What We Know About Screen Time and Social Media in Early Adolescence: A Review of Findings from the Adolescent Brain Cognitive Development (ABCD) Study

Abstract

Purpose of review

To review recent literature based on Adolescent Brain and Cognitive Development Study data of over 11,000 participants about screen time and social media use in early adolescence, including epidemiology and trends as well as associations with mental and physical health outcomes.

Recent findings

Time spent on screens and social media has risen among early adolescents (aged 9–15 years), and these increasing trends have been more pronounced with the COVID-19 pandemic. Both cross-sectional and one-to-two-year follow-up data show that higher screen use, particularly social media, video games, video chat, videos, and texting, is associated with a range of mental health symptoms, including depression, anxiety, eating disorders, obsessive-compulsive disorder, attention-deficit/hyperactivity, and disruptive behavior disorders, although effect sizes vary. Screen time is also associated with sleep problems and various cardiometabolic risk factors. Parents’ own screen use and restriction of bedroom and mealtime screen use are associated with lower early adolescent screen time and problematic use.

Summary

Analyses of current ABCD Study data reveal increasing use of screens and social media across early adolescence, with sociodemographic disparities in screen use as well as numerous associations between screens and adverse mental and physical health effects.

Introduction

The rapid advancement of technology in recent years has significantly increased screen use among children and adolescents, contributing to a variety of adverse health effects [1]. Given the health implications associated with digital media, particularly during this critical developmental phase when lifelong behaviors take shape, there is an increasing need to better understand screen usage in early adolescence.

This review synthesizes trends and health outcomes related to screen time and social media use in early adolescence and provides an overview of findings from studies that have used data from the Adolescent Brain Cognitive Development (ABCD) Study, the largest longitudinal investigation of adolescent health, brain, and cognitive development in the United States [2,3]. The ABCD Study’s national sample, longitudinal data, and comprehensive collection of screen use data provide an unparalleled resource for evaluating complex screen use associations among U.S. adolescents. In this review, we highlight disparities in screen use based on sociodemographic factors, summarize findings of associations between screen use and mental and physical health, and offer guidance for parents and adolescents on healthy screen habits (Figure 1).

Figure 1.

Summary of screen use findings in the Adolescent Brain Cognitive Development (ABCD) Study

BMI = body mass index; HDL = high-density lipoprotein

Findings

Epidemiology and Trends

During the ABCD Study baseline, 9–10-year-olds reported 3.99 daily screen hours across six different media types, with the highest usage among television shows and movies (1.31 hours), video games (1.06 hours), and videos (e.g., YouTube, 1.05 hours) [3]. Average daily recreational screen time increased to 7.7 hours during the COVID-19 pandemic [4]. Social media use, in particular, has become increasingly widespread among early adolescents, with 63.8% of 11–12-year-olds reporting having social media accounts, despite most social media platforms requiring users to be 13 years of age or older [5].

Studies have documented disparities in screen time, problematic use patterns suggestive of addiction, and cyberbullying across sociodemographic factors, including sex, sexual orientation, gender identity, race/ethnicity, and socioeconomic status [2,3,6–8]*. Among early adolescents, boys reported more overall screen time than girls and more time on video games and videos, whereas girls spent more time texting, using social media, and video chatting [3,9]. Correspondingly, boys reported higher problematic video game usage than girls, while girls reported higher problematic social media and mobile phone use [2]. Problematic screen use is characterized by elements of addiction, such as tolerance, withdrawal, conflict, and relapse. Surveys indicate that 47.5% of adolescents lose track of how much they are using their phone and 11% reported using social media so much it negatively impacted their schoolwork [2,5]. These findings highlight the potential value of more focused counseling from pediatricians for both caregivers and children on the risks and benefits of video game use for boys and social media for girls. The questionnaires used to assess for problematic video game, social media, and mobile phone use are shown in Table 1 and could be used by clinicians to assess for problematic screen use.

Table 1.

