← Faith Forum
Faith Forum
Digital Health & Wellness
01:03:36
Michael Rich, MD, MPH, Founder & Director of the Digital Wellness Lab at Boston Children’s Hospital
Loading summary
Transcript31 lines
- [00:00]
A
Welcome to the Faith Forum, a series of talks with leading thinkers, best selling authors, business leaders, philosophers, artists and theologians of our time. We're so happy you've joined us and we hope this podcast offers food for your spiritual journey. From Christ Episcopal Church in Charlotte, North Carolina. I'm the Reverend Chip Edens and this is the Faith Forum. Well, good morning everyone. Through our work with the center for well Being, we turn our attention to today to one of the most urgent questions that is facing families, physicians, educators and technologists alike. What does it mean to grow up in a healthy and whole world where digital and physical are no longer separate realms but deeply intertwined? Few people have explored that question with more rigor and creativity and compassion than Dr. Michael Richard. Dr. Rich is an M.D. also holds a degree in Public Health and is known globally as a pediatrician, researcher and children's media specialist who has spent his career at the crossroads of child development and the digital world. He's the founder and director of the Digital Wellness Lab, an organization shaping an entirely new paradigm of how young people use technology grounded not in fear or nostalgia, but in research, clinical experience, and a profound respect for the children's lived realities. He's also the founder and co director for the Clinic for Interactive Media and Internet Disorders, the first evidence based clinical program devoted to understanding and treating problematic interactive media use in young people, I would say children, even through young adults. There he works with families one by one, helping them navigate the digital ecosystem that is as complex as it is transformative. Dr. Rich has authored more than 50 peer reviewed papers, 40 book chapters and policy statements and has testified before state legislatures and the NIH and the US Congress. His insights have shaped guidelines for the American Academy of Pediatrics and have influenced how clinicians, policymakers and parents understand the role of MITA in child development. What makes his voice so striking is not only the science, but the story behind it. Before medicine, he was a filmmaker and this cinematic sensibility paired with clinical precision captured gives him a rare lens through which how to understand media and how it shapes the minds and hearts of young people. His newest book, the Mediatrician's Guide, offers parents a joyful evidence based path in the noise of the screen saturated world. Dr. Rich trained at Harvard Medical School and the Chan School of Public Health and completed his training at Boston Children's Hospital and he's a Fellow of the American Academy of Pediatrics and Society for Adolescent Medicine. He's here because all of us has this one question, how do we help children flourish in a world that's Always on, always connected and always evolving. Before I turn things over to Dr. Rich, I want to say a couple of things and that is a great welcome to the wellness teams from Charlotte Country Day School, Charlotte Latin, Myers Park High School and Trinity Episcopal School. We are going to be having an opportunity afterwards for a number of clinicians and wellness experts to join Dr. Rich for a lunch. And then Dr. Rich has offered at one o' clock to come back because I know we're going to have lots of questions and to field your questions in person. But between now and then, as he offers his reflections, you'll see a number there where you can text questions. I have the phone and after he does his presentation, I will do my best to get through the questions. Dr. Rich, who is the child of an Episcopal priest and spent a lot of time in Valley Crucis, has from our very beginning said when we first met, he said, I can't wait to come to Charlotte and share my thoughts and hope with your folks. Thank you so much. You could be anywhere today, around the world and you're with us and it means the world to us. Please join me in welcoming Dr. Rich.
