Chapter 8. Children's time online and well-being outcomes

Daniel Kardefelt-Winther

UNICEF Office of Research – Innocenti

This paper reviews existing knowledge on how the time children spend using digital technology affects their well-being in order to understand when and why digital technology has a positive or negative influence on children. This is relevant, as the increase in children’s engagement with digital technology has led to concerns about whether this is healthy or harmful. The methodology used is an evidence-focused literature review, which includes studies of children aged 0-18. In addition to summarising existing evidence, the paper emphasises the methodological limitations that exist in this area of research. The literature is reviewed in light of these limitations to determine how much it can truly tell us about impacts on child well-being. The paper highlights that methodological limitations need to be more carefully considered in research, attributing the general lack of conclusive evidence to these limitations. The paper provides concrete recommendations to improve research in this area.

    

This chapter is based on earlier work published as: Kardefelt-Winther, D. (2017), “How does the time children spend using digital technology impact their mental well-being, social relationships and physical activity? An evidence focused literature review”, Innocenti Discussion Paper 2017-02, UNICEF Office of Research – Innocenti, Florence, www.unicef-irc.org/publications/pdf/Children-digital-technology-wellbeing.pdf

Introduction

Children’s use of digital technology has increased rapidly over the past decade, raising important questions around how the time spent on digitally mediated activities might affect children in positive or negative ways (Putnam, 2000[1]; Turkle, 2011[2]; Bell, Bishop and Przybylski, 2015[3]; George and Odgers, 2015[4]). As George and Odgers (2015[4]) state, the question is no longer if children are using digital technology, but how, why and with what effects. It is clear that digital technology offers many potential benefits to children, allowing them to connect with peers or access educational resources or entertainment (Livingstone and Bober, 2006[5]; Valkenburg and Peter, 2009[6]; boyd, 2014[7]). At the same time, there are legitimate concerns around who children interact with online (Madden et al., 2012[8]), if they experience cyberbullying or access age-appropriate content (boyd and Hargittai, 2013[9]), or whether screen-based communication might hurt their social development or well-being (George and Odgers, 2015[4]).

In this chapter, a broad definition of digital technology is used to include all digital devices, such as computers, tablets and mobile phones, as well as the many digitally mediated activities that children today engage in via these devices, such as using the Internet, going on social networking sites, chatting or playing video games. Television is considered separately. Child well-being is considered as a multi-dimensional concept which in this paper covers mental/psychological, social and physical dimensions. The paper does not consider in detail the impact of specific content or experiences that children may have online. While recognising that these are likely important factors in determining the outcomes of children’s online engagement, the scope of this chapter is around the impact of time use specifically.

Even though adults also use digital technology to a great extent, concerns tend to centre on children’s use because of the many social, biological, cognitive and psychological changes that characterise this life period. Children go through critical developmental stages, such as identity formation and building positive friendships, while immersed in the digital age (George and Odgers, 2015[4]). Turkle (2011[2]) has argued that children today are interacting more with their phone than with each other, which may cause them to miss out on important social experiences. Others say that children still interact with one another as much as before and that the interactions are of similar quality; it is the venues for social interaction that have changed, to become digital (e.g. boyd (2014[7])). Because friendships and communication with peers are important for the development of lifelong social skills, there are concerns that children’s social skills might somehow be altered or negatively affected when digitally mediated ((George and Odgers, 2015[4]); see also Chapter 5 in this volume). This extends to a broader societal concern that children may lose out in important areas of life because they spend so much of their time in front of screens. In this respect, the digital age has introduced new challenges for parents who face the difficult task of striking a balance between allowing independent exploration on the one hand, and providing appropriate limitations and oversight on the other (Anderson, 2016[10]).

Responding to some of these concerns, researchers have explored how the time children spend using digital technology affects their lives across various domains. Over the course of the past two decades, individual research studies have indicated that increased use of digital technology might have some negative impacts on children’s well-being, ranging from mental health issues such as depression (Kim et al., 2010[11]) or addiction (Young, 1996[12]), to public health issues like obesity (Sisson et al., 2010[13]). At the same time, most of these claims have been disputed by other scholars and many studies show how digital technology brings great benefits to children (e.g. Livingstone et al. (2011[14]), Byrne et al. (2016[15]); Baranowski et al. (2008[16]); Granic, Lobel and Engels (2014[17])), highlighting its social and interactive features (e.g. boyd (2014[7]), Cole and Griffiths (2007[18]), Hussain and Griffiths (2009[19]), and Valkenburg and Peter (2007[20])), how it opens up new opportunities for performance, creativity and expression (Lowood, 2008[21]), and features as an everyday practice in the home for purposes of social interaction and relaxation with the family (Enevold, 2012[22]). Recent research suggests that video gaming positively influences cognitive, motivational, emotional and social development (Granic, Lobel and Engels, 2014[17]), while other research suggests that video gaming might disrupt children’s sleep patterns (Dworak et al., 2007[23]). So what can we make of such a seemingly contradictory body of evidence?

As Chas Critcher has written, concerns that new technologies, activities or content might affect children negatively are not a recent phenomenon in the Western public discourse, but go as far back as the early 1900s (Livingstone and Drotner, 2008[24]). Back then, there were concerns about how access to public cinema would affect children, followed by worries around the negative impact of comic books, targeted from the late 1940s by bans in parts of the United States because they supposedly made young people criminal and promiscuous. Concerns escalated with the introduction of the television in 1950, which was blamed for being addictive and isolating. In the 1970s, computer games were accused of making people both addicted and aggressive. It is not surprising to see the same pattern repeated today with digital technology, but it is important to critically appraise the legitimacy of these concerns.