Questionnaires Used to Assess Problematic Video Game, Social Media, and Mobile Phone Use in the Adolescent Brain Cognitive Development (ABCD) Study

Video Game Addiction Questionnairea
I spend a lot of time thinking about playing video games
I feed the need to play video games more and more
I play video games so I can forget about my problems
I’ve tried to play video games less, but I can’t
I’ve become stressed or upset if I am not allowed to play video games
I play video games so much that it has had a bad effect on my schoolwork or job
Social Media Addiction Questionnairea
I spend a lot of time thinking about social media apps or planning my use of social media apps
I feel the need to use social media apps more and more
I use social media apps so I can forget about my problems
I’ve tried to use my social media apps less, but I can’t
I’ve become stressed or upset if I am not allowed to use my social media apps
I use social media apps so much that it has had a bad effect on my schoolwork or job
Mobile Phone Involvement Questionnaireb
I interrupt whatever else I am doing when I am contacted on my phone
I often use my phone for no particular reason
I feel connected to others when I am using my phone
Arguments have arisen with others because of my phone use
I lose track of how much I am using my phone
I often think about my phone when I am not using it
I have been unable to reduce my phone use
The thought of being without my phone makes me feel distressed

Questions are from [2].

^aResponse options are: never, very rarely, rarely, sometimes, often, very often

^bResponse options are: strongly disagree, disagree, somewhat disagree, neither agree nor disagree, somewhat agree, agree, strongly agree

Lower household income and parental education correlated with higher screen usage after adjusting for sex and race [3]. Additional differences were identified by race and ethnicity for problematic screen use, with Native American, Black, and Latine adolescents reporting higher scores across all problematic screen measures compared to their non-Latine, White counterparts [2]. A trajectory analysis indicated that screen use increased at a faster rate among youth who are racial/ethnic minorities, come from households with lower parental education levels, and report greater experiences of perceived racism and discrimination [10,11]**. It is possible that these associations may be explained by neighborhood environments, including fewer opportunities for outdoor activities in low-income or predominantly Black neighborhoods.

Sexual and gender minority disparities in screen time use among early adolescents have also been reported [6,7]. Gay or bisexual identification was associated with 3.72 more hours of daily recreational screen time, while transgender adolescents reported 4.51 more hours of total screen time and higher problematic use than their cisgender peers [6]. For both sexual and gender minority youth, digital media presents a complex duality, serving both as a sense of support and a potential health risk. On the one hand, it offers a means of escapism and a platform for finding community; on the other hand, excessive use has been linked to adverse mental outcomes [6,7].

Cyberbullying

Rising screen use among children and adolescents has led to greater potential for exposure to cyberbullying victimization, defined as the willful and repeated harm by a perpetrator to a victim through the use of computers, cell phones, or other electronic devices [8]. Nearly a tenth (9.6%) of 11–12-year-olds reported experiencing cyberbullying victimization [8].

Online dating

Among 11–12-year-olds, 0.4% reported ever using a dating app, despite most online dating apps having a minimum age requirement of 18 years [12]*. Boys were three times more likely to report online dating than girls [12]. Sexual minority adolescents had 13.0 higher odds of online dating compared to heterosexual adolescents, illustrating further disparities in digital technology usage by minority groups [12].

Screen use and mental health

High screen time and social media usage have been associated with numerous mental health conditions in early adolescents, as evidenced by initial findings from the first four years of data from the ABCD Study. Several studies have proposed that these associations may be partially explained by the effects of digital media on brain development [13,14]*,**.

Among the various mental health conditions linked to screen time, eating disorder symptoms, specifically binge eating, have been highlighted in multiple studies. Increased screen time may elevate exposure to and pressures to adhere to socially constructed body ideals, which is further supported by a study that found each additional hour of screen time and social media use was prospectively associated with higher odds of eating disorder symptoms two years later [15]*. In terms of clinical eating disorders, more screen time, especially social media time, was associated with higher odds of binge eating disorder. Depressive symptoms partially mediated the association between higher screen time and the incidence of binge eating disorder [16], and both cyberbullying victimization and perpetration were also associated with eating disorder symptoms [17]. Those who engage in problematic social media use may be more prone to comparisons with content that embodies certain body ideals, increasing pressure to maintain a certain physical appearance.