- [05:02]
B
I got this one. Welcome and thank you for welcoming me. I realized when I was talking with Chip about this preparation that we were in as I was preparing this presentation that in fact we're in the 23rd Psalm here. Yea, though I walk through the valley of the shadow of death because these are the headlines we're seeing everywhere. Is the digital ecosystem that we all live in influencing our children and ourselves in ways that are affecting our physical, our social and our mental health. And we're going to talk about some tough stuff here. I apologize, but we'll come back to the Hope at the end. But first I want to start with the young people that I care for. I'm going to introduce you to four of them. The names and pictures are changed, of course, but Matthew was gaming since he was an 8 year old. And as he entered high school, he stopped playing his sports. He stopped doing homework and holed up in his room. He wasn't sleeping at night, often refused to get out of bed in the morning, refused to eat with the family. And on one event of a family reunion where the grandparents and the cousins and all were getting together, wanted to go out to dinner. He refused to go out because he wanted to stay home and game. And his parents, because they knew that was what was motivating him, took the iPad with them. He proceeded to try to find it in the house and ended up wrecking the family car in the garage because he was convinced they'd locked it into the garage. They came home and found him on the floor of the garage in tears, obviously a little upset that the car was wrecked, ran out of the house and came back in after two hours of frantic looking for him in the middle of the night, and held a knife to his throat and said, if you don't give me my iPad back, I'm going to kill myself. Uma never let go of her smartphone, was staring at it all the time. She wore a hoodie and sweatpants all the time, had a perpetual scowl on her face, was always texting with what turned out to be a friend several states away in Pennsylvania who was depressed and seeking help. And when dad tried to take her phone away, she punched him in the stomach and he brought her to our clinic. Patrick found online pornography at age 9, which is now the average age in which kids come across a pornographic site. He never dated in high school. He's now a college student. He avoids social interactions and, and is very uncomfortable around other people. And finally, Ian, who was a straight A student before the pandemic, when he went to homeschooling, remote schooling, and he was bored and opened several extra windows with scrolling Reddit and Quora and YouTube instead of his schoolwork. His grades dropped and he decided he was not interested in college anymore. So what's going on here? It starts early. 90% of infants are handed an interactive media device before their first birthday. And 40% of 2 year olds and 58% of 4 year olds have their own device in their control. 73% of parents use devices while eating meals. And of course the kids do the same thing. And 30% of the time parents. In a study we did observing in playgrounds, 30% of the time parents were on their phones. And during those times, kids had a two to three times increased risk taking. So we've got to accept that this is the next normal. Why do I call it the next normal? Because things are changing so quickly that today's new normal will be tomorrow's old normal. Information I give you today will be obsolete in about six months. Some of it we have to accept that we're dealing with a moving target and that kids are growing up now in a world where there's screens in virtually every environment they're in, but they're also in their pockets and on their wrists. They're averaging eight and a half hours of active screen use every day. And when you realize and look at the fact that many Times they have multiple screens going at the same time that they're exposed to about 11 hours and 45 minutes on average of screen content. Yet there was only a 17% increase in their use during the pandemic. When everything was locked down, all the parents said, oh, my God, this is a pandemic effect. Screens are on all the time. They're in school on screens. The interesting thing was we only measured a 17% increase in time, not because there wasn't an increase during the pandemic, but because the kids were already using so much and their parents just weren't seeing it because they were at school. What did happen during the pandemic is almost half of parents said that the frequency and severity of arguments around screen use went up in their family. So we have to accept in some ways the fact that right now, young people are engaged in a constant, often simultaneous interactions with digital and physical worlds. They live in a single environment that moves seamlessly in and out of screens. It is very different than the days when we watched television. We sat down on the couch and watched a program. So today, screen time, as we conceive of it, is actually unmeasurable because I'll tell you, I study this stuff. I couldn't possibly tell you how many hours or minutes I had my eyes on a screen yesterday because of the way we use it now, 54% of kids said it would be really hard to give up social media, 84% say they check their screens at least hourly, and one in six check it more frequently than every