Understandably, parents, teachers and others who have an interest in children’s health and well-being grow increasingly concerned as children spend more time using digital technology, but also confused due to the lack of consensus on whether this is good or bad for children. This confusion is apparent not only among parents in the developed world, but also in developing countries where children are increasingly gaining access to digital technology. Survey data from the Swedish Media Council (Statens medieråd, 2015[25]) show how parents in a developed country with near-ubiquitous access to digital technology consider online gaming a great asset in their children’s lives, providing them with many opportunities to benefit, while at the same time rating online gaming as one of their greatest sources of worry, fearing that children might spend too much time playing.

A similar narrative emerged from focus groups with parents of child Internet users conducted in South Africa (Burton, Leoschut and Phyfer, 2016[26]), where parents acknowledged the many benefits that the Internet could offer to their children while simultaneously expressing concern over the time their children spent online and the many risks they may encounter in the process. It is clear that parents face a difficult task in mediating their children’s use of digital technology, but it is an important one due to the central roles that both parents and digital technologies play in a child’s life. In the interest of making this task easier, this chapter presents the results of an evidence-focused literature review of how time spent on digital technology affects children’s lives, focusing on impacts in three domains: their mental well-being, social relationships and physical activity. The chapter examines the gaps in evidence and suggests new directions for future research and improvements to research methodology.

The main research question posed in this chapter is: How does the time children spend using digital technology affect their well-being?

Because children’s well-being is a complex concept with no universally accepted measurement, one common approach to conceptualising child well-being is to consider it as a multi-dimensional concept, covering mental/psychological, social and physical dimensions (Chapple and Richardson, 2010[27]).

The research question was broken down by these dimensions as follows:

• impact on children’s mental well-being

• impact on children’s social relationships

• impact on children’s participation in physical activity.

While child well-being in relation to digital technology has been explored using a variety of subjective and objective measures, in this chapter any references to child well-being refers to self-reported subjective well-being unless stated otherwise.

Terminology and theoretical assumptions

In the interest of clarity, the term digital technology will be used as a catch-all term that includes digital devices, such as computers, tablets and mobile phones, as well as the many digitally mediated activities that children today engage in via these devices, such as using the Internet, going on social networking sites, chatting or playing video games. Television is not encompassed by this term and will be mentioned separately when relevant.

For scholars studying time use and digital technology, the main purpose is typically to investigate how the time spent on digital technology affects an individual in various domains. For example, studies may look at specific outcomes such as how time spent on digital technology affects self-reported well-being over time, or if perceived quality of friendships is increased or reduced. When applied to children, the key aim for studies of time use has typically been to uncover eventual risks with overusing digital technology and to ensure an optimal developmental trajectory, avoid life interference and mitigate any negative health outcomes that might result.

A common assumption in this area of research is that time is a zero-sum commodity and therefore time spent on digital technology will inevitably detract from other activities that are thought to be more valuable, such as socialising face-to-face, reading books or exercising; this is sometimes referred to as the displacement hypothesis, which posits that the negative effects of technology are linearly proportional to exposure (Neuman, 1988[28]). This hypothesis initially received some support and its assumptions served to inform early policy statements and guidelines that proposed restrictions to children’s engagement with digital technology, such as the former guidelines by the American Academy of Pediatrics (AAP, 1999[29]). However, more recent evidence suggests that the displacement hypothesis may be simplistic or even inaccurate today, as recent technological developments offer many opportunities for children to pursue developmentally valuable challenges and activities (Przybylski and Weinstein, 2017[30]). These developments are reflected in an updated policy statement by the AAP which contains a less restrictive set of guidelines, recognising the value of digital technology also for the younger age groups (AAP, 2016[31]).

In light of these developments, some researchers have argued that the impact of digital technology on children might not necessarily be linear, in the sense that more use does not always lead to worse outcomes. Przybylski and Weinstein (2017[30]) suggest that the impact of the time spent on digital technology on children might rather be explained by a curvilinear relationship, which challenges the displacement hypothesis. In other words, not using digital technology at all might be expected to have a negative effect on children, while moderate levels of use could have a positive effect and excessive use might have a negative effect. Problematically, there is no clear agreement on when the time spent on digital technology shifts from being moderate to excessive, as this is likely to be highly individual. In this respect, excessive use is a value laden term and determining “how much is too much” inevitably depends on the age of the child, their individual characteristics, the culture that they live in and their broader life context.

For digital technology especially, opinions on “how much is too much” also vary over time and across generations. This makes the question of “how much is too much” in relation to digital technology particularly complex, as we might expect adults and children to have different opinions on the matter with neither group necessarily being more right than the other. This has made it difficult for researchers to design appropriate studies on time use that allow us to make recommendations that are grounded in children’s lived experiences, because adult perceptions on “how much is too much” tend to drive the inquiry. Since we cannot yet objectively determine how much is too much for a given individual, drawing the line between an engaging digital hobby and excessive use is difficult – many people have hobbies on which they sometimes spend a bit too much time to the detriment of other activities, but this is not always a problem for them, as much as it might be a problem for the people around them (Cover, 2006[32]; Charlton and Danforth, 2007[33]; Kardefelt-Winther, 2014[34]).

