Keeping children healthy in the digital age
Center on Media and Child Health – 2017 Annual Report
Michael Rich, MD, MPH, Founder and Director
-Michael Rich, MD, MPH, The Mediatrician
A public health crisis
Ariel* sat stone-faced, angry at her mother for bringing her to the Clinic for Interactive Media and Internet Disorders at Boston Children’s Hospital. Since the beginning of her junior year, Ariel, a former straight-A student and varsity athlete, had been withdrawing, distancing herself from school, friends, and family. She had been staying up at night doing homework on her laptop, oversleeping her alarm, falling asleep in school, sometimes not going at all. For the last several weeks, she has been refusing to go to school and having angry outbursts when her parents tried to make her go. Once her mother left the room, Ariel revealed that she had an active social media presence on Instagram, Snapchat, and Twitter, but felt “incredibly alone.” She had recently been receiving disturbing content and admitted to “trolling” and “sexting” people she didn’t know. When her parents confiscated her laptop and phone, Ariel took a handful of pills she found in their medicine cabinet and was rushed to the Emergency Department.
Ariel is an extreme—but unfortunately not rare—example of the millions of children and teens affected in significant ways by the media they use and how they use them. The Center on Media and Child Health’s work is more important than it ever has been; we’re pleased to share with you the following report on our progress over the last year.
*not her real name
Who we are and what we do
The Center on Media and Child Health (CMCH), founded in 2002, is based at Boston Children’s Hospital (BCH), Harvard Medical School’s pediatric teaching hospital. Our mission is to ensure that children and adolescents create and consume media in ways that avoid harm and promote their healthy development. Today, achieving this goal is more critical than ever, as the digital landscape continues to evolve at lightning speed and children continue to be avid early adopters of technology. Until recently, our work has pursued three broad initiatives:
- Investigating the positive and negative health effects of media on children. We’ve done this through our own research and by compiling research from around the world into a comprehensive database that is openly accessible to clinicians and parents.
- Translating the research into practical, actionable guidance for parents, teachers, clinicians, and other stakeholders. We do this through in-person presentations; by providing electronic “tool kits” and other resources to pediatricians; and through publications, blogs, social media and other forms of outreach.
- Innovating creative ways of using media tools to support and enhance children’s health and development.
In response to a growing need among children and increasing demands from parents and society, CMCH has now added a fourth initiative, Medical treatment for children and adolescents like Ariel who are struggling with media-related health problems.
Clinic for Interactive Media and Internet Disorders (CIMAID)
We launched the Clinic for Interactive Media and Internet Disorders (CIMAID) in November 2017 as part of Boston Children’s Adolescent/Young Adult Program. CIMAID is the only dedicated clinical program at an academic medical center to treat Problematic Interactive Media Use (PIMU), a health problem first defined and characterized by CMCH. Since the mid-1990s, the medical and psychiatric communities have debated over video game addiction, internet addiction, and other ways of characterizing and addressing uncontrolled use of various interactive media that impairs young people’s physical or mental health, relationships, and/or education. Although the World Health Organization’s International Classification of Diseases intends to recognize Gaming Disorder as a diagnosis in their upcoming 11 th edition, this only captures part of the population who are struggling with PIMU. At CIMAID, we have also seen young people who have problematic use of social media (like Ariel), pornography, and information-bingeing, in the form of videos or text.
The interdisciplinary CIMAID clinical team consists of a medical doctor, psychiatrist, psychologist, and social worker—all of whom specialize in treating media-related health issues in young people. The team evaluates children and adolescents, diagnosing media-related issues from PIMU to obesity to school avoidance, depression, and suicidality. CIMAID provides each family with a personalized recovery plan to be implemented by the child’s primary providers or by the CIMAID team. Identifying underlying issues from anxiety to ADHD that may be driving PIMU behaviors, CIMAID treatment plans frequently include talk therapy, coping strategies, behavioral modifications, and medication. Because the need is so great and CIMAID’s resources limited, CMCH is collecting and analyzing clinical data on CIMAID patients to better characterize media-related problems, develop and evaluate interventions, and train clinicians, both at BCH and in the larger community, to recognize and address these problems as early as possible. Ultimately, the goal of CIMAID and CMCH is to provide primary care clinicians, educators, and families with the information to prevent or intervene early on PIMU and other media-related health issues of the Digital Age.
