- There are many positive benefits of exposure to, and appropriate use of, media in children and young people.
- A number of issues concerning the problematic impact of media have been identified including Problem Internet Use and cyberbullying.
- Clinicians should be aware that problematic use of media, where it leads to significant social isolation and withdrawal, can impact adversely on normal development.
- Psychiatrists are particularly well placed to help work with children and young people with mental health problems where negative media experiences play a role.
- Further research is needed on the impact of excessive exposure to digital technology on development.
Media is generally defined as the means of mass communication, and includes broadcasting, publishing and the internet. The scope of media continues to increase dramatically as digital technology becomes more readily available. Social media has become a common method of communication and online gaming provides a further avenue for interaction. Rapid access to instant communication is increasingly the norm, and access from highly portable sources has created a climate where there is constant access to the digital world.
Digital skills, participation and access to online services are important for the whole community, and there is a need for everyone to interact with media and digital technology in a smart, safe and responsible way. However, there are specific issues to consider for children and adolescents, who are learning to navigate the online world at younger ages. While being the greatest beneficiaries of the digital era and its many positive benefits, children and young people are also at risk of being exposed to age-inappropriate content, encountering cyberbullying, or losing their privacy. There is a need to be aware of media and digital technology impacts in order to provide balanced and optimal advice and support (Richards et al., 2015).
Positive impacts of media
There are many positive aspects of media technology that impact children and young people. In Australia and New Zealand, proficient use of technology is increasingly a requirement in many professions, and children and young people who possess such skills will have advantages in many areas that positively impact their development. The Royal Australian and New Zealand College of Psychiatrists (RANZCP) Faculty of Child and Adolescent Psychiatry would seek to endorse these and support the access to such benefits for all children and young people.
Examples of general benefits of media and digital technology include:
- Social media sites provide young people with opportunities to connect with friends and family and develop technical and creative skills. These sites facilitate connection to a diverse and widespread group of people, providing a greater understanding of global issues. There is also evidence that media can have positive effects on social skills in children, and that experiences of using social media platforms are generally positive (Australian Psychological Society, 2017).
- Education can be enhanced in a number of ways through various media interfaces. For example, students can engage in self-directed learning, collaborate on group projects or exchange ideas about homework. There is evidence that engagement with digital delivery of material allows children and young people to enhance and consolidate learning on an almost inexhaustible range of topics. This access to technology provides young people with essential skills for future roles in adulthood.
- Electronic games and devices can be used to increase physical activity in children and, as technology has developed, allow for outdoor games and activity. They can also promote social interaction, communication and emotional well-being.
Examples of e-health related benefits of media and digital technology include:
- Technology provides information about a range of physical and psychological health problems of relevance to young people, which may lead to a positive benefit in terms of promoting engagement with health-care services. There are an increasing number of apps designed for children and adolescents that encourage behaviours such as healthy activity, enhanced medication adherence and smoking cessation, as well as specific mental health support (e.g. headspace).
- Mental health promotion, including to promote resilience, support parenting and family mental health, address risk factors for mental health problems and disorders, and increase mental health literacy (e.g. KidsMatter).
- There is a growing body of evidence supporting the effectiveness of e-health interventions for a number of mental health problems, which can be provided in a timely manner, in privacy and at the individual’s discretion (Rice et al., 2016; Peek et al., 2015). For some this may be a preferable way of accessing help and provide ways to overcome various barriers, including stigma and affordability, which lead to poor uptake of mental health care. E-health interventions may be used to increase access to treatment in remote and rural areas where distance and workforce shortages are a challenge. The World Psychiatric Association has developed a position statement on e-mental health which may help psychiatrists provide guidance in this area.
- The lives of children and young people who have access to media technology and who take advantage of opportunities such as these could be enriched, especially where this access is in the context of other life experiences and opportunities that promote social interaction, learning and exercise. There are potential benefits that arise from using media to improve health. However, it is important that such developments are additional to services that exist and are not seen as a replacement. Arguably children and young people who do not have such access may be disadvantaged.
Problematic impact of media
Despite the many clear benefits about exposure to, and appropriate use, of media technology, there is much we do not know and some clear problems identified. A significant unknown is the impact of excessive exposure to digital technology such as on development; this area needs further research. Identified problems include:
Problem Internet Use (PIU)
Whilst there is no internationally agreed definition on what constitutes PIU, a sensible working definition is: ‘the pervasive long term and heavy use by a person of internet and computer-based technologies, including gaming, that is out of keeping with one’s educational, social or occupational role, wellbeing and health’ (Tam, 2011). Some authors and commentators consider that, in its most severe form, PIU could be considered an ‘addictive’ condition (internet addiction), showing features such as dependence, mood alteration, tolerance, withdrawal and harm to psychosocial functioning. People experiencing problematic use at this level may require input from mental health or addiction services.
PIU is increasingly recognised as having a potentially significant impact on mental health to varying degrees and not all types will require specialist mental health intervention. Where such problems exist with other mental health disorders, such as depression, anxiety, distress and substance abuse, it is important that these are assessed and treated. As PIU is relatively new and not formally recognised as a mental disorder, research into treatment is still at an early stage.