Based on this, the term excessive use will be used to denote that a great deal of time is spent using digital technology, but without setting a specific threshold for how much time this implies in practice. In this respect Larkin and Griffiths’ (1998[35]) perspective is adopted, that for some individuals in some contexts, it makes sense to use excessively because the positives outweigh the negatives. Where studies have provided specific time-thresholds for excessive use, this will be highlighted.

Some scholars who study time use and digital technology have taken an exclusively clinical approach to the subject by arguing that some people use digital technology excessively because they are addicted to it, or addicted to specific activities mediated by digital technology. The harms that are assumed to result are suggested to be similar to the harms experienced from substance addiction. The assumptions that underlie this perspective are that behaviours and activities can be addictive in much the same way as substances (Marlatt et al., 1988[36]; Marks, 1990[37]), and that digital technologies, due to their many rewarding features, may be particularly addictive.

Addiction to digital technology is typically measured by asking questions based on substance addiction assessment instruments (Petry et al., 2014[38]). The key aim for studies appropriating an addiction perspective has been to show that digital technology can be truly addictive in order to advocate for the need for professional treatment of those who are affected. The proposal that digital technology can be addictive has been challenged by many researchers over the years and there is no consensus yet on whether such a perspective on excessive use of digital technology is accurate or useful (Griffiths, 2000[39]; Cover, 2006[32]; Kardefelt-Winther, 2014[34]; Van Rooij and Prause, 2014[40]; Griffiths et al., 2016[41]; Aarseth et al., 2016[42]).

Research on time use and addiction deal with distinctly different questions, but researchers often conflate them. While both areas focus to some extent on the link between time use and negative outcomes for the individual, the addiction perspective is driven by the underlying assumption that excessive use of digital technology may be caused by an addictive disorder, rather than driven by fascination or engagement.

The addiction perspective also takes a binary approach where an individual either has an addictive disorder or not, and where the presence of a disorder always leads to negative outcomes. In comparison, the study of time use views the time children spend on digital technology on a continuum where some negative outcomes can co-exist with benefits. That researchers conflate these perspectives has led to conceptual struggles in this area of research and in the public discourse, which has been recognised and discussed by several groups of researchers in recent years (Griffiths et al., 2016[41]; Aarseth et al., 2016[42]; Kardefelt-Winther et al., 2017[43]).

One unfortunate consequence of this confusion is that many studies have focused on exploring the hypothetical idea of addiction to technology instead of exploring why some children spend a lot of time using digital technology and when this might affect their lives and well-being positively or negatively (Kardefelt-Winther, 2014[34]). The latter question seems more relevant in response to the growing societal concerns around children’s increasing use of digital technology.1

Methodology

To respond to the main research question, an evidence-focused literature review was undertaken by drawing on some of the core principles of a systematic review (Khan et al., 2003[44]), while still leaving room for reflexivity and interpretation.

The review encompassed literature published between 2005 and 2017. The time frame captures the period when digital technology became available for everyday use by children in Western societies and regular use became the norm. The search strategy involved three step-by-step processes:

• an academic literature search for peer reviewed journal articles using the databases PubMed, PsycINFO and Google Scholar

• the identification of three experts working in the field followed by an email exchange to ascertain their knowledge of and access to further literature, and recommendations for other sources (snowballing technique)

• browsing the reference list of empirical articles found through processes 1 and 2 for additional relevant articles.

Search strings based on the three areas of interest were used for the database search. Search strings used were: (children digital technology AND (wellbeing OR well-being)), (children digital media AND (wellbeing OR well-being), (digital* OR “digital technology” AND child*), (digital* OR “digital technology” AND (well-being OR wellbeing OR physical* OR social* OR relationship*)), (digital* OR “digital technology” AND (child* OR adolescent*) AND (well-being OR wellbeing OR physical* OR social* OR relationship*)).

The results for each search string were sorted by relevance where possible, otherwise sorted by date, and screened for relevance to the three sub-questions. Results from the first ten pages of each search engine were included. If selected, the article was categorised according to theme (mental well-being, social relationships or physical activity). Cross-sectional studies, longitudinal studies and meta-analyses were included. Non-empirical chapters including literature reviews were excluded to avoid relying on secondary data sources. Only studies of children (age 0-18 inclusive) were included in the final corpus. Studies that used addiction measurements or lacked an indicator for time use were excluded.

A total of 301 unique, peer reviewed journal articles were identified in the literature search. Out of these articles, 226 articles were excluded as they covered the wrong subject or lacked indicators for time use, 10 articles were excluded for being reviews of the literature, and 45 articles were excluded for being studies of the adult population. A total of 20 articles were retained based on the database search, which is 6.6% of the total number of articles found in the search.

While every effort was made to capture a broad spectrum of material of possible relevance to the research questions, it was expected that achieving comprehensive coverage was unlikely only through database searches. Experts contributed another 6 articles. Browsing the reference lists of empirical articles from the literature search yielded another 29 relevant articles, making the total number of articles included in this review N=55. One limitation of the literature search was that only studies written in English were included.

Limitations

Before presenting the results of the literature review, limitations to research studying the impact of digital technology on people, sometimes referred to as “media effects” research, are highlighted. These limitations are highlighted because they generalise across most studies included in this literature review, which means that even the most rigorous studies presented in this chapter should be interpreted with some caution.

