International Journal of Mental Health and Addiction

https://doi.org/10.1007/s11469-019-00182-2

ORIGINAL ARTICLE

Effects of Excessive Screen Time on Neurodevelopment,

Learning, Memory, Mental Health,
and Neurodegeneration: a Scoping Review

Eliana Neophytou 1 & Laurie A. Manwell 1 & Roelof Eikelboom

1

# Springer Science+Business Media, LLC, part of Springer Nature 2019

Abstract
Evidence suggests that chronic sensory stimulation via excessive exposure to screen time
may affect brain development in negative ways. Excessive smartphone use may increase the
risk of cognitive, behavioral, and emotional disorders in adolescents and young adults that
also has the potential to increase the risk of early onset dementia in late adulthood. This
scoping review assessed theoretical and empirical evidence for the relationships between
excessive screen time and (i) neurodevelopment, (ii) learning and memory, (iii) mental health,
(iv) substance use disorders, and (v) neurodegeneration. Using Halas et al.’s (BMJ Open,
5(1), 1–6; 2015) five-stage scoping review methodology, we systematically identified articles
meeting the following inclusion criteria: published in English between January 1999–July
2019; human or animal subjects; primary and secondary sources including original research,
systematic reviews, meta-analyses, scoping reviews, and narrative reviews. Primary search
terms focused on “smartphone,” “mental health,” “substance use,” “neurodevelopment,” and
“neurodegeneration”; secondary search terms focused on “social media,” “anxiety,” “canna-
bis,” and “dementia”. We analyzed 44 articles across 16 countries in this review. Each article
corresponded to one of four research questions investigating screen time and mental health (n
= 13), mental health and substance use (n = 8), chronic stress and development (n = 14), and
chronic stress and neurodegeneration (n = 9). Overall increased screen time is associated with
negative outcomes such as lowered self-esteem, increased incidence and severity of mental
health issues and addictions, slowed learning and acquisition, and an increased risk of
premature cognitive decline. Future directions to better inform public policy should expand
research methodologies and explore the prolonged effects of excessive screen time on
cognition and mental health in diverse populations and contexts.

Keywords Screen time . Mental health . Social networking sites . Neurodegeneration . Substance
use

* Laurie A. Manwell
lmanwell@wlu.ca; lauriemanwell@gmail.com

1
Department of Psychology, Wilfrid Laurier University, 75 University Avenue West, Waterloo, Ontario
N2L3C5, Canada
 International Journal of Mental Health and Addiction

Technological innovation has allowed us to communicate with others instantaneously, increas-

ing the ability to create and maintain social connections. The ubiquity of electronic media over
the past 60 years, across several generations, has led to greater focus on research evaluating the
effects of screen time throughout critical periods of development. A study analyzing cohort
trends, while controlling for age and time period, found that from the period of 2008 to 2017,
those born in the 1990’s (IGen) and 1980’s (Millennials) reported significant increases in
severe psychological distress and thoughts of suicide in contrast to those born in the 1970’s
(GenX) and earlier (Baby Boomers) (Twenge et al. 2019). Compared to face-to-face (or
“offline”) social networks, which are positively associated with life satisfaction and mental
health, social media (or “online”) social networks, such as Facebook, are negatively associated
with overall well-being (Allcott et al. 2019; Shakya and Christakis 2017). Excessive exposure
to electronic devices may be related to an increase in sleep disturbances, both of which are also
independently associated with increased psychological distress such as suicidal ideations and
depressive symptoms (Pigeon et al. 2012; reviewed in Twenge et al. 2019). Social connection
appears to be more beneficial in offline contexts than online, as electronic based social media
may lower self-esteem, heighten the risk of internet addiction, and increase mental health
problems, for example, by moderating the effects of internet usage on internalizing problems
such as social anxiety and depression (Selfhout et al. 2009; Shakya and Christakis 2017). The
increasing use of electronic media by young children may have adverse consequences on
future cognitive functioning and attentional focus, considering the acquisition of learning and
attention capacities throughout the critical developmental periods of childhood (American
College of Pediatricians 2016).

Developmental Effects of Excessive Screen Time

Excessive screen time (e.g., more than 2–3 h exposure to electronic media including television,
computers, and mobile electronic devices) can affect the developing brain which has important
consequences for cognitive and motor development, learning and memory, emotional regula-
tion, and overall health. Compared to children born in 1970 who typically began watching
television at age 4, children born after 2000 began watching television on a regular basis at 4
months old (Christakis and Zimmerman 2006; Zimmerman et al. 2007). Research suggests
that earlier and longer exposure to electronic media is associated with an increased risk of
psychiatric symptomology, particularly those of attentional problems and hyperactivity, anx-
iety disorders, and depression (Maras et al. 2015; Yen et al. 2009). Studies suggest that even
the use of educational media, depending upon the age of the child, as well as the content, pace,
and degree of exposure, may have adverse outcomes on development in infants and children
(Christakis et al. 2018). These findings are consistent with a study showing that screen content
which encourages direct participation, such as “Dora The Explorer” and “Blues Clues,”
facilitated greater vocabulary and expressive language performance; in contrast, programs
with poor language models such as “Teletubbies,” significantly hindered language acquisition
in infants and toddlers (Linebarger and Walker 2005).
The consequences excessive screen time may pose on learning and memory may directly
affect academic performance in children, adolescents, and young adults. Pre-school children
exposed to excessive screen time showed delays in learning and failed to meet developmental
milestones in problem solving, language, and motor skills (Madigan et al. 2019). In conjunc-
tion with these findings, children exposed to excessive screen time displayed negative
International Journal of Mental Health and Addiction