Greater screen use was prospectively associated with a range of mental health symptoms, including depression, anxiety, somatic problems, mania, and attention-deficit/hyperactivity (ADHD), controlling for baseline symptoms [18,19]**. Although effect sizes were generally small, these associations were per hour of screen exposure and could become substantial with multiple hours over multiple years of exposure, especially at the population level. Total screen time (including video chat, texting, videos, and video games) was most strongly associated with depressive symptoms of the various DSM-oriented mental health outcomes [19]. Higher screen time was associated with higher odds of reporting suicidal behaviors [20]; some theories propose that greater screen time may heighten the incidence of cyberbullying, leading to poorer mental health and suicidal behaviors [21,22].

High screen use is linked not only to various mental health symptoms but also to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnoses. Each additional hour of total screen time (especially watching YouTube videos) was associated with 5% higher odds of obsessive-compulsive disorder (OCD) at two-year follow-up; one possible mechanism could be that video platform algorithms may mediate compulsive viewing of homogeneous content [23]. Higher screen time was also associated with a higher prevalence of conduct disorder and oppositional defiant disorder, though effect sizes were relatively small. Among screen modalities, the strongest association was found between social media and conduct disorder, as each additional hour spent on social media was associated with a 62% higher prevalence of conduct disorder [24]. Screen time may increase exposure to violent content, facilitating the development of disruptive behavior disorders such as conduct disorder and oppositional defiant disorder.

It has also been proposed that certain forms of digital media may be associated with psychotic-like experiences during adolescence, defined as the presence of hallucinations and/or delusions that can later lead to psychotic disorders. Specifically, online videos and television had the highest associations with psychotic-like experiences in early adolescents, suggesting that these forms of media may precipitate or perpetuate factors of psychotic-like experiences for those at risk [25].

Screen use and substance use

In early adolescence, problematic social media use was associated with positive alcohol expectancies [26], which refer to an individual’s beliefs about the positive effects associated with drinking alcohol. Further, more social media time was associated with a 1.31 times higher risk of new-onset experimentation with alcohol, an effect partially mediated by problematic social media use [27]*. These associations can likely be explained by the overwhelming positive depiction of alcohol in social contexts on social media, leading to peer comparisons and connections that influence early adolescents’ perception of alcohol consumption [28]. Another contributing factor could be exposure to cyberbullying with greater internet use, leading to substance use as a coping mechanism to address psychological pain associated with cyberbullying experiences. This theory is supported by recent research showing that cyberbullying was associated with substance use initiation in early adolescents [29]*.

Higher total screen time has also been linked to higher odds of early adolescent experimentation with cannabis and nicotine [30]. Social media use, texting, and video chatting were found to be the primary drivers of this association, suggesting that digital social connections may influence experimentation and perceptions of substance use. Adolescents who spend more time on social media are more likely to be exposed to positive depictions of substance use, as well as peer engagement in substance use, which may lead to them viewing these behaviors as normal and more likely to experiment with substances themselves.

Given adolescents who begin using substances before the age of 14 are more likely to develop substance use disorder later in life, these findings underscore the importance of policies that shield young adolescents from exposure to substance-related content on social media.

Screen use and physical health

The relationship between high screen time and aspects of physical health has also been extensively examined. Analyses revealed significant associations between screen time and sleep patterns, physical activity levels, nutritional habits, and cardiometabolic health.

Adequate and high-quality sleep is essential for the healthy behavioral, emotional, and cognitive development of adolescents, and lacking good-quality, sufficient sleep can lead to many physical health problems. The ABCD screen time questionnaire includes questions about screens in the bedroom and use close to bedtime and during the night. Approximately 63% of early adolescents had a television or an Internet-connected electronic device in the bedroom, despite associations between bedtime screen activities and trouble falling or staying asleep and overall sleep disturbance. These relationships were confirmed with prospective analyses of the next year’s data, controlling for baseline sleep problems [31,32]**. Proposed mechanisms linking bedtime screen use to sleep disturbances include greater blue light exposure, which suppresses melatonin secretion; heightened alertness and cognitive arousal from screen content; disruptions from sound notifications on devices; and a diminished association between the bedroom environment and sleep [31,32]. These findings underscore the critical importance of addressing screen time usage patterns in early adolescents to promote better sleep and overall physical health.