Other news and collaborations
Presentations and awards
In 2017, Dr. Rich traveled around the US and Canada, and to the UK, Jamaica, India, Cuba and Saudi Arabia, sharing with international professionals the latest scientific evidence about optimal ways to raise healthy children in our digital world. The American Academy of Pediatrics awarded him the prestigious Adele Dellenbaugh Hofmann Award, which recognizes a physician who exemplifies excellence in the field of adolescent health, advocating for and enhancing the health care of adolescents.
CMCH is building a new Leadership Board. Our members offer expertise in backgrounds including children’s play, media such as television and film, and health care. We look forward to building creative solutions with Katy Giffault of Hasbro, Jim Janco of Comcast NBCUniversal, Ramy Katrib of post-production house Digital Film Tree, Michael Sherman of Harvard Pilgrim Health Care, and Tiffany Shlain of film studio, Let it Ripple.
CMCH continues to partner with stakeholders in children’s media and health, to conduct research and provide education and developmentally optimal strategies for children and families.
Hasbro – More Play Today
Screen media use has reduced children’s unstructured outdoor and free play, leading to concerns about a “play deficit.” CMCH has teamed up with Hasbro Toys, Bentley University and Anahuac University in Mexico to study how children now play, moving seamlessly between traditional and digital settings, and how that may influence developmental outcomes. The three-year study, More Play Today, begun in late 2015, is using a modified version of Measuring Youth Media Exposure (MYME), CMCH’s proprietary research method, to study 327 children in the US and Mexico aged two-and-a-half through seven years. The research focuses on their play and the contexts in which it happens and assesses them every six months for social-emotional development, cognitive abilities, and executive functioning.
Marlo Thomas – Free to Be 2.0
Supported by the Armstrong Angel Foundation and in partnership with the Joan Ganz Cooney Center (JGCC) at Sesame Workshop, CMCH is working with Marlo Thomas and Ryan Seacrest to revitalize and reimagine Ms. Thomas’ classic 1974 musical television special Free to Be… You and Me as a multi-platform media production for tweens. The production will celebrate and encourage individuality, empathy, comfort with one’s identity, and embracing differences in others. CMCH worked with JGCC to build the research-based foundation for the Netflix special and to develop the educational curriculum, potential television series, and social movement of Free to Be 2.0.
Comcast NBCUniversal – Education and Outreach
For the past eight years, Comcast NBCUniversal has supported CMCH efforts to translate the science of media effects on children into education and outreach. Dr. Rich, known best as The Mediatrician, offers the latest evidence about media effects on child health to parents and others who care for children, adolescents, and young adults. CMCH resources are free to the public and include our informative website, cmch.tv; social media outlets; and our Database of Research from around the world examining positive and negative health effects of media use on youth.
Harvard Pilgrim Health Care – Clinician Toolkit
With the support of Harvard Pilgrim Health Care, CMCH has developed and is testing a Clinician Toolkit for pediatric providers to assess children and adolescents for physical and mental health issues related to media use. Recognizing that today’s youth are growing up in a media-saturated environment, the Toolkit integrates media exposure into the standard of care medical history and anticipatory guidance for each developmental stage. It includes “how to” suggestions and video training for pediatric providers; media use and health questionnaires for patients and parents; and age-based tip sheets for families on healthy media use, sleep, social skills, tobacco, alcohol, and other drugs. Guided by the Toolkit, physicians and parents will be able to be proactive in encouraging children toward healthy, mindful media use.
Establishing and sustaining CIMAID will take priority in 2018, as we build on our research database and clinical experience to care for media-related health problems in children. CIMAID will continue to play a leadership role in characterizing and treating Problematic Interactive Media Use and focusing on media influences on a wide variety of health issues from substance use to sexual risk behaviors to eating disorders. We are developing clear diagnostic criteria, evaluating treatment protocols and prevention strategies, and training clinicians to care for children and youth growing up in a new, rapidly changing environment. And we are helping.
With successful treatment at the CIMAID clinic, Ariel is now an accomplished college student majoring in chemistry. Other CIMAID success stories include Nathan, who has moved beyond gaming to political activism; Bill, who kicked his porn habit and established a healthy relationship with a girlfriend; Ari, who converted his information- bingeing into studying library science; as well as many others.
As the digital world continues to change and children continue to be avid consumers and creators, CIMAID will need to be flexible and scalable, possibly through web-based telehealth, so that its services can be current and accessible to the young people and families who need them.
Because of your generous support, children like Ariel will have the tools they need to grow up medically, psychologically and socially healthy in a constantly changing media environment.
For all that you do, our deepest thanks.