cognitive, behavioral, and physical outcomes (Madigan et al. 2019). The constant distraction
from television and mobile devices at a young age may also impede the development of social
capabilities, as real-life interactions are diminished (Madigan et al. 2019). Though electronic
media may be used for educational purposes, studies have shown that skills learned on these
mediums are often limited in comparison to those acquired in real-life contexts (Linebarger
and Walker 2005; Christakis et al. 2018). Over 2 h a day of screen time was associated with
decreased performance on thinking and language tasks in children, and those exposed to seven
or more hours of screen time a day showed significant differences in thinning of the cortex,
effecting cognitive functions, and memory (Lee 2018). Male adolescence diagnosed with a
behavioral addiction such as internet gaming disorder had significantly reduced orbitofrontal
cortex thickness, thought to play a fundamental role in reward-related decision-making and
addiction disorders (Hong et al. 2013).
Ninety five percent of teenagers in America use the internet on a daily basis primarily
for social networking and instant messaging (Purcell 2013; Gommans et al. 2015).
Digital media can heavily influence the perceptions individuals have pertaining to
substance use. A study analyzing electronic media communication found that screen-
based media use was associated with increased levels of adolescent substance use
(Purcell 2013; Gommans et al. 2015). Findings suggested that electronic media commu-
nication was highly associated with real-life interactions with tobacco and cannabis use
(Purcell 2013; Gommans et al. 2015). In addition, a study investigating screen time in
association with perceived attentional problems found that greater screen time exposure
was associated with heightened perceptions of attentional problems and increased can-
nabis consumption in young adults (Montagni et al. 2016).
The impacts of excessive screen time on neurodevelopment may have lasting effects
on those reaching adulthood (Madigan et al. 2019). For example, a study investigating
electronic device use in post-secondary education found that students in classrooms
where electronic devices were prohibited scored significantly higher on both unit and
final exams (Glass and Kang 2018). In contrast, students in classrooms where devices
were allowed, even if they refrained from using an electronic device, continued to score
lower due to overall classroom distraction (Glass and Kang 2018). Distractions which
decrease the mnemonic strategies used to support memory retention are associated with
diminished long-term memory (Glass and Kang 2018). Cognitive capabilities develop to
support the functions necessary to thrive in environmental and social circumstances,
suggesting the pervasiveness of screen use in younger generations may have significant
consequences on cognitive development (Glass and Kang 2018). With regard to the
adverse outcomes of sensory overstimulation during brain development, individuals
engaging in prolonged screen time may be at an increased risk of degenerative symp-
toms. Considering the prevalence of electronic media use and its adverse consequences,
individuals may have cause for concern in later adulthood. The lasting consequences on
learning, memory, and language in children of a technological era may lead to premature
symptoms of cognitive decline, compared to previous generations.

Purpose of Scoping Review

A scoping review was conducted to investigate the literature regarding the effects of sensory
overstimulation from electronic devices on mental health, learning and memory, performance,
substance use, and cognitive decline, with the aim of purposing a new hypothesis pertaining to
 International Journal of Mental Health and Addiction

the long-term consequences of screen time on the developing brain. We were particularly
interested in assessing the extent to which experimental studies have confirmed or refuted
findings from correlational studies and the extent to which animal models of human behavior
were used to address these issues.

Methods

We followed the five stages of the scoping review method created by Halas et al. (2015) which
were modified for the purposes of the current study.

Stage 1: Identifying the Research Question

We used an iterative search process, previously developed by Arksey and O’Malley (2005) and
adapted by Halas et al. (2015), to create guiding research questions in the development of a formal
medical hypothesis. We aimed to search the literature for evidence identifying potential causal
mechanisms underlying the relationships between smartphone use and (i) neurodevelopment, (ii)
mental health, (iii) substance use, and (iv) neurodegeneration. In order to narrow a research
question, we identified four guiding questions (refer to Table 1) to identify sufficient literature to
formulate a new hypothesis about the relationship between chronic sensory overstimulation (e.g.,
excessive screen time) during brain development and substance abuse (e.g., cannabis use
disorder) in young adulthood and the potential for early-onset dementia in late adulthood.

Stage 2: Identifying Relevant Studies

The main goal of a scoping review is to broadly address a wide range of research questions.
However, there are specific parameters that should be used to guide the search strategy. Currently,
we have decided on a search strategy, selected key terms and the eligibility criteria as follows:

Eligibility Criteria

The following inclusion criteria were used to guide the search and will also be used when
reviewing articles:

& Published in the English language

& Human and animal subjects
& January 1999–July 2019
& All age groups
& Original preclinical and clinical research
& Review articles including: systematic reviews, meta-analyses, meta-syntheses, scoping
reviews, narrative reviews, rapid reviews, critical reviews, integrative reviews, and brief
review-based expert commentaries
& Research reviews are limited to developed countries in North America, including Canada,
and the USA, Europe, Asia, Australia, New Zealand, and the Middle East where rates of
substance use, electronic media use, income, standard of living, and infrastructures may be
comparable.
International Journal of Mental Health and Addiction

