Developing Minds

American Psychiatric Association
Psychiatric News Alert
The Voice of the American Psychiatric Association and the Psychiatric Community


Should Psychiatrists Advocate Banning Screens From Kids’ Bedrooms?

Numerous studies have established a strong link between evening screen time and poor sleep quality. Yet should that association result in guidance from a child and adolescent psychiatrist, urging families to institute blanket bans on screens in bedrooms? That question was debated yesterday at this year’s American Association of Child and Adolescent Psychiatry’s (AACAP) annual meeting in New York City by members of AACAP’s Media Committee.

At the start of the debate, Paul Weigle, M.D., the session’s chair, took a poll of the room, asking if attendees thought child and adolescent psychiatrists should advocate banning screens from bedrooms. Fifty-four percent of participants agreed, while 25% disagreed, and 21% were unsure.

Argelinda Baroni, M.D., Lauren Hale, M.D., and Dale Peeples, M.D., argued in favor of banning screens from bedrooms. Some of their reasons included the following:

Screens in bedrooms contribute to poor sleep; they outlined the numerous consequences of poor sleep and the importance of sufficient, restorative sleep as fundamental to optimal functioning of the human body, especially the developing mind.
Screens and social media apps are addictive.
Unrestricted access to screens in the middle of the night is unhealthy.
While the ban proponents acknowledged that screen time in some capacity can have benefits for youth, they emphasized that those benefits can also be achieved in the living room, without disrupting sleep. “As your doctor, I can honestly tell you that you will feel better, sleep better, and have better concentration if you keep electronics out of your bedroom,” Peeples said.

On the opposite side of the debate were Gino Mortillaro, M.D., Ray Pan, M.D., and Michael Tsappis, M.D. They acknowledged the negative impact that screens have on sleep, but argued that bans are rarely ever followed. Other points of opposition included the following:

Blanket bans have the potential to compromise the alliance between the psychiatrist and the youth, as well as the parents and the youth.
Parents need to have a supportive alliance with their children. Banning screens from the bedroom reduces the opportunity for parents to have conversations with their youth.
Banning screens also reduces opportunities for the youth to learn how to regulate themselves as they enter adulthood.
Further, they argued that banning screens reinforces a negative emphasis on real, but also imagined, effects of screens, without allowing room to acknowledge the numerous benefits provided by screen access. “Screens are increasingly relied upon for everyday activities, especially by young people,” Tsappis said.

In the rebuttal phase of the debate, Baroni noted that science is on the side of the ban proponents. Hale argued that encouraging moderation and limit setting are one in the same. If youth put their phones away an hour before bed, they may sleep 20 minutes more, which is just enough to reduce the risk of car crashes and improve grades, Hale argued.

On the opposition side, Pan pointed out that when treating substance use disorders, the literature encourages a harm reduction approach rather than an absolute ban. “The idea of making a black-and-white ban really runs the risk of us being hammers and only seeing nails,” Mortillaro said.

The lively debate also drew numerous audience questions from AACAP members, who shared their thoughts and experiences in their own practices. By the end of the debate, Weigle took another poll to determine if either side had swayed more audience members. The result was almost a total reversal of the original poll: By the end, 55% were against advocating for bans on screens in bedrooms, while 35% were in favor of such bans, and about 10% were unsure.

The AACAP meeting will run through Saturday, October 28. Look for additional meeting coverage in Psychiatric News.

For related information, see the Psychiatric News article “Sleep Problems in Late Childhood, Early Adolescence Linked to Psychiatric Symptoms.”

American Psychiatric Association
Psychiatric News Alert
The Voice of the American Psychiatric Association and the Psychiatric Community


Stimulant Treatment in Youth Not Associated With Substance Use Later in Life

Children and adolescents with attention-deficit/hyperactivity disorder (ADHD) who are treated with stimulants do not have an increased risk of frequent alcohol, ma*****na, cigarette, or other substance use later in life, according to a study published yesterday in JAMA Psychiatry.

“Childhood [ADHD] carries risk for elevated substance use and substance use disorder (SUD) by adulthood,” wrote Brook S.G. Molina, Ph.D., of the University of Pittsburgh and colleagues. Because stimulant medications decrease impulsivity in patients with ADHD, some researchers believe the medications decrease substance use in these patients, they continued. “However, early exposure to stimulants may cause neurobiological and behavioral sensitization to other drugs and thus increase the risk for harmful substance use.”