More screen time has been associated with cardiometabolic risk factors, including high BMI [33,34]. For every additional hour of screen time, children aged 9–10 had a 0.22 higher BMI percentile after one year [33]. Cross-sectional data has shown that children who spend over four hours a day on screens are at higher risk of being overweight or obese compared to those who spend less than four hours per day [34]. Longitudinal data has demonstrated that while screen time is associated with higher BMI, this relationship varies depending on the behavior it replaces—whether it be physical activity or sleep—and also differs based on the participant’s sex [35].

Screen time’s association with higher BMI may be mediated by displacement of physical activity in lieu of screen use. Lower screen time and higher physical activity were associated with favorable cardiovascular health markers, including lower diastolic blood pressure and higher HDL cholesterol [36]*. Furthermore, the relationship between screen time and cardiometabolic health may also be influenced by the impact of screen use on dietary habits. Prospective and cross-sectional analyses have shown that higher screen time is associated with lower overall diet quality, as measured by the Mediterranean-DASH (dietary approaches to stop hypertension) intervention for neurodegenerative delay diet nutrition score [37]*. Screen time is a predominantly sedentary activity that displaces physical exercise and may contribute to poorer dietary habits due to mindless snacking and exposure to content advertising unhealthy foods. Consequently, these findings highlight why adolescence represents such a critical period for early media-use intervention, as behaviors that develop during this time can persist into adulthood and impact cardiovascular health across the lifespan [36].

Parental Guidance

To help mitigate the negative effects of high screen use, the American Academy of Pediatrics recommends implementing a Family Media Plan, which includes consideration of screen-free times, especially during meals and before bedtime, while also modeling healthy screen use by reducing their own usage around their children. ABCD Study data support these recommendations and are summarized in Table 2. Higher parental monitoring was associated with lower screen time, problematic screen use, engagement with mature content, and cyberbullying victimization, while restrictions on screen time helped lower problematic social media, video game, and mobile phone use [38–41]*,**. The American Psychological Association issued a health advisory on social media use in adolescence, which includes ten recommendations for adolescents, parents, and clinicians (Table 3) [1].

Table 2.

Recommendations for Parents to Encourage Healthy Screen Use in Early Adolescence Supported by ABCD Study Data

Limit parental screen use around children and model healthy screen use behaviors

Keep mealtimes screen free to encourage mindful eating. Screen use during meals has been associated with overeating, distracted eating, and weight gain/obesity.

Avoid using screens around bedtime and keep screens out of the bedroom. Leaving notifications on or on silent or vibrate was associated with less sleep compared to turning the phone off completely.

Minimize using screens as a disciplinary tool to control behavior. Taking away screens as punishment for bad behavior was associated with greater screen time and engagement with age-inappropriate media.

Monitor screen use and keep track of how much time children spend on screens.

Set screen time limits and encourage screen-free activities.

Develop an individualized Family Media Plan that considers children’s developmental stages, what electronic devices are in the household, and the family’s needs for communication and schoolwork on electronic devices. To do this, families can have regular and open conversations with adolescents about screen use.

Recommendations are supported by [31,31,32].

Table 3.

Summary of the American Psychological Association’s Recommendations from their 2023 Health Advisory on Social Media Use in Adolescence

Youth using social media should be encouraged to use functions that create opportunities for social support, online companionship, and emotional intimacy that can promote healthy socializations

Social media use, functionality, and permissions/consenting should be tailored to youths’ developmental capabilities; designs created for adults may not be appropriate for children.