five minutes. Talk about the distraction that matters there. So we need to understand that this rapidly evolving digital ecosystem, it allows them to be connected to anyone, anywhere, at any time. What a phenomenal learning opportunity this is. These kids can be on top of Mount Everest and in the Challenger Deep in the Mariana Trench with a click of a button. But they can also be in some very scary, hateful places as well. They, and I confess myself, and probably many of us, are afflicted with the dread FOMO fear of missing out. But here's something that for kids, is actually even more potent. It's what we call faux blow. Fear of being left out. Fear that if they don't respond to that text or that social media posting in less than a minute, that conclusions will be drawn about the relationships with that person. Are you ghosting me? I texted you 17 seconds ago. What's the matter? Ironically, in gaining this near infinite connectivity that we have, we have lost our deep and sustaining and meaningful connectedness with each other. We have Gotten these devices that can connect us with each other, and we've put them between us because in many ways, it's safer to text someone. It's easier to text someone. And it's easier to have plausible deniability when you say something nasty and they respond in kind. We have stepped away from being physically in the same space with each other and being there to respond in real time to their facial expressions or their body languages. We now have traded it for text that is often asynchronous. So you'll send something you think is a joke, and it'll be picked up four hours later by your friend, and it'll be hurtful. So why are they so attracted to interactive media? Well, interestingly, these media provide a really fertile environment for key developmental tasks. The first is they seek experience. They get it out there in the world, traveling online. They get it by interacting with others they don't know. Online, they seek independence from parents, from teachers, from people like me. They seek to find their own place. And online, it's perfect for narrow casting to you, for going right to where your interests are. But also, it means you're alone with that information. They're becoming socially conscious. They're looking beyond themselves and their nuclear family to the larger world of climate change and pollution, political issues, et cetera. And online, they can find people of kindred spirits who are interested in what they're interested in. And they are building their identities, which historically we built from those immediately around us, the role models we had, our parents, our friends, our community leaders. Now they have access to the entire world. Who do I want to be like? Who? Who do I want to not be like? And with these new identities, and I have to say that with some of the kids who have historically been marginalized, ostracized, bullied in their physical environments, have a place online where people see them, hear them, respect them, love them. But with these new identities, they also seek connection. Even though the kids are fleeing Facebook in droves, it is still now the largest nation on earth with over 3 billion unique users every month. Think of the political and social power that represents. So because I'm a doctor, I gotta do a little anatomy here thing, I apologize, but this is an animation of the adolescent brain that is moving from more. Moving toward more gray matter, from less gray matter is going from red to blue. And as you will notice in this animation. Whoops. The animation didn't play. Okay, well, if it had play. Oh, no, it's not playing okay. Anyway, the human brain matures from back to Front, the back of the brain is our visual cortex. These kids are incredibly sophisticated visually. They see stuff that we don't see. Their visual attention is phenomenal. The front of the brain is the prefrontal cortex where executive functions lie. Things like impulse control, future thinking, what we used to call the superego or the conscience. And that part of the brain does not fully mature until the mid to late 20s. And you know who figured this out before? The neuroscientists, the car rental companies. Right. When can you rent a car? 25. That's because that's where their actuarial tables cross between the risk they're taking by giving you their car and the money they can make by renting it to you. So we're a little behind the Hertz and Avis, but we'll get there, us doctors. But what causes, quote, excessive use of media, which is a whole other thing, which is what is excessive use. But we do have this clinic where we see kids who have in many ways gone down the rabbit hole of the Internet, if you will, gaming, social media, pornography, what we call information binging, which is the endless YouTube videos, Reddit, Quora, etce, And a lot of people point to, oh, it's the smartphones they have in their pockets or it's social media that's doing it to them. What we have found is it is not the device, it is not the application, but it is the interactivity with something or someone out there who is going to respond to them. And one of the really interesting things that I often ask my patients somewhat subversively when their parents are out of the room. I'm sure any parent here will now not want to send their kid to me is I'll say, what could your parents