Table 1 List of research questions and operational definitions

Research questions Operational definitions

1. What is the relationship between excessive screen Smartphone use
time (e.g., social media) and mental health • Advanced mobile devices used primarily for
problems? communication and offer a vast array of additional
features such as wireless internet access, social
networking, videogames, entertainment,
and both educational and leisure applications
Screen time
• Time spent on varying types of screens with internet
access such as phones, computers, television,
videogames and tablets (Minges et al. 2015)
Social media
• Interactive websites allowing users to create an online
profile and control the content they see from others
and share with others, including information
(e.g., news, ideas, opinions), images, audio,
and videos. Examples of current and popular social
media, also referred to as social networking sites,
include Facebook, Twitter, Instagram, Snapchat,
LinkedIn, and Pinterest (Meshi et al. 2015)
2. What is the relationship between mental health Mental health problems
problems and substance use, specifically cannabis? • Anxiety
• Attentional problems
• Psychopathologies
• Mood regulation/depressive affect/anhedonia
Cannabis use disorder
• A preoccupation with acquiring and using cannabis,
over a recurrent period of time, despite adverse
consequences, distress, and impairment
(American Psychiatric Association 2013)
3. How does chronic stress affect the developing Stages of brain development
brain? • Proliferation
• Migration
• Arborization (circuit formation)
• Myelination
• Synaptic Pruning
4. How does chronic stress affect neurodegeneration? Neurodegeneration
• The continuous loss of neurons and their processes,
leading to impairment in cognitive functions, most
often observed in association with ageing
(Clifford and Holtzman 2013)

Explicit exclusion criteria identified are:

& Articles academic or peer reviewed (i.e., outside of those defined in the inclusion list), such
as book reviews, opinion articles, commentaries, or editorial reviews

Databases

The following electronic databases were searched: Google Scholar, PubMed, PsycInfo, and the
Educational Resources Information Centre (ERIC).
 International Journal of Mental Health and Addiction

Search Strategy

Our research team determined primary search terms and a multitude of secondary search
terms as well as filtering methods. The primary search term focused on the main modes
of social networking, “screen time” and “social media.” The secondary search terms
focused on potential problems associated with social networking, “mental health,”
“cognitive decline,” “substance use,” and “cannabis.” The filtering methods included
the date range (within the last 20 years) and English in order to narrow the results of the
search. Upon completion, the searches from each database were documented and refer-
ences were imported into database-specific folders in Dropbox, where duplicates were
eliminated.

Stage 3: Study Selection

We designed a two-part study selection process. First, titles were reviewed by a single
reviewer to determine eligibility based on the defined inclusion and exclusion criteria
and by using the defined key terms. The second part of the selection process included
two independent reviews of the titles and abstracts using the eligibility criteria. At this
point, the two reviewers assessed the systematic approach as well as the results of the
study that is reported in the abstract. Given that abstracts commonly contain less specific
details, we developed criteria (Table 2) to determine the acceptable level of rigor based
on a preliminary review of the abstracts and an inductive approach drawing on Gough
(2013) and Gough et al.’s (2012) observations of varied review methods. While scoping
review methodology does not specify a process for evaluating study quality, we only
included abstracts that demonstrated sufficient evidence answering the proposed research
questions (Table 1).

Stage 4: Charting the Data

In order to collect key findings, we collected key findings and information by

conducting a scan of the abstracts of selected literature (Table 3). Data extracted from
the journal articles was analyzed and summarized into tables and included standard
information such as author, year of publication, study objectives, etc. In order to
ensure the consistency of the questions and the data that is presented within these
tables, a study by Daudt et al. (2013) suggested a “trial charting exercise and team
consultation” (Halas et al. 2015, p. 4). The abstracts of the articles explained the

Table 2 Inclusion and exclusion criteria determining acceptable articles

Criteria for inclusion Criteria for exclusion

At least one of the following minimum criterion required in the • Non-academic sources such as
abstract: websites
• Screen time
• Social networking/social media
• Smartphone use
• Mental health
• Substance use
• Addiction
• Neurodegeneration/cognitive decline
International Journal of Mental Health and Addiction

Table 3 Data extraction framework

Bibliometric Characteristic of Coding the characteristics

the article
Authors Objective(s) and Action areas:
Title methods • Excessive screen time and its association with
Source • Mental health
Year of publication • Learning and memory
Country • Substance use
Language • Neurodevelopment
• How consequences of excessive screen time may lead to earlier and
more severe neurodegeneration
Type of article
Number of
included studies
Time frame

necessary data such as the main findings that allowed us to conduct a scoping review.
If pertinent information was missing from within the abstracts, then the research team
consulted to report the findings.

Stage 5: Collating, Summarizing, and Reporting the Results

The findings were presented as a broad overview of guiding questions that encompassed the
gaps that were identified within the current literature, rather than a narrow scope. Thus, we
were able to identify where specific research is necessary and what population must be targeted
when looking at the effects of excessive screen time on development.

Results

Using the outlined search strategy, a total of 2379 documents were screened through database
searching and other sources; of these publications, 44 articles were eligible for inclusion in this
qualitative synthesis (refer to Table 4). Once selected, articles were separated into four tables
based on relevance to each research question: Table 5 includes articles investigating screen
time and mental health (n = 13), Table 6 explores mental health and substance use (n = 8),
Table 7 examines chronic stress and development (n = 14), and Table 8 investigates chronic
stress and neurodegeneration (n = 9). Each table includes the authors and year of publication,
participants, location, research method, major findings, and recommendations.