In early adolescence (i.e., typically 10–14 years), adult monitoring (i.e., ongoing review, discussion, and coaching around social media content) is advised for most youths’ social media use; autonomy may increase gradually as kids age and if they gain digital literacy skills. However, monitoring should be balanced with youths’ appropriate needs for privacy.

To reduce the risks of psychological harm, adolescents’ exposure to content on social media that depicts illegal or psychologically maladaptive behavior, including content that instructs or encourages youth to engage in health-risk behaviors, such as self-harm (e.g., cutting, suicide), harm to others, or those that encourage eating- disordered behavior (e.g., restrictive eating, purging, excessive exercise) should be minimized, reported, and removed; moreover, technology should not drive users to this content.

To minimize psychological harm, adolescents’ exposure to “cyberhate” including online discrimination, prejudice, hate, or cyberbullying especially directed toward a marginalized group (e.g., racial, ethnic, gender, sexual, religious, ability status), or toward an individual because of their identity or allyship with a marginalized group should be minimized.

Adolescents should be routinely screened for signs of “problematic social media use” that can impair their ability to engage in daily roles and routines and may present risk for more serious psychological harms over time.

The use of social media should be limited so as to not interfere with adolescents’ sleep and physical activity

Adolescents should limit use of social media for social comparison, particularly around beauty- or appearance- related content.

Adolescents’ social media use should be preceded by training in social media literacy to ensure that users have developed psychologically-informed competencies and skills that will maximize the chances for balanced, safe, and meaningful social media use.

Substantial resources should be provided for continued scientific examination of the positive and negative effects of social media on adolescent development.

Recommendations from [1].

During the pandemic, notable discrepancies between parent and adolescent reports of screen time emerged, with parents generally reporting higher overall use for their child than adolescents self-reported (but lower social media use than adolescents reported) [42], highlighting the importance of open communication between parents and their children.

Limitations and Future Directions

There are several limitations of the studies reviewed that should be acknowledged. Much of the data was collected via self-report, introducing the potential for biases such as recall bias, which may affect the validity and reliability of the findings. More broadly, the observational nature of the ABCD Study restricts the ability of the studies to establish causal relationships between variables.

The ABCD Study findings thus far have highlighted various associations within a large, diverse sample, focusing on early adolescence. As participants age, there will be an opportunity to examine digital media patterns in mid-to-late-adolescence, as well as developmental trajectories across the entirety of the second decade of life. As such, future directions for the ABCD Study screen use analyses should include identification of longer-term trajectories, directionality of and mechanisms driving associations, as well as analyses using data from objective measures of screen time, such as Effortless Assessment of Risk States (EARS) [43,44]*. Future research could also examine the potential benefits of technology and digital media to further refine guidance that maximizes positive aspects, such as social support and as a source of information, while minimizing the negative health impacts [45].

Conclusion

In summary, analyses using data from the ABCD Study have highlighted the rapid increase in screen time among young adolescents. Screen use, especially when problematic, has been linked to a range of negative mental and physical health outcomes, including depression, eating disorders, sleep disturbances, and cardiometabolic risk factors. Sociodemographic disparities have also been identified, with boys, sexual/gender minorities, racial/ethnic minorities, and adolescents from lower-income families reporting higher screen time.

Findings from the ABCD Study highlight the importance of parenting rules and monitoring to promote healthy consumption of digital media. Further research is essential to establish personalized recommendations that address the unique needs of different age groups—early, middle, and late adolescence—while also delivering targeted guidance for various media modalities and platforms.

Key points.

• Research has linked high screen use with a variety of adverse health effects, including anxiety, depression, inattention, poor sleep, and inactivity.

• Disparities in screen time, problematic usage patterns, and cyberbullying are evident across various sociodemographic factors, including sex, sexual orientation, gender identity, race, ethnicity, and socioeconomic status.

• To help mitigate the negative effects of high screen use, parents and adolescents can adopt several proactive strategies, including screen time limits and monitoring of screen content.

• While the American Academy of Pediatrics offers guidelines on media use, further research is necessary to develop more personalized recommendations tailored to various age groups and media platforms.