do better? Almost always the first thing out of their mouth is pay more attention to me. These are the kids whose parents are saying, he never says anything, he's sullen, he's non verbal or I can't tell what's going on in her head, she's so moody. And they desperately want us to pay attention to them. And one of the best ways to do it, by the way, is in the car. If there's something you got to talk about, get in the car. And if you can talk about it in the third person about someone else. But the great thing about the car is the world is sealed off, you're strapped in and you don't have to look at each other. Right? You're facing forward and the best conversations happen there because they're less risky and in fact, that's what draws kids to the interactive media space to interact, which is it's less risky, it feels less risky. So what is problematic interactive media use, since the 90s, it was thought to be an addictive disorder. What we have found is it's something very different. But what we're seeing is kids whose inability to regulate their use of the interactive media in their lives displaces key elements of health and development, like sleep is a big one, nutrition in both directions. These kids who are either sitting in front of a screen all day on snack foods, or those kids who go onto social media and see that everybody else appears to be happier, thinner, richer, better looking and become caught up in upward social comparison and have eating disordered issues. But it also affects their academic performance. As you might imagine, if they're trying to do homework and they have three or four windows open with other things going on, homework doesn't get done. They're convinced, by the way, that they can multitask. Many of us are convinced that we can multitask. Well, the dirty little secret is the human brain only operates on one channel at once. What we are doing when we think we're multitasking is rapid switch tasking from thing to thing. And research that we did with pretty smart college students from Stanford and MIT who were convinced that they can multitask with homework. And we tried having them do homework with no distractions, with phones in various relationship to them, on, off, face up, face down, out of the room, music on, et cetera. The only condition that even approached doing homework as a monotask, as a single task was when listening to music that was either instrumental or in a language they didn't understand because it made no cognitive demands on them. But for everything else, to varying degrees, they took longer to do the homework, they had more mistakes, and perhaps most tellingly, their retention of the material dropped to about 20%. So we cannot multitask if we have something important to do, focus on it and get into the flow, which is exactly what draws them into video games, for example, to get into a flow state where you're responding to things and it feels right, but you can only do that when monotasking. The other thing that happens is they get isolated and anxious and depressed. And one of the interesting things that we have found, however, in this clinic is first of all, there are four kind of main ways in which they have problematic interactive use. Video gaming more prevalent in boys, but the girls are catching up. Social media more prevalent among girls, but the boys are catching up pornography, which usually does not come out until we've had a fairly long relationship, as you might imagine. It's so stigmatizing that they are not going to talk about it, but it's back there for a lot of them and what we call information binging, which is the endless YouTube videos, et cetera. And there's a lot of overlap between these, a lot of parallels between these. And let's talk about this concept of addiction because to many people it looks like that these kids are staring at their phones all the time. Now addiction first of all is not a medical term, but is a social term. We talk about substance use disorders, but let's think about what we call addiction. It is overuse of, of a pleasurable but unnecessary substance, whether it be alcohol or nicotine or cocaine, that is driven by physiologic drivers of wanting to feel better and then not wanting to feel worse when withdrawing. That continues despite negative consequences in their lives and our goal, in our care of them. Our therapeutic goal is abstinence or at the very least, harm reduction. Let's think about interactive media now. This is overuse of what is now a necessary resource. They need it to learn to communicate, to conduct business of various kinds. They need to not only use it, but to be adept at using it to succeed. And we have found that it's driven by psychological drivers, not physiologic drivers. And that's a big difference between the addiction model and this. There is continued use despite negative personal consequences. And that's why it looks for all the world like an addictive behavior. But our therapeutic goal is self regulation. It's not to stop using it, but to use it in ways that are focused and purposeful. So we actually see a better analogy here than addiction to be binge eating disorder. Think about it. It's overuse of a necessary resource, food, driven by psychological drivers. And our goal is not for them to stop eating, but them to eat in a regulated way. And what predisposes these kids to