Table 4 Methods chart

Identification Records identified through database searching: Additional records identified through other
(n = 106,524) sources (n = 5)

Duplications Records after duplicated removed (n = 104,913)

removed
Screening Records screened (n = 2379) Records excluded (n = 2055)
Eligibility Review abstracts assessed for eligibility Review abstracts excluded with reasons
(n = 324) (n = 280)
Included Studies included in qualitative synthesis (n = 44)
 International Journal of Mental Health and Addiction

Table 5 Screen time and mental health. Articles primarily answering question 1: what is the relationship between
excessive screen time (e.g., social media) and mental health problems?

Author and Participants Country Research methods Findings

year (human/
animal)

Selfhout - N = 307 Netherlands - Self-report - Major: electronic-based social media may

et al. - Humans - Quantitative study lower self-esteem, heighten the risk of
2009 - Adolescents - Empirical study internet addiction, and increase mental
- Longitudinal data health problems by moderating the ef-
- Prospective study fects of internet usage on internalizing
problems
- Recommendations: future investigation on
longitudinal effects of excessive screen
time and internalizing symptomology
Lepp et al. - N = 536 USA - Self-report - Major: cell phone use was associated with
2013 - Humans - Empirical study decreased life satisfaction, diminished
- College - Quantitative academic performance and heightened
students anxiety.
(18+) - Recommendations: There should be
increasing awareness regarding the
academic consequences pertaining to
problem smartphone use.
Davey and - N = 6 articles India - Mixed method, - Major: mobile phone use significantly
Davey - Adolescence meta-analysis and associated with psychological problems,
2014 systematic review behavioral, emotional, and physical
deficits.
- Smartphone abuse between 39–44% with
variability ranging between abuse and
addiction.
- Recommendations: smartphone addiction
can have detrimental effects on the
academic performance, psychological
symptoms and stress levels of
adolescence.
Maras - N = 2482 Canada - Cross-sectional - Major: time spent engaging in sedentary
et al. - Humans design screen time is significantly associated
2015 - Youth - Empirical study with the rigorousness of depression and
- Interview anxiety symptoms.
- Video game and computer use were
significantly associated with depression,
but only video game use was associated
with anxiety.
- Recommendations: future research should
investigate the times of day adolescence
engage in digital media use, the type of
media and information being accessed
and their associations with psychological
symptoms.
Minges - N = 15 USA, - Qualitative - Major: screen use is associated with
et al. articles Canada, - Meta-analysis personal, peer, and parental perceptions
2015 - Humans New - Recommendations: suggests monitoring of
- Adolescents Zealand, screen time and limitations
and families Australia, - Suggest qualitative and quantitative
Israel and methods of investigation to further
UK research
Darcin - N = 367 Turkey - Quantitative study - Major: those using smartphones primarily
et al. - Humans - Empirical study for the use of social networking were at
2016
International Journal of Mental Health and Addiction

Table 5 (continued)

Author and Participants Country Research methods Findings

year (human/
animal)

- University an increased risk of addiction to their

Students smartphones.
- Loneliness and social anxiety are highly
associated with smartphone addiction.
Social phobia in both sexes and loneliness in
females as increased risk factor for
addictive smartphone use.
- Recommendations: Attention to young
adults’ social environment, degree of
loneliness, and social phobia to prevent
negative effects of smartphone addiction
Montagni - N = 4816 France - Cross-sectional - Major: increased time on electronic media
et al. - Humans study is associated with heightened
2016 - Adults - Epidemiological self-perceived attentional problems and
study hyperactivity.
- Recommendations: future investigation
should focus on if limiting/decreasing
screen time leads to lowered perceptions
of attentional problems and hyperactivity
in adolescence.
Shakya - N = 5208 USA - Longitudinal, - Major: Facebook use was negatively
and - Humans correlational, associated with well-being and positively
Christa- - Adults study associated with BMI
kis 2017 - 3 wave nationally - Recommendations: Facebook use was not
representative found to promote wellbeing, and thus,
survey social media users should direct more
- Prospective study focus on in-person, real-life interactions
Green - N = 19 USA - Repeated measures - Major: short wave length light exposure
et al. - Humans - Empirical study for 2 h before bed interrupts sleep quality,
2017 - Adults thermoregulation, and melatonin
production
- Increased reports of negative mood the
next morning
- Recommendations: future exploration on
larger populations exposed to light
pollution and how this effects our
cognition and health
Twenge - N = 40, 337 USA - Stratified random - Major: screen time was significantly
and - Humans sample associated with lower psychological
Camp- - Adolescence - Self-report well-being, poor emotion regulation,
bell - Empirical study self-control, and increasingly more likely
2018 - Quantitative to be diagnosed with depression or
anxiety.
- Recommendations: further investigation
into the effects of screen time on mental
health in representative samples as well
as the possible benefits of screen time
limitations
Allcott - N = 2743 USA - Randomized - Major: Facebook account deactivation was
et al. - Humans experiment associated with decreased news
2019 - Children, - Self-report knowledge, increased offline activity and
adolescence - Empirical study heightened subjective well being
and adults - Recommendations: Further investigation
should focus on mediating and
 International Journal of Mental Health and Addiction

Table 5 (continued)