First, many studies are correlational in nature and use cross-sectional data, which means that they cannot establish what is cause and effect or establish long-term consequences. In other words, the data collected cannot be used to determine whether an effect, say increased levels of depression, is the cause or the consequence of using digital technology. Both may be plausible – a person could feel more depressed after spending a lot of time online, or someone who is feeling depressed might spend a lot of time online to cope with these feelings. Longitudinal studies are needed to tell us more about causality and whether any effect is persistent over time or not, which is important to determine if the time spent on digital technology has an effect on well-being in the long term.

Second, it is likely that individual differences influence how the use of digital technology affects a child, depending on their age, gender, personality, life situation, social and cultural environment and other factors (Livingstone et al., 2011[14]; Kardefelt-Winther, 2014[34]; Byrne et al., 2016[15]; Livingstone, 2016[45]; Banaji, 2016[46]). Most studies tend to account only for a limited number of background variables for practical reasons such as survey cost and length. Traditionally, it has been more common to only investigate the psychological characteristics of a child and what they do online, without a strong emphasis on their broader life context. This means that studies may a) overestimate the effect of digital technology on children, or b) assume that digital technology has an effect when the effect results from another factor that was not measured.

Third, it seems likely that the activities and content children engage in via digital technology are equally or more relevant than overall time use for positive or negative outcomes (Etchells et al., 2017[47]; Przybylski and Weinstein, 2017[30]). Focusing on time use alone without considering what a child is actually doing online limits the scope of the inquiry and the value of the conclusions drawn.

Fourth, most research on media effects do not have pre-registered study protocols, which means that the studies may suffer from confirmation bias or selective reporting of results. Pre-registering research protocols is part of a recent movement towards reproducible science, where researchers are encouraged to publicly register a study and its hypotheses prior to data collection to be transparent about the foundation for their analysis. The importance of pre-registration was recently advocated in an article in Nature as a way to combat low reproducibility of research findings and to maximise the efficiency of the research community’s use of the public’s investment in research (Munafò et al., 2017[48]). While pre-registration of study protocols for randomised controlled trials in clinical medicine has become standard practice, this is not the case in the psychological sciences. Pre-registration is increasingly advocated to reassure the research community that the analysis conducted was planned in advance, to avoid cherry-picking of results and intentionally or unintentionally highlighting only those relationships that were statistically significant (Munafò et al., 2017[48]).

With these shortcomings in mind, the next sections will present the results of the literature review.

Literature review

Impact of time spent using digital technology on children’s mental well-being

Some cross-sectional studies have found a positive association between both Internet and mobile phone use and self-reported feelings of depression (Bezinović et al., 2015[49]; Ikeda and Nakamura, 2014[50]; Kim et al., 2010[11]). However, the effect sizes for the associations found were small, which is a finding that has also been observed in larger and more robust studies. For example, in a study of 6 000 children aged 12-18, Ferguson (2017[51]) found a small positive association between screen time and depressive symptoms and delinquency.

A longitudinal study by Selfhout and colleagues (2009[52]) provides a more nuanced perspective on the relationship between digital technology and depression; for children with low quality friendships, spending time just surfing seemed to lead to a slight increase in self-reported feelings of depression over time (Selfhout et al., 2009[52]). For children with medium or high quality friendships, there was no association between time spent just surfing and self-reported feelings of depression. However, if the children with low quality friendships instead spent their time socialising with others online, this led to reduced self-reported feelings of depression, leading the authors to conclude that what children do online is crucial to consider in addition to the time they spend. The authors suggest that reduced feelings of depression might occur because socialising online increases the chance of receiving social support, which may otherwise not be available to children with low quality friendships.

Ferguson (2017[51]) found a small but significant positive association between time use and feelings of depression and delinquency only for those children who repeatedly reported more than six hours of screen time per day. Given the relatively weak impact even on children who report more than six hours of screen time per day, the author suggests that reducing screen time in efforts to improve youth well-being is unlikely to be effective for most children. Ferguson (2017[51]) suggests based on these findings that youth seem to be quite resilient to screen consumption at much higher levels – up to six hours daily – than is typically recommended by most policy statements.

This perspective is further supported by a recent cross-sectional, large-scale, pre-registered study conducted in the United Kingdom with over 120 000 15-year-old children, where Przybylski and Weinstein (2017[30]) found that the time children spend using digital technology only had negligible impacts on mental well-being. In this robust inquiry, Przybylski and Weinstein (2017[30]) studied the impact of a variety of digitally mediated activities on children’s mental well-being, such as watching television and movies, playing video games, using computers and using smart phones.

The activities differed somewhat in their respective impact, but the authors conclude that in general, no use at all was associated with lower mental well-being, while moderate use (between 2-5 hours per day depending on the activity) seemed to have a small positive effect on mental well-being. Watching television and movies or using computers had a small negative impact when use exceeded 4 hours per day, in contrast to smart phones which had a small negative impact when use exceeded 2 hours per day. Playing video games showed a small negative impact after use exceeded 7 hours a day. Prior to reaching these cut-off points, each activity showed a positive impact on mental well-being. The study controlled for gender, ethnicity and economic factors. The negative impacts were somewhat higher when the time spent on digital technology went beyond these cut-off points during weekdays, indicating that for some children, screen time might interfere with structured activities during the week, such as homework, but can be used more extensively on weekends.

