Wednesday, January 23, 2013

Lessons from Sandy Hook: The Truth About Violent Video Games

On Saturday 2-16-13 from 1pm to 3pm I am offering a free seminar on the relationship  between violent video games and violent behavior. It has been widely speculated that Adam Lanza, the shooter at Sandy Hook, was a compulsive gamer who played first person shooter games. This seminar will present the most current research on video gaming and review how teens at risk for violent behavior can be identified.

Tuesday, January 15, 2013

The Impact of the Internet on Adolescent Health

The Impact of the Internet on Adolescent Health
Over the past five years the Internet has come to occupy a central place in the lives of teens. Teens use the Internet for communication with friends and family, school-related research, artistic expression, recreation, and in some cases, participation in local and global political movements. Most teens view the Internet as a way of enhancing their off-line lives and are able to find a balance between the time they spend in three dimensional reality and virtual reality.

Unfortunately, there is a sizable minority of teens -- current research suggests as many as 10% -- that cannot regulate their use of the Internet and lose their ability to balance their off-line and online lives.

There is an ongoing debate within the medical and mental health communities about whether the term “addiction” should be applied to teens and adults who have lost the capacity to balance their off-line and online lives. Medical and mental health professionals are also debating whether sustained use of the internet results in depression, anxiety, personality disorders, and even transient psychotic states.  
Although this debate is far from being resolved and therefore additional research is needed, it is clear to clinicians that there is a subset of teens who exhibit behaviors related to Internet use that closely resemble behaviors found in drug addiction, alcohol addiction and behavioral addictions such as compulsive shopping, gambling, and sexual activity.

Cravings/preoccupation: teens develop an almost constant craving/psychological preoccupation with being online via the computer and/or smart phone.
Tolerance: teens develop the need to spend increasing amounts of time online in order to feel excitement and satisfaction (e.g., one hour per day becomes three hours and three hours becomes five hours).
Withdrawal symptoms: teens experience feelings of anxiety, anger, tension, irritability, and/or depression when they are off line.
Persistence despite negative consequences: teens continue to engage in ever-increasing amounts of time online despite obvious negative consequences, such as conflict with parents, loss of off-line friendships, neglect of school work, failing grades, neglect of chores, reduction in physical activity, fatigue, and overall poor health.
In addition to addiction related symptoms, clinicians are seeing a cluster of serious mental health problems that appear to be caused by or exacerbated by interaction with the internet.

What is known about the impact of the Internet on adolescent mental health? The following represents a summary of current thinking on mental health problems associated with Internet use.

