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The Screen Time Evidence Gap. · Inside The Consulting Room - Understanding the Child Behind the Behaviour

• 0:00
  SPEAKER_00: Hello, this is Kim Lee, child and adolescent psychotherapist.
• 0:04
  SPEAKER_00: And before I commence the series Children or Childhood in a digital world, I want to say something about the iStag report that was commissioned by the government and guidance from it was published yesterday.
• 0:24
  SPEAKER_00: To say it is disappointing is an understatement.
• 0:32
  SPEAKER_00: The most important, well, there are a number of features.
• 0:35
  SPEAKER_00: First, the review was done on a very compressed timetable, and ISEG says that the work was necessarily limited by very rapid timescales, and it was unable to undertake a fully comprehensive review, and therefore the evidence was really more of a rapid assessment.
• 0:53
  SPEAKER_00: And this matters because speed increases the risk of incomplete retrieval.
• 1:00
  SPEAKER_00: Also, the literature search was very narrow.
• 1:05
  SPEAKER_00: The methodology document says that the umbrella review used a single database and it was searched only by one reviewer.
• 1:16
  SPEAKER_00: This is not research.
• 1:19
  SPEAKER_00: Third, there was no formal quality appraisal of the underlying evidence.
• 1:24
  SPEAKER_00: And this matters because although it didn't explicitly access the quality of the literature, it made recommendations or recommendations were made on the strength of that.
• 1:36
  SPEAKER_00: Also, much of the underlying evidence is correlational rather than causal.
• 1:42
  SPEAKER_00: So this means that the report itself, whilst noting that it certain studies were cross-sectional, but it meant that they couldn't they could only show associations, but they can't establish cause and effect.
• 1:57
  SPEAKER_00: And that opens the door to confusion.
• 2:03
  SPEAKER_00: So the report also combines some very different phenomena under the umbrella of screen use.
• 2:10
  SPEAKER_00: And ISDEG itself says that one major limitation of the literature is that many studies simply looked at total time on screens, while few examined what children were watching, when they were watching, and with whom.
• 2:28
  SPEAKER_00: The age band that was examined is developmentally too broad for neat conclusions.
• 2:36
  SPEAKER_00: And iStag themselves acknowledged that under-five, or the term under-five, covers a very wide range from newborns to children approaching school age.
• 2:46
  SPEAKER_00: And that evidence for the under-twos was particularly sparse.
• 2:52
  SPEAKER_00: This one-hour recommendation is really shaky, shakier than it looks in public messaging, because, as the report says, there is no clear evidence for a single safe threshold.
• 3:06
  SPEAKER_00: It then argues there is minimal risk at or below about an hour a day for children age two and over.
• 3:14
  SPEAKER_00: But that inference is built upon sparse and very mixed evidence.
• 3:21
  SPEAKER_00: The consultation element in this is informative, but it's not strong evidence.
• 3:27
  SPEAKER_00: The report drew on 132 call for evidence responses, interviews and discussions with 32 families across six settings, and a separate survey of 53 parents and 19 stakeholder reviews.
• 3:45
  SPEAKER_00: Now, whilst this may be valuable, it's certainly not enough.
• 3:51
  SPEAKER_00: And there is a degree of circularity in the way that using external guidance has been drawn upon by WHO and the CMO, the UK CMO.
• 4:06
  SPEAKER_00: Now I my my view is that this this is not in any way a comprehensive look.
• 4:17
  SPEAKER_00: The report is commendably honest about uncertainty, but that honesty itself and the uncertainty has to do with the reliability of the evidence.
• 4:29
  SPEAKER_00: But that expression of uncertainty weakens any strong policy.
• 4:35
  SPEAKER_00: And I stag says that the evidence on harms and benefits is emerging and it's often of low quality.
• 4:43
  SPEAKER_00: So essentially, this is not a definitive causal study.
• 4:48
  SPEAKER_00: It's a rapid policy-oriented umbrella review plus consultation.
• 4:55
  SPEAKER_00: Its search strategy was restricted, its screening relied heavily on one reviewer, and it didn't formally rate the study quality.
• 5:07
  SPEAKER_00: So much of the underlying evidence is cross-sectional.
• 5:11
  SPEAKER_00: Now, in very simple language, I don't believe this to be helpful.
• 5:17
  SPEAKER_00: In my own experiences of research, I have looked at different research models, been involved in different research exercises, and I have learned a good deal about the different standards, the categories, the A, B, and C categories of research.