Molina and colleagues used data from the Multimodal Treatment Study of ADHD, a 14-month randomized clinical trial of medication and behavior therapy. Participants aged 7 to 9 years who were diagnosed with ADHD were randomly assigned to one of four treatment groups: medication management, multicomponent behavior therapy, a combination of the two, or referral to usual community care. Participants were assessed prior to randomization, at months three and nine, and at the end of treatment. They were then followed for 16 years and were assessed at years 2, 3, 6, 8, 10, 12, 14, and 16.

During the 12-, 14-, and 16-year follow-ups, the participants completed a questionnaire on their use of alcohol, ma*****na, ci******es, and several illicit and prescription drugs. Information on the participants’ stimulant treatment was collected via the Services for Children and Adolescents Parent Interview until the participants reached the age of 18 years; after age 18, the participants reported on their stimulant treatment.

A total of 579 participants were included in the analysis. Substance use increased steadily through adolescence and remained stable through early adulthood. After accounting for developmental trends in substance use through adolescence into early adulthood, there was no association between current or prior stimulant treatment and substance use. Further, there was no evidence that a longer duration of stimulant treatment was associated with less substance use in adulthood. However, while cumulative stimulant treatment was associated with increased heavy drinking, the authors noted that the effect size of this association was small.

The authors concluded that their study “failed to support any hypotheses of substance use protection or harm from stimulant treatment for ADHD.”

They continued: “Although these results contrast with recent conclusions of protection found in other data sets, across all studies the findings lend a measure of comfort in the consistent lack of evidence that stimulant treatment predisposes children with ADHD to later substance use.”

For related news, see the Psychiatric News article “Symptoms, Impaired Function of ADHD Often Persist Beyond Childhood.”

Limiting Consumption of Ultra-processed Foods May Help Slow Cognitive Decline, Study Suggests

People who consume more than 20% of their total daily calories in ultra-processed foods may experience faster cognitive decline than adults who consume fewer ultra-processed foods daily, a study published yesterday in JAMA Neurology suggests. Ultra-processed foods include cookies and cakes, diet and regular soda, processed meats, frozen meals, and more.

“Our findings are in line with previous studies linking consumption of [ultra-processed foods] and adverse health outcomes, such as the increased risk of overweight and obesity, metabolic syndrome, cancer, cardiovascular diseases, and all-cause mortality,” wrote Natalia Gomes Gonçalves, Ph.D., of the University of São Paulo Medical School in Brazil and colleagues.

The researchers analyzed data collected from participants in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil study). Public servants aged 35 to 74 years from six Brazilian cities were recruited for the study and followed up in three waves, approximately four years apart, from 2008 to 2017. Upon enrollment in ELSA-Brasil, these participants were asked about their food and drink consumption over the last 12 months using a validated Food Frequency Questionnaire. The researchers classified the participants’ consumption of foods and beverages into three categories, according to the extent of industrial processing:

Unprocessed or minimally processed foods (for example, fresh or frozen fruits and vegetables and grains) and processed culinary ingredients (for example, table sugar, oils, and salt)
Processed foods, which are manufactured using unprocessed or minimally processed foods (for example, canned fruits and smoked meat)
Ultra-processed foods, which are formulations of processed culinary ingredients with food additives not used in home preparations, such as flavors, colors, sweeteners, emulsifiers, and other substances
The ELSA-Brasil study participants received multiple cognitive assessments over the follow-up period. These tests included evaluating the participants’ immediate recall, late recall, word recognition, and semantic and phonemic verbal fluency.

Gomes Gonçalves and colleagues focused their analysis on 10,775 adults (mean age of 52 years, 53% White, and nearly 57% with at least a college degree). After a median follow-up of eight years, participants who reported consumption of ultra-processed foods of more than 19.9% of daily calories at baseline had a 28% faster rate of global cognitive decline compared with those who reported consumption of ultra-processed foods less than 19.9% of daily calories, Gomes Gonçalves and colleagues reported.

“Limiting [ultra-processed food] consumption, particularly in middle-aged adults, may be an efficient form to prevent cognitive decline,” Gomes Gonçalves and colleagues wrote. “Future studies investigating the mechanism by which [ultra-processed food] may lead to cognitive decline are needed, as well as confirmation of our findings in other longitudinal studies and randomized clinical trials.”