Author and Participants Country Research methods Findings

year (human/
animal)

moderating factors associated with social

media addiction.
Twenge - N = 611,880 USA - Nationally - Major: significant increases in
et al. - Humans representative psychological distress and suicidal
2019 - Children, survey ideation form 2008 to 2017 in those born
adolescence - Cohort study in 1980s compared to 1970s and earlier.
and adults - Empirical study - Recommendations: future research should
- Interview focus on interventions pertaining to
- Quantitative digital media and factors associated with
sleep hygiene, mood disorders, and
suicidal ideations.
Hussain -N=9 UK - Systematic Review - Major: data found significant associations
and - Articles with problematic social networking site
Griffiths - Adolescence use and psychiatric disorder
2019 and Adults symptomology.
- Recommendations: exploration of
problematic social networking site use in
adult populations

The methods used to investigate the associations of screen time on cognition and mental
health varied widely. Of the articles selected, 27 presented correlational data gathered through
longitudinal (34%) or cross-sectional study designs (25%). Five articles described findings
extracted through experimental designs (14%), and 11 articles portrayed descriptive data,
obtained through meta-analysis or systematic review (25%). Overall, very few studies inves-
tigated all age groups or only infants and children (< 11 years old). Many articles investigated
adult populations (> 25 years old), while a vast majority of articles explored adolescent (11–17
years old) and young adult (18–25 years old) populations.

Discussion

The current review investigated findings from 44 articles across 16 countries pertaining to
excessive screen time and its association with cognition and mental health. Though electronic
media pose many benefits such as communication and entertainment, results of this study
indicate that excessive screen time can have detrimental effects on cognition and development,
particularly for children, adolescents, and young adults. Thus, many studies highlight the
importance of parental monitoring and the potential benefits of screen time limitations.
Studies exploring the relationship between excessive screen time (e.g., social media) and
mental health problems strongly indicated time spent on digital media was associated with
increased symptoms of psychopathologies, specifically those of anxiety, depression, and
attention deficit disorders (Lepp et al. 2013; Maras et al. 2015; Montagni et al. 2016). Time
spent primarily on social networking sites was explored in most of the literature and was
associated with poor emotional regulation and self-control, increased psychiatric disorder
symptomology, and comorbid addictions to substances (Twenge and Campbell 2018;
Hussain and Griffiths 2019.) Social networking sites allow impression management, as users
International Journal of Mental Health and Addiction

Table 6 Mental health and substance use. Articles primarily answering question 2: what is the relationship
between mental health and substance use?

Author Participants Country Research Findings

and year (human/animal) methods

Bergen - N = 1579 Australia - Longitudinal - Major: perception of academic failure at

et al. - Humans - Self-report 13–15 years old is associated with alcohol,
2005 - Adolescence - Empirical marijuana, and tobacco consumption at age
study 15.
- Prospective - Association with marijuana consumption
study may be fully mediated by antisocial
behavior.
- Recommendations: intervention with a focus
on increasing academic confidence in
emerging adolescents may have significant
benefits in mediating future substance use.
Hall et al. - N = 66 sources Australia - Systematic - Major: epidemiological studies portrayed that
2009 review comorbidity between anxiety, depressive
and substance use disorders are very
common.
- A third to one half of individuals with any
mental health disorder meet the criteria for
substance use.
- Recommendations: increased
epidemiological, twin, and neuroimaging
studies should be implemented in attempt to
understand the contributing factors to
comorbidity between substance use and
other psychopathologies.
Kuss and - N = 43 articles UK - Systematic - Major: addictive social networking use is
Griffiths - Adolescence and Review associated with decreased degree of
2011 adults community belongingness.
- Those with low harm avoidance are at
significantly higher risk of comorbid
addiction to social networking sites and
substances.
- Recommendations: further investigation
should be directed towards comorbidity of
problematic social networking site use,
substance use, and etiology.
Gommans - Humans Netherlands - Random - Major: higher levels of electronic media
et al. - N = 5642 stratified, communication were significantly
2015 - Adolescence multilevel associated with substance use,
analysis primarily alcohol use.
- Empirical - Electronic media communication was highly
study associated with afternoon, real-life interac-
tions with tobacco use and evening,
real-life interactions with cannabis use
- Recommendations: the association between
substance use and electronic media
communication should be considered with
regard to substance use interventions and
research.
Gutierrez - N = 162 sources Spain - Systematic - Major: problematic cell phone use is an
et al. - Humans review increasingly prevalent problem associated
2016 - All ages with decreased sleep quality, increased
substance use, and psychopathological
symptoms.
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Table 6 (continued)

Author Participants Country Research Findings

and year (human/animal) methods

- Recommendations: research should expand

to investigate adult populations and global
impacts of PSU.
Long et al. - N = 2059 Australia - Longitudinal - Major: For internalizing and externalizing
2016 - Humans twin study disorder symptoms, hours of internet use
- Young adults - Empirical were positively correlated with social
study phobia.
- SNS used for peer contact was positively
associated with alcohol abuse but
negatively correlated with cannabis use,
cannabis use disorder, and nicotine
dependence.
- Recommendations: while social networking
may be a protective factor against cannabis
use disorder, frequency of internet use and
peer contact are linked to social phobia.
Meshi - Humans Germany - Experimental - Major: excessive social networking site
et al. - N=71 Design (SNS) use was associated with lower per-
2019 - Adolescence and - Empirical formance on risk evaluation and decision
adults (18–35 design making.
years old) - Recommendations:
- Results suggesting similarities between
excessive SNS users and those with
substance and behavioral addictions
Dey et al. - N = 5096 Switzerland - Multiple linear - Major: social anxiety and ADHD were
2019. - Humans regression significant risk factors of problematic
- Adults - Longitudinal smartphone use.
cohort study - PSU significantly associated with risky single
- Empirical occasion alcohol consumption.
design - Recommendations: focus on subgroups that
- Prospective may be at a higher risk for problematic
study smartphone use may be beneficial.