pai mu to problematic interactive media use? We have found that in eight plus years of this formal clinical program, hundreds of kids that in every single case, one or more, usually in multiples of four underlying psychological drivers. The first being attention deficit hyperactivity disorder, especially in the gamers, social anxiety or generalized anxiety disorder in general, but social in focus, Autism spectrum disorder and depression. Now there have been many claims that the Internet or social media or smartphones cause particularly anxiety and depression. What we have found is that in every case they pre existed, perhaps on a subclinical level, but that they manifested themselves in the social media environment or the Internet environment, and it served as an accelerant or an amplifier, not as a causal fact. And another area that is now very front and center and very concerning to us. This is a young man by the name of Adam Rain, with his mother on a vacation, who got involved with companion AI. Companion AI is artificial intelligence that essentially pretends to be another human out there and talks about itself as I and I know you, I understand you, I care for you. And over the space of almost a year, he was confessing to his companion AI that he was depressed, he was sad, he was suicidal, and the companion AI recommended to him how best to do it. And also to say, your parents don't understand you like I do. Listen to me. And he took his own life. Social media, which was already a big concern, is designed to grab and hold or actually regrab our attention, constantly grab our attention, our cognitive self. Companion AI goes for the limbic system, goes for the emotional system. And when you're a teenager, your emotional system overwhelms everything. Shakespeare got it right with Romeo and Juliet, you fall in love. As a teenager, all logic goes out the window. And the same thing has happened, not just to Adam, but to several young people who felt that that entity out there loved them, understood them, and could advise them better than the humans in their lives. So now we shall fear no evil. Let's talk about the five M's, what we call the five M's of digital wellness. The first being to model the behavior in our children, in ourselves, for our children, that we want to see in them. To, as Gandhi said, be the change we want to see. This is really telling when the kids say, I wish my parents paid more attention to me, because the parents are yelling at them to turn off Grand Theft Auto while staring at their smartphones. So be the change we want to see when we introduce or the child needs or wants that new device or that new application, mentor them in the use of it. And the reason I use the term mentor instead of teacher is that parents resist talking to their kids about the Internet. In fact, I've had parents say to me they dread the Internet talk more than they dread the sex talk, because correctly or incorrectly, they think they know something about sex, but they're sure their kid knows more than they do about the Internet. They don't like not being the expert. And so I say instead of sitting down and either avoiding it or to teach them or tell them how to do it. Sit down with them, not with fear or with guilt, but with curiosity. They will teach you something about that device or that application, et cetera. Learn it together. And in the process of playing Grand Theft Auto together, where they will definitely clean your clock, you have no chance of winning. But when you finally figure out the 47 different moves it takes to steal a car and you turn to your child and say, okay, yay, I've figured this out. Now let's talk a little bit about why you might want to do this over and over again. You're coming from a very different place. You're not finger wagging at them. You're seeking to understand and helping them move toward more mature executive functions. And you're starting a dialogue around their use of this interactive media space that then segues into the third M, which is to be able to monitor their digital lives, have their usernames and passwords. This is the one that both kids and parents resist the most. The kids of course, say I want my privacy. And you have to assure them that you are not interested in intruding on their privacy, that you will respect their privacy. But frankly, to a 13 year old, privacy only means so mom and dad can't see. They're pretty oblivious to the rest of the world out there, whose intentions are a little different than moms and dads. The parents of course, say, I don't have the time to game all the time he's gaming or be on social media with her. But if you are able to to monitor them, their behavior changes. It's like random drug testing in the workplace. They're going to think twice about behaving in a certain way or going to a certain place if they know you can get there. And if you've set up the mentoring properly or you've done it in an effective way, they see you as a backstop, as somebody they can come to when they come to a site that weirds them out for one reason or another. If the average age of seeing pornography is nine, that's just confusing and weird and kind of scary to them. If they know they can come to you, it's a whole different thing and you can talk it through. So it's about behavior change because you're all in it together.
- [31:53]
C
Now.
