stop arguing about screen time! (with your middle schooler) peter della bella, md clinical assistant...

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Stop Arguing About Screen Time! (with your Middle Schooler) Peter Della Bella, MD Clinical Assistant Professor, NYU School of Medicine Fellowship Supervisor, NYU Child Study Center Private Practice, New York & Montclair March 3, 2014

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Page 1: Stop Arguing About Screen Time! (with your Middle Schooler) Peter Della Bella, MD Clinical Assistant Professor, NYU School of Medicine Fellowship Supervisor,

Stop Arguing About Screen Time!(with your Middle Schooler)

Peter Della Bella, MDClinical Assistant Professor, NYU School of Medicine

Fellowship Supervisor, NYU Child Study CenterPrivate Practice, New York & Montclair

March 3, 2014

Page 2: Stop Arguing About Screen Time! (with your Middle Schooler) Peter Della Bella, MD Clinical Assistant Professor, NYU School of Medicine Fellowship Supervisor,

Intro

• Middle school intro and your biggest concerns• What is screentime?• What’s good and bad about screentime?• Is all screentime the same?• Vignettes & warning signs• Behavioral psychology• Suggestions• Screen hygiene• 5 tips to know where you are getting somewhere• Your plan for this week

Page 3: Stop Arguing About Screen Time! (with your Middle Schooler) Peter Della Bella, MD Clinical Assistant Professor, NYU School of Medicine Fellowship Supervisor,

Late childhood/Early teens

• Less supervision and more freedom• Still highly impressionable/naïve• You still have some control over screen access

and content• What are your worries?• First exposures to sex, bullying, harrassment, and

overtly violent media• Becomes the preferred mode for self-soothing • YOU WILL BE SETTING THE PATTERN NOW

Page 4: Stop Arguing About Screen Time! (with your Middle Schooler) Peter Della Bella, MD Clinical Assistant Professor, NYU School of Medicine Fellowship Supervisor,

VignettesLuke can’t wait to get home from school to play Minecraft. He talks about Minecraft to his friends and adults, he is up until late at night playing and spends really excessive amounts of time on weekends. When you tell him to stop, he protests that he is right in the middle and can’t stop now or he’ll “die.” and gets really angry if you insist. He pleads for more time, and when you give it to him, he takes more time than you give him. And even THEN, he is unappreciative and even more angry.

Rachel comes home and sits on the sofa. She is clearly interacting with her friends: texting, laughing at cute animal pictures and the selfies that she and her friends are passing back and forth between each other using Snapchat. She also is on level 244 of Candy Crush. She seems happy and can do this for hours. At night, she willingly goes into her room at a good time, but the light stays on for hours.

Page 5: Stop Arguing About Screen Time! (with your Middle Schooler) Peter Della Bella, MD Clinical Assistant Professor, NYU School of Medicine Fellowship Supervisor,

WARNING SIGNS• They seem depressed in real life, happier on-line• They’re using screen time destructively• They’re overweight• They’re extremely irritable when you ask them to

shut down • They always talk a lot more about what’s on the

screen than things in real life• They sneak or lie in order to get more screen

time• You catch them in their rooms when they’re

supposed to be asleep

Page 6: Stop Arguing About Screen Time! (with your Middle Schooler) Peter Della Bella, MD Clinical Assistant Professor, NYU School of Medicine Fellowship Supervisor,

Why Limit Screentime?

• Because they can’t• Displaces opportunities for real social interaction• Displaces physical activities and hobbies• Disallows opportunities for self-regulation skills• Cuts into sleep, …family routines,…reading,…

Page 7: Stop Arguing About Screen Time! (with your Middle Schooler) Peter Della Bella, MD Clinical Assistant Professor, NYU School of Medicine Fellowship Supervisor,

Think of the use of electronic devices as an addiction…

…big trend in addiction medicine is harm reduction

Page 8: Stop Arguing About Screen Time! (with your Middle Schooler) Peter Della Bella, MD Clinical Assistant Professor, NYU School of Medicine Fellowship Supervisor,

STRIKE A BALANCE

Page 9: Stop Arguing About Screen Time! (with your Middle Schooler) Peter Della Bella, MD Clinical Assistant Professor, NYU School of Medicine Fellowship Supervisor,

Behavioral Psychology Basics

• The vast majority of behaviors are learned.• Whether adaptive or maladaptive, these behaviors

serve a function

POSITIVE REINFORCEMENT (reward) social, tangible goods, internalNEGATIVE REINFORCEMENT (escape/avoidance) social (escape from demands), internal

Page 10: Stop Arguing About Screen Time! (with your Middle Schooler) Peter Della Bella, MD Clinical Assistant Professor, NYU School of Medicine Fellowship Supervisor,

Behavioral Psychology Basics

• Noncompliance, aggression, and tantrums have all been found to occur due to social positive reinforcement (rewards) or negative reinforcement (escape/avoidance).