have full control of the online profile others view of them. The ability to share such controlled
information can have detrimental effects on self-esteem and life satisfaction as individuals tend
to portray the most idealized versions of oneself and one’s experiences. Thus, users often
compare their real-life experiences and struggles with others’ positively highlighted moments
shared on social media. Negative emotions often provoked by such upwards social compar-
isons may increase the risk of smartphone and social networking site addictions and increase
the risk of substance use.
Studies assessing the relationship between mental health problems and substance use,
specifically cannabis, largely supported a connection between smartphone addiction and
substance addiction. Screen-based media allow individuals to expand social networks and
connections; however, time spent on the internet was positively associated with social phobia,
a decreased degree of perceived community belongingness and lower performance on risk
evaluation (Meshi et al. 2019). These factors significantly contribute to the risk of internet
addiction and comorbid substance use (Kuss and Griffiths 2011). In adolescents and young
adults particularly, individuals are often influenced by peer perceptions. A number of studies
found that problematic smartphone use and social media used for peer contact may be
International Journal of Mental Health and Addiction

Table 7 Chronic stress and development. Articles primarily answering question 3: what is the relationship
between chronic stress and development?

Author and Participants Country Research methods Findings

Year (human/animal)

Fredriksen - N = 467 Scotland - Self-report - Major: poor sleep quality was most
et al. 2004. - Humans - Empirical design significantly associated with
- Children and nighttime social media use.
emerging - Those with poor sleep quality
adolescence depicted decreased self-esteem and
(11–14 years old) grades and heightened prevalence
of depressive symptoms over time.
- Recommendations: further
investigation may benefit from
longitudinal research exploring the
effects of sleep loss on long-term
developmental outcomes.
Christakis - N = 1278 infants USA - Representative - Major: early television exposure is
et al. 2004 at age 1 longitudinal dataset associated with increased risk of
- N = 1345 children - Empirical design attentional problems later in
at age 3 - Prospective study development.
- Humans - Hours of television exposure at 1
year old is associated with an
increased risk of attentional
problems by 28%.
- Recommendations: future
investigation should focus on the
effects of television content and its
associated effects on infants and
children.
Linebarger - N = 51 USA - Longitudinal process - Major: screen content either
and Walker - Humans product design with inhibited or encouraged language
2005 - Infants and repeated measures acquisition in toddlers and infants
children - Empirical study - Recommendations: further
- Parent self-report investigation of the effect of screen
- Prospective study content on early cognitive
development is needed.
Zimmerman - N = 1009 parents USA - Telephone survey - Major: results suggest a negative
et al. 2007 - Humans (parents) association between hours of
- Infants and - Empirical study television viewing and language
Children - Prospective study acquisition in children at 8 to 16
- - months.
- Recommendations: investigation via
randomized trial to allow for
determination of causal inferences
about television viewing and
associated effects on acquisition
and learning.
Yen et al. - N = 2793 Taiwan - Cross-sectional - Major: attention deficit followed by
2009 - Humans design impulsivity were the most highly
- College students - Self-report associated ADHD symptoms of
- Empirical study internet addiction.
- Association more significant in
females
- Recommendations: further
exploration of biopsychosocial
models investigating the
association between ADHD
symptoms and internet addiction.
 International Journal of Mental Health and Addiction

Table 7 (continued)

Author and Participants Country Research methods Findings

Year (human/animal)

Christakis - Mice USA - Experimental design - Major: over stimulated mice

et al. 2012 - N = 61 over - significantly more likely to display
stimulated deficits in cognition and behavior
- N = 48 controls - Recommendations: overstimulation
was associated with increased risk
taking, decreased long-term
memory, learning, and diminished
anxiety
Pigeon et al. - N = 39 Studies USA Meta-analysis - Major: sleep disturbances, insomnia,
2012 - N = 147,753 and nightmares were each
Humans significantly associated with
- Primarily suicidal ideations and behaviors
adolescence - Recommendations: future research
should investigate further into the
mediating and moderating factors
contributing to the association
between sleep quality and mental
health.
Wedekind - N = 59 alcohol Germany - Cross-sectional de- - Major: high prevalence of insecure
et al. 2013 addicted males sign attachment styles in
and females - Empirical study alcohol-addicted individuals
- Adults - Associated with significant increases
in cognitive avoidance of
anxiety-inducing thoughts.
- Recommendations: future research
should consider associations of
attachment style in diagnosis and
treatment of alcohol addiction.
Alteba et al. - Rats Israel Experimental design - Major: early exposure to stress can
2016 - N = 72 (8 mothers have prolonged consequences on
and 64 pups) development.
- Recommendations: treatment of
early stress exposure with
endocannabinoid administration
may reverse the detrimental effects
on emotional behavior and
short-term memory.
American - N = 64 Studies USA - Review - Major: use of electronic media by
College of - Humans young children may have adverse
Pediatri- - Children and consequences on future cognitive
cians 2016 adolescence functioning, emotional and
behavior development, and
attentional focus.
- Recommendations: discourage use
of electronic media in children and
encourages heightened media
literacy in parents to protect against
possible developmental
consequences in family.
Contractor - N = 347 USA - Quantitative study - Major: all PTSD symptom clusters
et al. 2017 - Adults (18+) - Self-report were significantly associated with
- Empirical study PSU and other psychopathology.
Cross sectional - Recommendations: exploration of
problematic smartphone use in
individuals with increased arousal
International Journal of Mental Health and Addiction