• 5:39
  SPEAKER_00: I would rate this as D.
• 5:42
  SPEAKER_00: It is it is it's obviously been done in a hurry.
• 5:49
  SPEAKER_00: And my guess would be that the motivation for its commissioning was political because I think it's intended to pacify a very real and very reasonable set of concerns.
• 6:05
  SPEAKER_00: But what it doesn't do is to address the much wider considerations.
• 6:11
  SPEAKER_00: Now, we know that there is a mental health impact on screen time.
• 6:15
  SPEAKER_00: Ever-increasing screen engagement has particular impacts, and numerous concerns have been highlighted with some of the key potential downsides.
• 6:26
  SPEAKER_00: Things like shortened attention span, sleep disruption, impairment of social skills, effects upon physical health, developmental concerns.
• 6:36
  SPEAKER_00: And I think what that tells us is that we don't know enough.
• 6:42
  SPEAKER_00: We need to be able to recognise the signs of screen time addiction and what that really means.
• 6:49
  SPEAKER_00: Are we seeing children who are demonstrating a loss of interest in other activities?
• 6:56
  SPEAKER_00: Is there a neglect of other responsibilities?
• 7:00
  SPEAKER_00: Are children and young people avoiding other things which we might regard as their ordinary responsibilities?
• 7:08
  SPEAKER_00: Are we seeing changes in behavior, poor sleeping patterns, an overwhelming need to be online, social withdrawal, mood swings related to screen time?
• 7:20
  SPEAKER_00: Now I I think on the one hand, asking these questions and taking an intelligent look at what this really means involves a lot more than 130 interviews or 132 interviews and only one person reviewing the findings.
• 7:48
  SPEAKER_00: And what were the questions that were asked?
• 7:51
  SPEAKER_00: Because to me, like so many things, this is an example of what's the problem, how do we fix it?
• 7:59
  SPEAKER_00: But it seems to me you don't understand the problem because you haven't taken the time to really look at it and to look at the evidence and to make connections between cause and effect.
• 8:11
  SPEAKER_00: It seems to me that all of this has been done in a hurry.
• 8:17
  SPEAKER_00: Now, why I'm, if you haven't already told it, just a little bit fed up about this, is because once again it demonstrates a lack of preparedness to actually look beyond the presenting problem, and it's lazy.
• 8:34
  SPEAKER_00: People in positions of influence have a responsibility to give parents something that is informed, not in a specifically scientific kind of way, but to actually help them see the bigger picture.
• 8:49
  SPEAKER_00: Otherwise, all we're simply doing is providing first aid for potentially serious problems.
• 8:56
  SPEAKER_00: In the series, which interestingly was written before this study was published yesterday, we look in a broader context.
• 9:07
  SPEAKER_00: What we want to try and do is de-pathologise screen time.
• 9:12
  SPEAKER_00: We don't want to see it as a problem that has to be fixed.
• 9:17
  SPEAKER_00: We want to instead look at it in terms of what it's telling us.
• 9:23
  SPEAKER_00: And the other thing I would say is there is not a one-size-fits-all understanding.
• 9:29
  SPEAKER_00: So when we're talking about children under the age of five and as young as two, what were they thinking?
• 9:37
  SPEAKER_00: Then we're looking at different developmental factors.
• 9:39
  SPEAKER_00: We're looking at where the child is in terms of their psychological, social development, as opposed to middle childhood, where there are other factors, and certainly in adolescence, where the the use of screens as a means of involvement, social interaction, do have their benefits, but my goodness, they have a lot of concerns as well.
• 10:03
  SPEAKER_00: So in the series, we're going to look uh a bit more forensically, I think, and my hope would be that my my, I wouldn't say findings, but that my stance and guidance is something which can actually be translated into something that is usable and something which helps parents to take a balanced view, which is informed by the much bigger picture.
• 10:34
  SPEAKER_00: If this introduction has sounded like a bit of a rant, that's because it is.
• 10:41
  SPEAKER_00: However, rant over, I'll be back with episode one shortly, and thank you for listening.
• 10:51
  SPEAKER_00: This is just a short post script.
• 10:54
  SPEAKER_00: I wanted to say that having listened back to the track, my my big scary dog, well, four actually, but one of the big scary dogs, who is neither big nor scary, was making a fuss.
• 11:10
  SPEAKER_00: So please excuse the background noise.
• 11:13
  SPEAKER_00: I'm going to