Page 11: Stop Arguing About Screen Time! (with your Middle Schooler) Peter Della Bella, MD Clinical Assistant Professor, NYU School of Medicine Fellowship Supervisor,

Behavioral Psychology ABCs

ANTECEDENTSBEHAVIORSCONSEQUENCES

Page 12: Stop Arguing About Screen Time! (with your Middle Schooler) Peter Della Bella, MD Clinical Assistant Professor, NYU School of Medicine Fellowship Supervisor,

Behavioralism in the Home• No need to yell• Not much need to argue• You just need to be mindful of the antecedents and

control the consequences

• A ounce of prevention…• Strength in numbers• Clearly communicate the limits• Precedents are easier to set than to reverse• Be aware of what you reinforce• Consequences, consequences, consequences

Page 13: Stop Arguing About Screen Time! (with your Middle Schooler) Peter Della Bella, MD Clinical Assistant Professor, NYU School of Medicine Fellowship Supervisor,

Elisabeth Kubler-Ross5 Stages of Grief

DenialAngerBargainingDepressionAcceptance

Page 14: Stop Arguing About Screen Time! (with your Middle Schooler) Peter Della Bella, MD Clinical Assistant Professor, NYU School of Medicine Fellowship Supervisor,

VignettesLuke can’t wait to get home from school to play Minecraft. He talks about Minecraft to his friends and adults, he is up until late at night playing and spends really excessive amounts of time on weekends. When you tell him to stop, he protests that he is right in the middle and can’t stop now or he’ll “die.” and gets really angry if you insist. He pleads for more time, and when you give it to him, he takes more time than you give him. And even THEN, he is unappreciative and even more angry.

Rachel comes home and sits on the sofa. She is clearly interacting with her friends: texting, laughing at cute animal pictures and the selfies that she and her friends are passing back and forth between each other using Snapchat. She also is on level 244 of Candy Crush. She seems happy and can do this for hours. At night, she willingly goes into her room at a good time, but the light stays on for hours.

Page 15: Stop Arguing About Screen Time! (with your Middle Schooler) Peter Della Bella, MD Clinical Assistant Professor, NYU School of Medicine Fellowship Supervisor,

Suggestions – dealing with antecedents (1 of 2)

• Establish a family home use plan• Parents unite and conquer• Remember: You have all the power!• The right tone is: balance• Meet with your child together and lay down the new rules explicitly• Communicate your monitoring plan and the consequences• Remember: portable devices are the most accessible and least controllable!

Ground rules• Nothing in the bedroom, nothing at the kitchen table• Stationary is always better than mobile• Collect all mobile devices at night• Suggestion: use time as the arbiter. Define all screens the same.

Page 16: Stop Arguing About Screen Time! (with your Middle Schooler) Peter Della Bella, MD Clinical Assistant Professor, NYU School of Medicine Fellowship Supervisor,

Suggestions – dealing with antecedents (2 of 2)

Work on• Re-establish non-electronic bedtime rituals• Using limited time forces them to make choices• The longer you delay the purchase, the better• Control access. If you can’t, control the opposite• Make available alternatives: they’ll scoff at them at

first• Breaks and screen holidays are good, but don’t do it

capriciously.• On vacations, consider a screen holiday.

Page 17: Stop Arguing About Screen Time! (with your Middle Schooler) Peter Della Bella, MD Clinical Assistant Professor, NYU School of Medicine Fellowship Supervisor,

Suggestions – more antecedents

• Talk to the friends’ parents… • Decide on if you have to install

monitoring/shut off devices• Decide on whether you want to reward with

additional screentime beyond their standard (but keep it small).

Page 18: Stop Arguing About Screen Time! (with your Middle Schooler) Peter Della Bella, MD Clinical Assistant Professor, NYU School of Medicine Fellowship Supervisor,

Suggestions – dealing with consequences

• Reward /punish screentime problems by altering screentime!

• Don’t punish screentime problems by taking away NON-electronic activities• Remember the Kubler-Ross Stages• Expect relapse and trickery!

– Sneaking off, tech shifts, going to friends’, smaller devices• If they get nasty and surly, calmly take time away from tomorrow, and tell them

the behavior you expect• Teach them to self monitor!• Always stick to your guns

When it gets really bad – take it away!

Page 19: Stop Arguing About Screen Time! (with your Middle Schooler) Peter Della Bella, MD Clinical Assistant Professor, NYU School of Medicine Fellowship Supervisor,

“4 Ways to Say No”

• No with an explanation• No with a redirection• No with feeling• No and go

Page 20: Stop Arguing About Screen Time! (with your Middle Schooler) Peter Della Bella, MD Clinical Assistant Professor, NYU School of Medicine Fellowship Supervisor,

Screen Hygiene

• No screens when it is inappropriate socially: dinner, company,…

• No screens as a tool for avoidance or emotional regulation

• No screens in the bedroom• Screens are not a substitute for babysitting• Limits: time, access. Supervise.• If they are extremely irritable when you make

them get off, they were on too long.

Page 21: Stop Arguing About Screen Time! (with your Middle Schooler) Peter Della Bella, MD Clinical Assistant Professor, NYU School of Medicine Fellowship Supervisor,

5 SIGNS YOU’RE GETTING SOMEWHERE

• They don’t have a screen with them all the time• They have life activities that have nothing to do

with screens• They can play with others without screen time• They’re picking up books, playing chess (the

antivideo game), or have a hobby• They tell you to limit your screen time!• You can bust on them (or yourself) re: screens,

and they can laugh about it.

Page 22: Stop Arguing About Screen Time! (with your Middle Schooler) Peter Della Bella, MD Clinical Assistant Professor, NYU School of Medicine Fellowship Supervisor,

American Academy of Pediatrics

• 2 questions at every well child visit– How much recreational screen time does your

child use daily– Does your child have a TV/web-connected device

in his/her bedroom?

• Establish a Family Home Use Plan

Page 23: Stop Arguing About Screen Time! (with your Middle Schooler) Peter Della Bella, MD Clinical Assistant Professor, NYU School of Medicine Fellowship Supervisor,

Family Home Use Plan

• Time• Devices• Content• Location• Monitoring• Consequences

Page 24: Stop Arguing About Screen Time! (with your Middle Schooler) Peter Della Bella, MD Clinical Assistant Professor, NYU School of Medicine Fellowship Supervisor,

Your Family Home Use Plan…