Table 7 (continued)

Author and Participants Country Research methods Findings

Year (human/animal)

symptoms and negative alterations

in cognition and mood.
Christakis - Humans and USA - Review - Major: early sensory stimulation was
et al. 2018 animals associated with diminished
- Children and learning, anxiety, and memory as
Adolescence well as increased risk taking.
- Recommendations: consequences of
early sensory overstimulation may
persist in the absence of social
isolation and cognitive
engagement.
Glass and - N = 118 USA - Experimental design - Major: study depicted that divided
Kang 2018 - Humans attention does not show immediate
- College students disadvantages but rather long-term
effects of divided attention on
retention in educational settings.
- Recommendations: re-evaluation of
benefit of technology used to con-
trol for electronic distraction.
Emirtekin - N = 443 Turkey - Self-report survey - Major: child emotional
et al. 2019. - Adolescents - Cross sectional maltreatment, body image
- Empirical study dissatisfaction, depression, and
anxiety are associated with
problematic smartphone use
- Females scored higher on all
problematic smartphone use
addiction scales, childhood trauma,
social anxiety, and depression.
- Recommendations: future direction
may focus on environmental
factors effecting problematic
smartphone use.

mediators of cannabis and alcohol consumption, while other studies suggested moderating
effects on substance use (Gommans et al. 2015; Long et al. 2016).
Developmental effects of chronic stress from excessive screen time were explored in many
different methodological contexts. Evidence suggests that early and excessive screen time
exposure can have detrimental and prolonged effects on attention, memory, learning, and
language acquisition in infants and children (Christakis et al. 2004; Linebarger et al., 2005;
Zimmerman et al. 2007). With regard to adolescents and emerging adults, chronic stress from
excessive screen time is associated with increased anxiety and risk-taking behavior (Meshi
et al. 2019; Maras et al. 2015). Few studies explored the effects of electronic media and
sleeping patterns, though evidence suggests that screen time before bed contributes to poor
sleep quality, often leading to negative mood and decreased academic performance in adoles-
cents and emerging adults (Fredriksen et al. 2004). One study showed that divided attention
using electronic media in the classroom has few immediate effects, but significant long-term
effects on retention of educational content (Glass and Kang 2018).
Prolonged effects of chronic stress from electronic media may have developmental conse-
quences to and throughout early adulthood. In children, premature and excessive screen time
 International Journal of Mental Health and Addiction

Table 8 Chronic stress and neurodegeneration. Articles primarily answering question 4: what is the relationship
between chronic stress and neurodegeneration?

Author and year Participants Country Research Findings

(human/ methods
animal)

Zunzuneegui et al. - N = 964 Spain - Stratified - Major: number of relatives seen monthly
2003 - Humans random and social integration were significant
- Older sample predictors of cognitive decline.
adults - Longitudinal- Contact with friends may act as a
(65+) study protective factor to cognitive decline for
- Interviews female but not males.
- Empirical - Recommendations: further investigation of
design the social and contextual factors, as well
- Prospective as gender differences associated with
study cognitive decline.
Barnett et al. 2013 - Humans UK - Review - Major: over 50% of risk factors for
dementia are lifestyle factors including
obesity, smoking, depression, diabetes,
hypertension, and cognitive and physical
activity.
- Recommendations: focus on prevention
may be increasingly beneficial in
reducing the incidence of dementia.
Hong et al. 2013 - N = 15 South - Cross-sectional - Major: males diagnosed with a behavioral
- Humans Korea study addiction such as internet gaming
- Males with - Empirical disorder, had significantly reduced
addiction design orbitofrontal cortex thickness, and
- thought to play a fundamental role in
reward-related decision-making and
addiction disorders.
- Recommendations: findings suggest
common biological marker between
behavioral addictions and addictive
disorders.
Morena et al. 2015 - Human UK - Review - Major: chronic stress exposure is
- Animal associated with the loss of CB1 receptors.
- eCB signals play role in stress regulation
and response.
- Recommendations: research should
explore pharmacological and
neuroscientific techniques to further
investigate eCB signaling in the brain and
possible treatment options on the eCB
system in stress-related conditions.
He et al. 2017 - N = 50 Netherlands - Cross-sectional - Major: Excess social media users depicted
- University study decreased grey matter volume in bilateral
students - Quantitative amygdala and right ventral striatum
- Humans - Empirical - Recommendations: future research should
design investigate the morphological differences
- in GMV in the brain regions associated
with excessive social media use.
Falck et al. 2017 -N=8 Canada - Systematic - Major: prolonged sedentary time impairs
- Studies review glucose and lipid metabolism which
- Adults poses risk for early cognitive impairment
(40+) and dementia.
- Recommendations: limiting sedentary time
and increasing physical activity may be
International Journal of Mental Health and Addiction

Table 8 (continued)