An important point emphasised by the authors was that even though negative effects were found after the time spent exceeded a certain point, these effects were very small, contributing less than 1% to explaining the overall well-being of the young people in the sample. This led the authors to conclude that “the possible deleterious relation between media use and well-being may not be as practically significant as some researchers have argued” (Przybylski and Weinstein, 2017, p. 213[30]). Similar findings have since been reproduced by an analysis of three large-scale datasets (N=335 358) in the most robust effort so far to study associations between well-being and technology use, which was conducted after the first version of this review was published (Orben and Przybylski, 2019[53]).

For very young children, findings from a large cohort study of more than 13 000 children aged five in the United Kingdom show that using screen entertainment for more than 2 hours a day was associated with a small increase in emotional and conduct problems in girls only. The study found no evidence that longer duration of screen usage was associated with any other mental health problems investigated for boys or girls, such as hyperactivity, peer problems or prosocial problems (Griffiths et al., 2010[54]). A qualitative study providing case study evidence from observations and participatory research with more than 50 families and their 3-4 year-old children in Scotland (United Kingdom) found no evidence from parents that technology was having a detrimental effect on their children in terms of behaviour, health or learning (Plowman and McPake, 2013[55]).

This was further supported by a longitudinal study that followed UK children from age 5 to 7, finding no negative impact from playing video games on either conduct problems, emotional symptoms, hyperactivity/inattention, peer relationship problems or pro-social behaviour (i.e. behaviours which contribute positively to society or the social context (OECD, 2011[56])), with no gender differences observed (Parkes et al., 2013[57]). Television viewing however was associated with a small increase in conduct problems over time, if viewing exceeded 3 hours per day.

In a study of children aged 10-15 years old, Przybylski (2014[58]) found that low levels of video game playing of less than one hour a day were associated with many benefits, such as higher levels of pro-social behaviour and life satisfaction, as well as lower levels of conduct problems, hyperactivity, peer problems and emotional problems. Children who played between 1-3 hours per day saw no effects on these outcomes, while those who spent more than half of their daily free time on video games saw some small negative effects. This supports the idea that video games can function similarly to traditional forms of play, presenting opportunities for identity development as well as cognitive and social challenges (Przybylski, 2014[58]). However, as stated previously, after time spent on gaming exceeds a certain threshold these positive influences may diminish or disappear.

Looking at another popular online activity, use of social networking sites, longitudinal research found that too much time spent on this activity might have some negative impact on mental well-being (Mcdool et al., 2016[59]). Exploring the relationship between time spent on social networking sites and mental well-being further, an experimental study found that passive Facebook use, meaning passively browsing news feeds or looking at friends’ pages and pictures without interacting with others, led to a decrease in well-being by enhancing feelings of envy (Verduyn et al., 2015[60]). This might explain why a number of studies of young adults (e.g. Kross et al. (2013[61]), Chou and Edge (2012[62])) have found a negative association between using social networking sites and well-being; as profiles on social networking sites are often used to craft and convey a positive image of a person, this might influence our perceptions of other people and their lives and lead to feelings of envy or inadequacy.

Taken together, this review shows that the time spent on digital technology can have both positive and negative effects on child well-being, depending on the activity and how much time is spent. No use and high use tends to be associated with negative effects, while moderate use seems to have positive effects. However, these effects - whether positive or negative - are typically weak and only contribute a small part to explaining overall child mental well-being.

As a number of studies have concluded, if the goal is to improve the mental well-being of children it seems more important to ensure a healthy lifestyle for children in general rather than reducing screen time. As Przybylski (2014[58]), Parkes et al. (2013[57]) and Ferguson (2017[51]) suggest in their respective studies, compared with factors shown to have robust and enduring effects on child well-being such as family functioning, social dynamics at school and socio-economic conditions, the direct influence of time spent using digital technology does not seem as important. This is further explored in study conducted by Orben and Przybylski (2019[53]), published after the first version of this review was completed. While gender differences were found in relation to how children use digital technology, few significant gender differences were found in these studies in terms of the impact on mental well-being.

As Przybylski (2014[58]) suggests, even if no direct negative effects result from heavy technology use, a potential issue is that it may crowd out other activities that could benefit the child. Longitudinal data and cohort studies will be necessary to understand the cumulative effects of spending a lot of time on digital technology from a young age.

Impact of time spent using digital technology on children’s social relationships

Research on the impact of digital technology on children’s social relationships tend to follow four main hypotheses, some of which predict positive outcomes while others predict negative outcomes. These hypotheses are expanded upon in chapter 5.

• The first hypothesis is the displacement hypothesis mentioned previously, suggesting that online social interaction is replacing face-to-face interaction which could result in lower social capital and fewer personal acquaintances (Kraut et al., 1998[63]; Putnam, 2000[1]; Turkle, 2011[2]).

• The second hypothesis is the rich-get-richer hypothesis (Kraut et al., 2002[64]), suggesting that those who already have strong social networks and skills will benefit more from digital technologies in terms of social interaction than those who have weaker social connections.

• The third hypothesis is an alternative to the rich-get-richer hypothesis, called the social compensation hypothesis, which essentially suggests that online communication will be more beneficial to people who are socially anxious and isolated as they may feel more at ease when developing friendships online in a safe environment (McKenna, Green and Gleason, 2002[65]; Kraut et al., 2002[64]).