Gaming may be a form of PIU. The Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5), lists internet gaming disorder as a ‘condition for further study’, meaning it is not officially recognised. However the draft 11th International Classification of Diseases (ICD), due for publication in 2018, proposes to include the condition ‘gaming disorder’, describing it as a pattern of persistent or recurrent gaming behaviour so severe that it takes precedence over other life interests.
A survey by the Australian Psychological Association (2017) found that adolescents spend 3.3 hours a day on social media with some logging on as much as 50 times per day. The survey found high use of social media and technology impacts self-esteem, with two in three adolescents feeling pressure to look good. Further, many are contacted by or make contact with strangers via Facebook, with 15% of respondents in the survey saying this occurs daily. Although the impact of social media on the mental health and well-being of young people is largely unknown, encouragement of better patterns of use may help to minimise the harmful effects.
Cyberbullying and sexting
Bullying is a major problem in Australia and New Zealand. Cyberbullying has been defined as ‘deliberately using digital media to communicate false, embarrassing or hostile information about another person’ (O’Keefe and Clarke-Pearson, 2011). The Australian Human Rights Commission has said that such bullying is ‘endemic’ (Stolz and Chilcott, 2013). The potential for those who engage in bullying at a distance from their victims means that those affected have even more limited places and times when they do not feel under threat. There is evidence of a consistent relationship between cyberbullying and depression and some studies show associations with other mental health problems (National Institutes of Health, 2010). There have been accounts of suicide in young people associated with cyberbullying (Stolz and Chilcott, 2013).
Sexting is the sending of provocative or sexual photos, messages or videos (Office of the eSafety Commission). They are generally sent using a mobile phone but can also include posting this type of material online. Young people may engage in transmitting images of a sexual nature of themselves or others without fully realising the implications, as sexting can have serious social and legal consequences. The police sometimes need to become involved in sexting cases where creating and/or distributing sexual images with minors constitutes the production and/or distribution of child pornography (Office of the eSafety Commissioner). Sexting can be a particular form of cyberbullying. Young people who engage in this kind of cyberbullying may be charged with criminal offences. Some will not be aware this is a potential outcome and this can lead to significant distress
Many online activities, such as subscribing to content, entering competitions and playing online games, require users to enter personal information. This information may then be misused by others including spam, scams, identity theft and fraud. Young people are also specifically targeted by advertisers who may sell their personal information to other organisations/marketers (Office of the eSafety Commissioner, 2015).
There continues to be controversy about the extent to which exposure to media violence causes aggression. Impacts are likely to be different at different ages and any effects will be mediated by other influences to which a child or young person is exposed (Porter and Starcevic, 2007). The extent to which exposure to violence encourages aggression, and minimises the impact of aggression – especially where it is played out in a fantasy world – remains a particular issue. Parents may not always be aware of the content of the media their children and adolescents access or of their level of exposure (Gentile et al., 2011). Clearly the extent to which households monitor the viewing habits of their children and young people is important.
Sexualisation of children
Sexualisation of children refers to the imposition of adult models of sexual behaviour and sexuality onto children and adolescents at developmentally inappropriate stages and in opposition to the healthy development of sexuality. It encompasses sexual objectification and representation of children in adult or sexual ways and in ways that imply the child’s value depends on conforming to a particular appearance, sexual display or behaviours. Children may also experience secondary sexualisation through exposure to sexualised advertising material and products aimed at adult consumers.
The use of sexualised images of children and young people may occur in popular media, as the theme is present in music, fashion, magazines, television, and video games. A virtually limitless store of pornography on the internet means that children and adolescents have easier access to more varied, explicit and sometimes violent, unsafe and non-consensual sexual content. Exposure is highly likely to occur. An Australian Institute of Family Studies report found that just under half (44%) of children aged 9–16 had encountered sexual images in the last month and that this exposure to mainstream, online pornography can have a range of negative effects on knowledge, attitudes, and beliefs about sex and gender; sexual practices; mental well-being and the risk of sexual aggression (AIFS, 2017).
There is evidence that premature exposure to adult sexual images and values has a negative impact on the psychological development of children, particularly on self-esteem, body image and understanding of sexuality and relationships (APA, 2010). Exposure to sexualising messages contributes to girls defining their self-worth and popularity in terms of sexual attractiveness, with negative impact on self-esteem. Excessive focus on appearance and a narrow definition of attractiveness has been found to contribute to the development of abnormal eating behaviours and lack of positive body image. Negative self-image is associated with depression, impaired sexual development in adolescence and poor self-protective behaviours in adolescent relationship. Efforts are required to address concerns that children and teenagers are being inappropriately sexualised (Lumby and Albury, 2010).
Starting to address some of the problems
The Office of the eSafety Commissioner (Australia) and Netsafe (New Zealand) take a lead role in assisting young people and their families to have positive online experiences, providing online safety education, a complaints service for people experiencing cyberbullying and a system to address illegal online content. This resource can help promote appropriate use of social media and is a useful resource for those who have experienced difficulties associated with cyberbullying.
