” • “Who are the people that you are the closest to?” • With technology overuse, may show that • Several hours of day on technology • Very few hours on non-electronic activities, or face-to-face time, or nature time, or other things which give purpose, belonging, hope and meaning
Diagnostic Issues
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