• The fourth hypothesis is the stimulation hypothesis (Valkenburg and Peter, 2007[20]), which suggests that online communication stimulates communication with existing friends, leading to mostly positive outcomes and stronger friendships overall.

Studies in this area of research have typically focused on exploring one or several of these hypotheses.

A cross-sectional study of 1 300 adolescents in the United States aged 12-18 years old showed that although time spent on digital technology did reduce the amount of time adolescents spent interacting with their parents, it did not actually reduce the quality of the parent-child relationship (Lee, 2009[66]). While time spent using a computer to study was related to spending less time with friends, greater engagement in online communication seemed to strengthen friendships.

The positive relationship between online communication and friendship quality or social capital has been found in a number of cross-sectional studies both of children, adolescents and young adults (Peter, Valkenburg and Schouten, 2005[67]; Valkenburg and Peter, 2007[20]; Ellison, Steinfield and Lampe, 2007[68]; Jacobsen and Forste, 2011[69]; Davis, 2013[70]). For example, Peter and colleagues (2005[67]) found that extroverted individuals tended to self-disclose and communicate online more often than others, which improved their online friendships. In other words, there are good grounds to believe that it is easier to talk about personal or sensitive topics online, which would account for some of the positive associations observed between online communication and social relationships.

Similar findings also emerged from a qualitative study (Davis, 2012[71]). As another example, Valkenburg and Peter (2007[20]) found in a cross-sectional study of Dutch adolescents that online communication was positively related to time spent with friends and improved the quality of existing friendships, which was predictive of higher well-being.

Existing research suggests that children use online communication as an additional modality to enhance quality of existing friendships and that this is an effective strategy (see Chapters 4 and 5). Partly for this reason, several authors have suggested that those who communicate online more frequently also tend to feel more connected to their school environment (Ellison, Steinfield and Lampe, 2007[68]; Lee, 2009[66]), because they have friendships that are more cohesive. These findings broadly support the stimulation hypothesis and the rich-get-richer hypothesis, but some of the findings also suggest that the displacement hypothesis might be relevant for relationships that are less prioritised by adolescents. Since peer relationships tend to be prioritised over family relationships during teenage years, this would explain why time spent on online communication is associated with a decrease in family time but not in time spent with peers (Lee, 2009[66]).

There is also some support for a social compensation hypothesis; Peter and colleagues (2005[67]) found that introverted adolescents were more motivated to communicate online to compensate for lacking social skills, which increased their chances of making friends online. This might be particularly beneficial for those children who find it easier to self-disclose online compared to offline, which seems to be more common among boys than girls (Valkenburg and Peter, 2009[6]).

Also in support of the social compensation hypothesis, a meta-analysis of eight studies on Facebook use and loneliness found that people who feel lonelier tend to use Facebook more often (Song et al., 2014[72]), rather than Facebook use causing people to feel lonely. However, the estimate of the causal direction was based on path modelling of cross-sectional data, which means that the true causal direction is still unclear.

Taken together, the results from this review support the statement that the Internet and digital technology are not main effect causes of anything by themselves (McKenna and Bargh, 2000[73]; Peter, Valkenburg and Schouten, 2005[67]), but that it is the contextual and individual factors that influence social interaction and relationships. Valkenburg and Peter (2009[6]) conclude in their review of a decade of research on the social consequences of the Internet for adolescents that there has been a clear shift in research findings in this area; while early research from the 1990s tended to report that Internet use was detrimental to social interaction and relationships, recent studies tend to report mostly positive impacts, a conclusion also reached in a review by George and Odgers (2015[4]) and in Chapter 5.

Valkenburg and Peter (2009[6]) speculate that this has to do with changes in how adolescents used the Internet in the 1990s compared to today; while before it was difficult to use the Internet to maintain existing friendships since a great part of one’s social network was not yet online, this is no longer the case today, with most young people now having access. This makes it more likely that digital technology will have positive impacts on friendships and social networks because a great deal of time spent online is spent on strengthening existing bonds between friends, or forming online ties or mixed-mode friendships, rather than isolating people in a lonely online space. Today’s Internet users are far from lonely, which seems to explain the positive impacts of time spent using digital technology on children’s social relationships (Valkenburg and Peter, 2009[6]).

Impact of time spent using digital technology on children’s physical activity

Another aspect of children’s lives that has received considerable attention under the displacement hypothesis is the relationship between time spent using digital technology and physical activity. Concerns have been raised that as time spent on digital technology increases, time spent on physical activity will be reduced, which might be a contributing factor to child and adolescent obesity and physical health problems (Kautiainen et al., 2005[74]). Iannotti and colleagues (2009[75]) drew on an older cross-sectional sample from the Health Behaviour in School-Aged Children (HBSC) survey implemented in 2000 in Canada and United States and found that an increase in screen time was associated with small reductions on several health indicators, such as physical health status, quality of life and family relationships.

Another cross-national study drawing on a cross-sectional sample of over 5 000 9-11 year-olds (LeBlanc et al., 2015[76]) found that an increase in screen time was associated with small reductions in physical activity and healthy diet. However, in both studies the effect sizes were small. Because of this, Iannotti and colleagues (2009[75]) conclude that interventions targeting screen time alone are unlikely to significantly increase time spent on physical activity. Leblanc and colleagues (2015[76]) suggest that although screen time is an important aspect of sedentary behaviour, it would be beneficial to also consider the positive and negative effects of non-screen based sedentary behaviours in addition to screen time to gain a better understanding of their relative impacts.