Several strategies are being put in place to protect children who are at risk of being exposed to age-inappropriate content, who encounter cyberbullying, or put their privacy at risk. These include media regulation and psycho-educational approaches to provide children and adolescents with skills to deal with issues relating to the potential pitfalls of media and digital technology use. School-based media literacy programs and parenting programs are examples of this.
The changes brought to society by the development of media technology are profound and farreaching. These developments bring benefits, but also challenges and risks. These recommendations are made in light of this knowledge and with an understanding that they will need regular review. The RANZCP recommends that:
- All mental health professionals, as well as workers in related health and education fields, become aware of the positive benefits of media and encourage use in a way that encourages development and well-being.
- Access and affordability to technology are addressed as it becomes ever more present in dayto-day life. Children and young people from disadvantaged backgrounds may not have ready access to the benefits of media and so could potentially be disenfranchised and disempowered as citizens.
- Tools are developed that help people navigate the range of e-mental health resources (e.g. websites, apps) to ensure that people can confidently access quality resources.
- There should be an awareness that Problem Internet Use, where it leads to significant social isolation and withdrawal, can impact adversely on development. Whilst problem use is not recognised as a disorder within classification systems, such as the Diagnostic and Statistical Manual of Mental Disorders (DSM), clinicians should be alert to its existence and offer guidance and support as necessary.
- Responsibility for media literacy and appropriate and safe use of technology exists at several levels; family, school, community and government. All levels should work to minimise potential harms.
- Parents, carers and those working with young people should be made aware of the benefits and potential problems associated with media use. They should be encouraged to educate themselves about these topics where they feel lacking in knowledge and should be empowered to help young people set reasonable limits around media usage in a way that enhances their development and minimises problematic use.
- As technology becomes more widely used in schools from an early age, there needs to be a commensurate program of media literacy and responsible media use in schools to cover issues of cyber safety. The Office of the eSafety Commissioner in Australia and Netsafe in New Zealand are good examples. The RANZCP recommends that educational input begin as soon as children start using technology. This means they will be empowered to use technology appropriately and be able to identify misuse, particularly where it impacts negatively.
- Cyberbullying, which includes sexting, is an area of high concern that requires specific and ongoing strategies to reduce incidence, and protect children at risk.
- Support measures are taken across all jurisdictions, as well as internationally, to minimise the sexualisation of children in the media and better protect children and young people. This includes generalised approaches to children who are exposed to pornography that should sit alongside more targeted, specialised supports for children who are in a high-risk group, such as those in out of home care, or who experience neglect or violence.
- Psychiatrists should become familiar with the impact of media on children and adolescents and can provide advice to children and young people and those that care for them about:
- ready access to e-health resources that promote social health and emotional well-being to enhance recovery
- harms to well-being that may arise from internet use
- Psychiatrists are well placed to help work with children and young people with mental health problems where negative media experiences play a role. Expertise in developmental psychopathology, and a treatment focus that is holistic, means psychiatrists consider a young person in the context of their family and community. They can make comprehensive assessments and offer guidance about appropriate management options.
- Workers in the field should seek, as part of the assessment of any mental health difficulties, to assess a person’s use of media. This would help to highlight situations where problematic use may be an issue but also open up the possibility of using media-based interventions as a way of offering support.
- Training of psychiatrists working with children, young people and their carers should address skills and competencies in:
- targeted use of e-health resources in psychoeducation and as adjuncts to assessment, management and treatment monitoring
- assessment of internet use and problems that may arise
- management of internet use problems and comorbidities.
- More research is needed in this field. In Australia and New Zealand, children and young people have ready access to technology. Arguably however, research lags significantly behind China and Europe. It is recognised that there are problems but there is no research agenda to explore these. It is important that the impact of technology is understood in Australian and New Zealand contexts so that the best advice and support can be given.
Suggested further reading/resources
Alannah and Madeline Foundation. Improving cyber safety, increasing digital literacy and reducing cyber bullying across Australia. Available at: www.esmart.org.au/
Harkin J (2009) Cyburbia: the dangerous idea that’s changing how we live and who we are
. London, UK: Little Brown.
Kutner L and Olson C (2008) Grand theft childhood. Available at: www.grandtheftchildhood.com/GTC/Home.html
(accessed 24 November 2016).
Netsafe. Available at: www.netsafe.org.nz/
Office of the eSafety Commissioner. Available at: esafety.gov.au/
Roberts K (2011) Cyber Junkie: Escape the Gaming and Internet Trap
. Minneapolis, USA: Hazelden Information and Educational Services
World Psychiatric Association. Position statement on e-mental health
Young K (2011) Assessment and Treatment of Problem Internet Use. In: Grant JE, Potenza MN (eds) The Oxford Handbook of Impulse Control Disorders
. New York, USA: Oxford University Press
Young KS, Nabuco de Abreu C (2010) Internet Addiction: A handbook and guide to evaluation and treatment
. New Jersey, USA: John Wiley and Sons.