(1)There is variation in the amount of time teens are spending on the Internet and there is no specific amount of time that produces mental health problems. The Kaiser Family Foundation has conducted ongoing research on the amount of time teens between the ages of 14 and 18 are using various forms of technology. This research has determined that the average amount of time spent engaged with technology is 10 1/2 hours per day. This number includes switch tasking or multitasking – that is, teens using a laptop with three or four applications running simultaneously, listening to music, watching a film or television, and texting.
(2)Although there is not a specific amount of time on the internet that has been confirmed to result in mental health problems in teens, it is clear to mental health professionals that teens who lose the ability to balance their interest in online activities and off-line activities, experience significant social, emotional, and academic consequences. Compulsive engagement with online activities reduces the motivation to develop and expand crucial offline social-emotional capacities such as self-awareness, empathy, resilience, initiative, deliberation, and collaboration.
(3)Internet use, especially social applications such as e-mail, instant messaging, and social media sites, results in the activation of “pleasure centers” in the brain which, in turn, results in an increase in the level of the neurotransmitter dopamine. Dopamine is a neurotransmitter that is increased by both substance and behavioral addictions: cocaine, compulsive shopping, gambling, and sexual activity. High levels of dopamine produces high levels of pleasure - including euphoric states - which can result in a teenager pursuing online activities at the expense of focusing on off-line activities and responsibilities.
(4)Internet use allows socially anxious teens to engage in social relationships with a wide variety of online “friends.” It is well documented that the Internet can help a socially anxious and isolated teen feel confident and popular. The problem for these teens is that the commitment to online relationships ultimately overtakes any motivation to improve off-line relationships, resulting in a withdrawal from three-dimensional reality. This withdrawal can have devastating consequences by virtue of the fact that the teen stops taking on age appropriate social and emotional challenges, opting instead to remain within the safety of their preferred virtual reality.
(5)Teens who spend significant amounts of time online (25-30 hours per week) frequently present with symptoms of depression. Multiple studies have shown that teens and adults who devote a significant majority of their social and recreational time to online activities and relationships, present with symptoms of depression. It is not clear at this time whether being online 25 or more hours per week produces depression or whether teens who have depression seek out Internet related social and recreational activities. In either case, the Internet does not improve the mood of teenagers and may in fact interfere with a team seeking help for depression.
(6)Teens that have been diagnosed with ADHD are drawn to the Internet, particularly online gaming. It has long been documented that teens with ADHD are at high risk for drug and alcohol addiction due to deficits in the functioning of the prefrontal cortex. Research has confirmed that teens with ADHD are drawn to the dopamine producing activities offered by the Internet, resulting in high rates of compulsive/addictive use of technology.
(7)Teens with high functioning autism are also vulnerable to the compulsive use of the Internet, including online gaming, social media sites, YouTube videos, and research on areas of special interest. The problem for the teen with high functioning autism is the pleasure that is experienced through the Internet serves as an obstacle for remediating the core social and cognitive deficits associated with autism. The Internet represents a worst case scenario for teens on the autism spectrum in that it produces high levels of pleasure spent in complete social isolation, resulting in withdrawal from the types of off-line activities needed to improve their overall social and emotional functioning.
(8)Research on cyber behavior has identified a universal phenomenon referred to as the “disinhibition effect.” In this context disinhibition refers to impulsive-compulsive online behaviors -- such as sending multiple inappropriate e-mails (raging), engaging in sexual risk-taking behaviors (sexting or online porn), binge shopping, gambling, and misrepresenting one's identity. It is currently believed that the combination of anonymity and invisibility results in impulsive and self-destructive behaviors online - behaviors that a person would inhibit off-line.
(9)Increasing numbers of teens are developing significant problems with online pornography. The combination of the accessibility and intensity of online sexual stimulation is resulting in increasing numbers of teens becoming focused on cybersex -- to the exclusion of pursuing sexual and romantic relationships off-line. Many teens are becoming involved in perverse and forbidden areas of sexual behavior including fetishes and child pornography. Ongoing exposure to cyber pornography actually serves to rewire the adolescent brain in such a way that their sexual preferences -- or what is referred to as their “arousal template” -- is oriented only towards porn sex and not towards healthy sexual behavior and emotional intimacy.
(10)Sustained time online can also lead to the development of narcissistic personality characteristics. Adults diagnosed with what is referred to as  NarcissisticPersonality Disorder are grandiose, have an constant need for admiration, and exhibit a lack of empathy. Narcissists also believe they are special and unique and can only be understood and should associate with other special or high status people. To make matters more problematic, they tend to exhibit arrogance, have an exaggerated sense of entitlement, and are self-worshipers who want other people to worship them. For some teens, online social interaction stimulates the development of narcissistic character features. Social media sites can encourage a self-obsessed focus where teens a driven to achieve online popularity and status at the expense of empathy and compassion.
(11)Due to access to the internet, teens now have an unprecedented opportunity to become engaged in compulsive shopping and gambling. The fact that a purchase is made online or a bet is made in cyberspace serves to alter the reality of the consequences of impulsive-compulsive behavior. Teens who engage in online shopping and/or gambling often say their behavior seems “less real” than does behavior that occurs in three-dimensional reality. The fact that a 16-year-old can access eBay and find online gambling sites represents a significant risk to their long term emotional well-being -- as well creates the potential for financial risks for the family.
(12)The “I” generation of teens also are at risk for losing the capacity for self-reflection. The constant connection to their peers via the Internet, whether it is through the computer or a smart phone, leads to teens losing the capacity to be alone and reflect on their own thoughts and feelings. Many teens text thousands of times per month, firing off a message every time they have a feeling or thought, which in turn deprives them of the ability to think about their own lives in a serious way before communicating. For many teens the internet has served to deprive them of the time to contemplate and reflect on their thoughts, feelings, and choices – which reduces the capacity for both self-awareness and empathy.
(13)Sustained online interaction also can lead to the deterioration in the “art” of conversation for teens. The vast majority of teens do not use their smart phone for conversation purposes, relying almost exclusively on  texting or the sending of photos to communicate. The ability to sustain and expand on topics of conversation, to improvise, to add important details to a  narrative, are all lost when a teenager devotes the significant majority of his or her communication to text messages and emoticons.
(14)Finally, sustained online interaction deprives teens of the ability to understand and use nonverbal communication. Whether it is tone of voice, body position, facial expressions, or hand gestures, the teen “I” generation teen loses thousands of opportunities over the course of a year to read and react to nonverbal communication. The long-term negative consequences of this loss of practice is significant. As 70% of human communication is nonverbal, the inability to read and appropriately react to nonverbal communication can be interpreted as a lack of interest, a lack of focus, or worst of all, a lack of consideration and empathy.
A majority of teens manage the Internet successfully and are fully capable of taking advantage of the many opportunities that are unique to the Internet: creating art, editing music, writing code, engaging in local and global political action, creating blogs, creating websites, and maintaining healthy off-line relationships.
Unfortunately, the Internet is a toxic form of stimulation for some teens, resulting in isolation, impulsivity, depression, self-absorption, compulsive shopping and gambling, compulsive sexual behavior, and an inability to engage in meaningful self-reflection and empathy.
Educators in school settings are in a unique position to identify teens that are experiencing the negative consequences of the Internet. How would an educator know who to focus on? More than likely, the teen that is struggling online is the same teen who is struggling off-line. The Internet provides a powerful solution to complex off-line problems for teenagers, a solution that unfortunately increases off-line vulnerabilities and challenges. Students should be screened for Internet related problems who are struggling socially and academically and educators need to learn to conceptualize mental health problems as existing both off-line and online and provide meaningful assistance by working with teens on their virtual and three-dimensional identities.