The two studies cited above used aggregate estimates of screen time without considering the differences between digital devices, activities or content. This is a weakness that several authors acknowledge (e.g. Kautiainen et al. (2005[74]), Sisson et al. (2010[13]) and Straker et al. (2013[77])).

Straker and colleagues (2013[77]) showed empirically that different screen time activities relate differently to physical activity and health indicators. Their findings build on an early cross-sectional study with a representative sample of Finnish youth (14-18 years old) which found that only certain forms of technology were associated with higher obesity rates; television watching was associated with a small increase in the likelihood of being overweight for girls only, while playing digital games had no such effect (Kautiainen et al., 2005[74]). Kautiainen and colleagues (2005[74]) noted that when accounting for biological maturation and weekly physical activity, the statistical associations were weaker and non-significant for some age groups, which might suggest that it is the lack of physical activity rather than screen time that increases the risk of being overweight.

That digital technologies differ in their impact is corroborated by several cross-sectional studies included in this review; television viewing has been linked to a reduction in physical activity (e.g. Devís-Devís et al.(2012[78]) and Kimbro, Brooks-Gunn and McLanahan (2011[79])), while time spent with mobile phones was linked to reductions in physical activity in one study (Lepp et al., 2013[80]), but linked to an increase in physical activity in another, though only for weekday use (Devís-Devís et al., 2012[78]). Devís-Devís and colleagues (2012[78]) speculate that because mobile phones can be used while children are mobile or engaging in other activities, this could explain the increase in physical activity. Though few control variables were included in the analysis. These mixed results appear also in studies using aggregate screen time measures where differences in terms of activities or devices are not considered. Some studies find no association between screen time and physical activity (Laurson et al., 2014[81]) while others report a negative association (Sisson et al., 2010[13]).

A large cross-national study drawing on survey data from over 200 000 adolescents aged 11-15 years old found that the relationship between time spent using digital technology and leisure time physical activity seems to also differ depending on age, gender and nationality (Melkevik et al., 2010[82]). Broadly, the study found that spending two hours or more per day on screen-based activities resulted on average in half an hour less per week spent on leisure-type physical activity.

Again, the form of screen-based activity adolescents engaged in mattered for the outcome; regular computer use was associated with an increase in physical activity while gaming and watching television were associated with a decrease. However, these patterns were not stable across all countries; for example, in Eastern and Southern Europe, gaming, watching television and general computer use were associated with increases in spare time physical activity. The authors conclude that physical inactivity is unlikely to be a direct consequence of adolescents spending too much time on screen-based activities, but rather suggest that already inactive adolescents have more time to spend in front of screens.

This conclusion is supported by findings from a separate longitudinal study of 11-13 year-olds showing that increased engagement in computer use or video gaming was not directly associated with leisure time physical activity, indicating that screen-based activity and physical activity should be addressed separately in health promotion activities (Gebremariam et al., 2013[83]). The authors suggest that other factors than computer use or gaming might better determine whether children spend more or less time on physical activity, and that the association between screen time and obesity found in some studies might be due to dietary behaviours rather than lack of physical activity. This claim was supported by a systematic review of studies on sedentary behaviour and dietary intake for children, adolescents and adults (Pearson and Biddle, 2011[84]).

In summary, evidence on the impact of time spent using digital technology on physical activity is mixed and inconclusive. While a number of longitudinal and cross-sectional studies have found a link between time spent using digital technology and reduced physical activity, other studies report no such associations. Explanations for reduced physical activity seem to depend on multiple factors beyond only the time spent on digital technology, some of which have yet to be examined.

However, researchers seem to broadly agree that the link between screen time and physical activity is unlikely to be direct; for example, Kimbro and colleagues (2011[79]) suggest that perceptions of neighbourhood safety and the residential environment (access to parks or playgrounds) might influence the time spent both on digital technology and physical activity. It has been suggested that indoor play offers a compelling alternative to outdoor play in less affluent neighbourhoods and in families where parents have less time available to supervise their children (Tandon et al., 2012[85]). This claim is supported by studies showing that individuals who live in more disadvantaged neighbourhoods tend to have less access to portable play equipment and report lower levels of physical activity and higher rates of obesity, but the causal nature of these relationships is unclear (Kimbro, Brooks-Gunn and McLanahan, 2011[79]; Tandon et al., 2012[85]).

The finding that screen-based activity and physical activity seem to be independent behaviours is particularly important to stress for health promotion policies; longitudinal data suggest that only reducing time spent with digital devices will not automatically increase time spent on physical activity (Gebremariam et al., 2013[83]). Rather, some authors argue that promoting physical activity independently may be a more useful strategy. This argument is supported by previous longitudinal studies on television viewing and physical activity in adolescence (Taveras et al., 2007[86]).

Discussion

Research on how digital technology affects children’s well-being has been ongoing for almost two decades, with research conducted between 2005 and 2017 reviewed here. While some high quality studies are now emerging, research in this area still suffers from theoretical and methodological weaknesses that make the evidence collected so far unreliable and inconclusive. Four issues need to be addressed to produce more conclusive evidence:

• Many studies use aggregate screen time measures where the self-reported total time spent with screens per day or per week is used to predict well-being outcomes. The assumption that all screen time is equal has been criticised and it would be beneficial for future studies to measure the effects of specific instances of screen time separately, such as mobile phone use, video gaming or using social networking sites (e.g. Przybylski and Weinstein (2017[30])). This would also enable an examination of how the content of children’s digital experiences influences the outcomes, providing necessary granularity to screen time research.

