Screen Media: A Powerful Reinforcement

Abstract

The use of screen media has significantly increased and several lifestyle consequences have occurred following this change. Screen media exposure is more common among younger age children. Multiple factors may be the reason for this; however, their use is likely reinforced. Parents seek support from screen media devices, which can help calm and occupy their children in a matter of minutes. However, resorting to electronic devices for instant relief is likely to persist due to both negative and positive reinforcement. Reinforcing screen media in this way will make the use of screen devices inextricable for parents and their children. Explaining the issue clearly and coming up with feasible solutions will help minimize the negative health effects of prolonged screen use, the general desirability of screen media devices, and also improve (and increase) healthy screen time habits in children.

‘Early childhood, especially the first 35 months of life, is crucial in establishing healthy screen time behavior because this is the age where screen viewing begins to increase rapidly . . .’

Technology is evolving rapidly, and it is difficult to understand how to be best protected from the negative consequences associated with these advances. Before a discussion on mitigating the consequences of technological advances is discussed, it may be appropriate to clearly state that these are not arguments to “return to the good old days” when these advances were not present. The condemnation of new technologies is not novel. For example, books were thought to be poisonous substances,¹ electricity was discussed as a mysterious power that bent the laws of nature,² and flight was predicted to be an unnecessary danger.³ The new technology that is currently under scrutiny is screen media use. As discussed by Stevens and Egger in this issue,⁴ the benefits of having access to almost unlimited amounts of information with this new form of technology are clear, but consequences are also apparent. Given the benefits of this technology, it is likely disadvantageous for most to remove screen media completely from their lives; however, it is vital to train screen media usage in an age-appropriate manner.⁵ Early childhood, especially the first 35 months of life, is crucial in establishing healthy screen time behavior because this is the age where screen viewing begins to increase rapidly, and habits formed at this time tend to persist across the lifespan.⁶

The impact of extended screen media exposure on children’s health has been clearly established.^7-9 Increased TV viewing at an early age negatively affects cognitive development, language development, and parent-child relationships.^7-9 Screen media that includes violent content elevates violent thoughts, angry feelings, and aggressive behavior; it also decreases empathy among children.¹⁰ Additionally, increased screen media use has been linked to obesity in children and adolescents, possibly because of a reduction in sleep, increase in energy intake, and overall changes in eating preferences.¹¹ The American Academy of Pediatrics recommends avoiding any use of screen media for children under 18 months and to limit viewing time for older children to 1 hour per day of high-quality programs.¹² However, a longitudinal study demonstrated that preschool-aged children are exposed to screens for an average of 4.1 hours a day.¹³

This excessive screen time exposure may be unintentionally reinforced by parents.

Anyone who has been trapped on an airplane with a crying baby knows how aversive children’s crying and whining is, particularly for parents.¹⁴ When parents become desperate to make it stop, they may try anything to calm their child including things they know should be limited and possibly avoided altogether like sweets or screen devices.^15,16 Screen media devices are appealing because they quickly change children’s behavior and are readily available to most adults at any moment.¹⁷

The Appeal of Screen Media

Children show interest in screen media starting at a very early age. Babies lying on their backs will turn around at a 180° angle to watch TV.¹⁸ Certain stylistic techniques used in television, such as zooms or sudden noises, activate the “orienting response,” which is an innate sensitivity to movement and sudden changes in vision or sound.¹⁹ For example, infants and toddlers show a preference for image-sound coexistent apps over puzzle-solving apps while using touch screens.²⁰ Stated simply, young children are drawn to specific features on small screens. Furthermore, these stylistic techniques have increased in children’s programs such as Sesame Street in the past few decades to hold children’s attention.²¹

Screen media is rewarding.^22,23 Dopamine, a neurotransmitter related to reward-seeking behaviors and addiction,²⁴ is produced when playing video games or using the internet.^23,25 Video game designers include tasks, challenges, and success/failure factors into game settings that increase the rewarding effect of the game.²⁶ In addition, rewarding children with access to screen media for desirable behaviors strengthens the rewarding effect of said devices.²⁷