Author and year Participants Country Research Findings

(human/ methods
animal)

beneficial for healthy cognitive

development in older adults.
Madigan et al. - N = 2441 Canada - 3 wave - Major: excessive screen time in children
2019 - Humans longitudinal was significantly associated with
- Mothers, cohort study decreased performance on developmental
infants, - Empirical tasks
and design - Recommendations: suggests screen time
children - Prospective management plan for families may be
- study beneficial.
Domenech-Abella - N = 5066 Ireland - Longitudinal - Major: association between social
et al. 2019 - Humans representative networking major depressive disorder
- Adults cohort study and generalized anxiety disorder was
(50+) - Interview bidirectional.
- Self-report - Recommendations: focus on objective and
- Prospective subjective factors effecting social
study isolation to improve adult mental health.

was related to decreased performance on developmental tasks (Madigan et al. 2019). A

number of cross-sectional studies showed that excessive screen time, dependent on the context,
can significantly alter neurophysiology (He et al. 2017). Adolescent males with behavioral
addictions, including internet gaming disorder, demonstrated diminished orbitofrontal cortex
thickness, while excessive social media users showed reduced grey matter volume (Hong et al.
2013; He et al. 2017). Additionally, sedentary time spent by adults, such as time spent on
electronic media, was associated with the risk of early cognitive decline and dementia, while
in-person social interactions may act as a protective factor against neurodegeneration
(Zunzuneegui et al. 2003; Falck et al. 2017).
Experimental studies investigating the animal models of human behavior are integral in
understanding individual mechanisms and properties of chronic stress on development. When
rats were exposed to excessive stress, impaired learning, memory, social behavior, and
alterations in sensitivity of the hypothalamic pituitary adrenal axis were observed (Alteba
et al. 2016). Mice exposed to excessive sensory stimulation from the lights and sounds of
television in particular portrayed significantly poorer short-term memory, learning, risk eval-
uation, and cognitive functioning (Christakis et al. 2012). Results suggest that chronic stress
from sensory overstimulation during critical periods of maturation can have lasting detrimental
effects on development (Christakis et al. 2018).
Findings consistently suggest the deleterious effects that excessive screen time may have
independently and in combination with mental illness, substance use, and chronic stress on
behavioral and cognitive development. Thus, we hypothesize that chronic sensory overstim-
ulation from excessive screen time, associated with increased mental health problems and
addictions, may lead to premature neurodegeneration and early-onset dementia in younger
generations. This hypothesis is based off of the vast array of findings suggesting the most
detrimental consequences from excessive screen time were observed in language acquisition,
learning, memory, and severity of psychopathological symptoms. In addition, research
displaying the adverse effects of screen time regardless of social isolation or cognitive
engagement suggests any use of electronic media, whether it be for educational, occupational,
 International Journal of Mental Health and Addiction

leisure, or entertainment purposes, can be detrimental on development without adequate

regulations or limitations (Christakis et al. 2018). Thus, considering the pervasiveness of
electronic media today, specifically in younger generations, particular attention should be paid
to the prolonged consequences excessive screen time may have on cognitive development and
neurodegeneration in later adulthood.
Several strengths and limitations of this study should be considered. First, although the
operational definition of screen time as described in this study is similar across studies,
numerous terms were found within the literature referring to the same general phenomenon
(e.g., problematic smartphone use (PSU), problematic mobile phone use (PMPU), problematic
social networking site use (PSNSU), cell phone addiction, digital media overuse, internet
addiction, excessive social media use, excessive smartphone use, excessive video game use,
etc…). Considering the degree of diverse terminology used in reference to excessive screen
time, it is probable that a portion of relevant sources was not identified through the designated
search terms and inclusion criteria. Second, the varied terms generally used to describe screen
time may obscure important differences between how electronic media is used, the context in
which it is used, and the content that is interacted with. For example, it is important to parse out
the common effects of all types of excessive screen time (e.g., chronic visual and auditory
overstimulation) from the specific effects of different types of screen time (e.g., depressed
mood from excessive social media use versus generalized anxiety from excessive video-
gaming). Third, a large portion of the data included was obtained through self-report surveys
or interviews, which may introduce biases. Lastly, the studies included in this qualitative
synthesis were restricted to those published in the English language which may not be
representative of a significant proportion of the estimated 5 billion people who use mobile
devices worldwide (GSMA 2018). The ability to use findings published in various languages,
from diverse places and populations, would serve to provide further insights on the current and
emerging uses of mobile technology, the associated effects of excessive screen time, and
differences across users who tend to be younger, more educated, and have higher incomes
(Silver 2019).
Despite these limitations, the studies included in this qualitative synthesis covered a broad
range of research methods including correlational, experimental, and descriptive methods
assessing many integral relationships such as the associations between screen time, chronic
stress, development, cognition, mental health, and substance use. The literature incorporated
involved both human and animal participants, and analyzed all ages, ranging from infants to
older adults. Additionally, the variety of countries encompassed in this review provides data
from diverse populations and subgroups, allowing the analysis of information across a number
of environmental and cultural contexts.

Conclusion

The majority of studies evaluated demonstrated a range of detrimental effects of excessive

screen time on neurodevelopment, learning, memory, mental health, and potential increased
risks of early neurodegeneration. However, experimental research exploring screen time is
limited and future research should include greater use of animal models of human behavior,
specifically to assess the effects of chronic sensory stimulation on the developing brain and
neurobiological differences between males and females. Research should also aim to assess
any lasting effects of early screen time exposure on middle and late adulthood.
International Journal of Mental Health and Addiction

Compliance with Ethical Standards

Conflict of interest The authors declare that they have no conflict of interest.

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