• There is a need for more longitudinal studies in this area. Cross-sectional research has been useful as a starting point for hypothesis-generation and initial theory-building, but to advance theory and arrive at firm conclusions we need longitudinal evidence that looks at how digital technology affects children over time. It is possible that digital technology may not have immediate positive or negative effects on children which could explain the small effect sizes found in some studies, but there may be cumulative outcomes for which we require long-term studies to be able to capture.

• Researchers can help to promote age- and context-specific policies by collecting data over time, from children of all age groups and from boys and girls, taking into account their life context and socio-demographics to the greatest extent possible (see Byrne et al.(2016[15]) or Livingstone (2016[45]) for a useful research framework). More background variables need to be included as controls in quantitative studies to ensure that we do not exclude variables that have known effects on child well-being outcomes. Children’s online experiences cannot be studied in isolation from their lives in general. Qualitative data from children and parents could be particularly beneficial to understand the circumstances under which children’s use of digital technology has positive or negative impacts on their lives. Qualitative data has an advantage in that it allows participants to express themselves freely, which can generate new knowledge and insights driven by children’s own voices and experiences.

• The research community needs to strengthen reproducibility of research and the reliability of findings. Researchers may wish to register their hypotheses before collecting data and then share the raw data and analysis code attached to each publication, so that every policy-relevant research finding is produced in a transparent way, is computationally reproducible and freely accessible online (through the Open Science framework, for example). This would enable stakeholders to vet claims that are being made and enable transparent debate within the research community before evidence is used to inform policy or practice.

A final point concerns the role of media outlets, which ideally should provide evidence-based and balanced reporting on issues relating to children’s use of digital technology. As George and Odgers (2015[4]) write in their review of fears around digital technology, media coverage can both capture as well as influence societal fears, which reinforces the importance of providing a nuanced picture. This is not easy to do given that evidence in this area is inconclusive and conflicting, which puts journalists in a difficult spot.

Even so, too many news articles share evidence from single studies or studies that are methodologically weak, or exaggerate or misrepresent the evidence provided. This can distract attention from more pressing issues for children, or lead to a situation where research and policy seek to address problems too quickly via interventions that have not been properly evaluated. This is not necessarily the fault of the media outlets or journalists - it also signals that there may be issues with respect to science communication by universities and research institutes.

One way to tackle this issue is to write press releases together with researchers, to ensure that both findings and study limitations are communicated properly. This requires researchers in turn to become more aware of the limitations of their studies and use appropriate descriptions for the research conducted when speaking to journalists; the distinction between exploratory hypothesis-generating research and confirmatory hypothesis-testing research is critical. Cross-sectional data are too often used to test hypotheses that require longitudinal or experimental data, without the appropriate caveats in place. Such studies dilute the evidence base and contribute to confusion among researchers, media, policy makers and the public – more research is only a good thing when it is of sufficient quality. Going forward, journalists, editors and science communicators have a major role to play in ensuring that policy initiatives or interventions are based on high quality evidence.

Conclusions

As research on children’s use of digital technology moves forward, an important challenge is to understand where to draw the line between healthy and harmful use, which is likely to require an individual approach where each child and their life context is considered separately. Although few negative impacts have been found in relation to the time children spend using digital technology, in order to maximise its positive impact, younger children may require provisions and support of a different nature than older children. Similarly, what is harmful for a very young child to see or do online may be largely unproblematic or even positive for an older child. In this respect, blanket-recommendations and policies are unlikely to be effective.

There is an unanswered question with respect to the activities that children’s increased use of digital technology may be crowding out. Research on digital technology and children’s well-being rarely asks whether other activities could have had some positive influences on the child if they were more regularly engaged in them. This relates to the displacement hypothesis mentioned previously. Although plenty of research has explored this hypothesis, the consequences of an increase in children’s use of digital technology are rarely considered together with a decrease in other potentially beneficial activities.

More comprehensive, large-scale and longitudinal studies that look at children’s time use in general are needed in order to be able to truly say whether the time spent using digital technology over time has a positive or negative influence on child well-being. These must consider the activities that may be crowded out, as it is not feasible to investigate the effects of digital technology in isolation from children’s lives more broadly. Use of digital technology, as a multifaceted activity, needs to be compared to other activities that are part of children’s lives before the trade-offs can be identified. These in turn will inform work towards achieving the best possible life balance for each individual child.

Adapting to the increased use of digital technology in society will require some adjustments in parenting, carrying out research and the development of policy, among other things. The current situation is unusual as children are in many ways the pioneers and experts in this area, often the first to try new apps and programmes, and sometimes even creating them on their own. To be able to effectively adjust to this situation and build constructive dialogues around healthy and harmful use of digital technology in the family, school, and society at large, there will likely be a need to rely more on children’s voices and experiences.

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Note

← 1. A secondary aim of the original paper was to provide the reader with a critical overview of the hypothetical idea of addiction to technology. This paper only includes research on time use, while the original paper also included a separate section on digital technology and addiction.

Chapter 8. Children's time online and well-being outcomes