Parents find screen media to be convenient, easily accessible, and efficient tools for distracting or occupying their children.¹⁷ In fact, screen media is useful in situations when parents want their child to be quiet (eg, restaurants, doctor’s office waiting room, church) and in other situations when they need their child to be still and safe with little supervision.²⁸ For instance, TV is often used as a “babysitter” by parents who need to focus on other responsibilities, be it housework, their other children, or personal duties.^17,29 Parents may find screen media useful for managing their child’s behavior in early childhood but become more concerned when their school-age child seems to have an incessant desire for screen time.^17,30 Parents of older children often struggle to get their child to reduce screen media use. Understanding how parents and children are mutually reinforced and conditioned to repeat the interactions around screen media may help to break this cycle.

Negative Reinforcement Trap

Negative reinforcement strengthens behavior through the removal of an unpleasant stimulus.³¹ When parents give their child a screen (behavior) and crying or loud disruptive behavior (unpleasant stimulus) stops, provision of the screen to the child (behavior) by the parent is reinforced. This means that the parent will be more likely to give their child a screen to stop them from crying or being loud and disruptive in the future. Positive reinforcement strengthens behavior through a reward.³¹ Giving a child a screen (natural reward) in response to the child’s crying reinforces the use of crying when the child wants screen time and increases the value of the screen to the child. Therefore, in the future, the child will be more likely to cry or be disruptive. In this exchange, both the parent and child are reinforced for their respective behaviors, making this interaction play out repeatedly with increasing intensity.

The “trap” of this type of reinforcement schedule is that both the parent and child are reinforced to engage in an undesirable behavioral pattern. This pattern becomes very difficult to modify. Parents may report that they know they should limit their child’s screen time but feel trapped by their child’s demands for it. A lack of awareness of how the parent’s response is reinforced and the difficulty of breaking this reinforcement schedule for the parent (instead of just their child) is critical for meaningful changes to be made. Without disruption, we would anticipate the behavior to continue because of the dual reinforcement schedule.

To break this cycle, parents should increase their tolerance for the child’s crying or disruptive behavior. Parents should expect that withholding the screen media will result in increased crying and disruptive behavior by the child. What may help parents to tolerate this elevation in crying and disruptive behavior is knowing that this is an “extinction burst.” After a peak in behavioral intensity, the crying and disruptive behaviors will rapidly subside. After multiple episodes of crying without reinforcement, the child’s likelihood of crying for screen media use will decrease. The parent is also more likely to not provide the screen media because the negative reinforcement schedule is also being addressed. Over the course of multiples episodes in which the screen is withheld, and the child’s extinction burst is left to peak and subside, the intensity of the extinction burst will diminish and eventually stop. The difficulty in this process is teaching parents to expect an increase in the unpleasant behavior before they can expect an improvement. In this case, increasing the frequency of these episodes means that additional learning is taking place. The more the child presents the unpleasant behavior, the more the parent also learns to deal with disruptive behavior by using other skills instead of relying on screens.

Conclusion

The need for and use of screens does not appear to be declining. The use of screens is not only intrinsically rewarding for most individuals, it is trained at an early age. One of the most important ways of dealing with lifestyle issues is to train children for appropriate use. Even if screen media seems like an easily accessible and convenient solution to manage children’s behavior, parents should be aware that it can turn into an inextricable trap. Defining the issue and how it occurs clearly by explaining operant conditioning (eg, negative and positive reinforcement) may help parents to understand the problem and to change their perception of seeing screen media as a solution. Overall, as with most of lifestyle medicine, learning takes place at early stages of development. The better we equip parents to help the next generation to engage in healthier lifestyles, the more likely we will decrease the behaviors, when done in excess, that cause illness.