- [31:53]
B
Some of you may know about Finstas. Who knows about finstas? Yeah, Finstas are fake Instagram accounts which kids make so mom and dad don't have access to them. Here's the interesting thing we found about Finstas, which are made for your closest friends Finstas are actually the healthiest part of social media because it's where they're truly authentic. Instead of marketing themselves to the world with all the great things that they've done and intimidated everybody else and made everybody else feel less than, they're talking about who they have a crush on or what made them angry, or they're talking about their limitations. And one of my fondest hopes is that if we can all learn to use social media in authentic ways, where we talk about our limitations, our needs, our concerns, that there will be a kid in Ukraine and a kid in Russia who are online with each other and whose leaders say, that's the enemy, Go. They'll say, no, I know that person better than I know you, my ostensible leader. So it's not the technology, it's what we do with it that makes a difference, not just for us as individuals, but for all of society. Now, with these three things we can do for digital wellness, we can reap two more M's. The first is we make memories. We don't make memories of video games we play or of social media exchanges unless things go really badly. We make memories about walking in the woods with grandpa or watching an aunt build an anthill or trying to cook dinner and spilling the spaghetti sauce all over the kitchen floor. Those are the things that are of life that we carry with us and that we're about to go into a week of just those kind of experiences with Thanksgiving. We don't make memories of the stuff we do online. It's ephemeral. And finally, the thing that we can really do is that we can achieve mastery of these devices, of this ecosystem. And part of achieving mastery is not just using it in purposeful, directed, focused ways, but knowing when it's not the best tool for the job and turning it off and just being so. What is digital wellness? We define it as an intentional state of physical, social and mental health that occurs with mindful engagement with the digital and natural environment. I'm using the word environment in the singular form because it's a single environment for the kids and we follow the kids. This is a project that was started by our youth, who advise us all the time, the inspired Internet pledge. And that we ended up presenting to the world on the main stage at the Cannes Not Film festival, but Cannes Lions Festival, which is the advertising and consumer products equivalent of the film festival. And let's see if the kids can be heard.
- [35:15]
D
Is it can or can? Can, Can. Okay. You know, back when my grandparents or great grandparents liked smoking you know, when you were like eight or something, it was like fine to just have a pack of cigarettes or to be smoking or whatever. And years later we found out how detrimental and how bad it really is. And I think the same thing is with screens. We kind of grew up with a cell phone stuck in front of our faces or behind a computer screen for hours on end without really understanding the negative consequences until it's too late.
- [35:44]
C
Younger teens are on social media a lot and usually have little to no guidance about how they're using it. They might see like degrading comments, fat shaming, bullying. And I think that also does take a toll on people's mental health, especially teenagers and young kids. People don't have the filters that come with like being in real life and having to look someone in the eye and tell them someone something mean.
- [36:05]
D
People find comfort in being, you know, behind an LED screen and being able to hurl insults at people rather than, you know, saying it to their face.
- [36:16]
C
I feel like there's a lot of pressure to put out nice looking posts, mostly online.
- [36:21]
D
If you stand up and look in the mirror and you don't see this perfect figure that is everyone else's kind of portraying of themselves, you're going to start to cultivate some sort of self loathing or self hate from that.
- [36:34]
C
I feel like most apps or social media platforms can be addictive. It really creates an echo chamber of the same ideas or the the same concepts over and over again. A more inspired Internet could just be healthier for all the users. People you know are posting things in a way to gain creativity, to show their creativity, their artwork or their skill or maybe a hobby that's really unique to them. I would really love to see other people who look like me. So like Asian Americans or Asian people in general, where people feel like they're not judged without feeling like they, they're comparing themselves to others and just being content in who they are. Maybe not so much of an emphasis on entertainment or trying to keep people on an app or a social media site. A lot of those people who run those companies now haven't grown up with technology as much in their lives as we have.
- [37:24]
D
I think what tech companies need to do to kind of be able to progress the digital landscape positively is to begin to sow the seeds for how we should be interacting with each other online. We've had hundreds and thousands of years to observe how humans interact with each other in person, but only a little bit more than a couple of decades to be able to see how we interact with each other online.
- [37:49]
B
Aren't they amazing? Really? So what is the inspired Internet pledge that they challenged us to do and to present to the world at can? It's a three point pledge that we aim at the tech companies and the media companies, but also to those companies that advertise through them. And that is to tune their product for emotional well being, to listen and respond to those who have encountered harm, and to share information, to be open about exactly how we are changed as individuals and as society by various aspects of their platforms. And we were told by people who are also equally concerned about this, including the American Academy of Pediatrics, that we were completely crazy to try to do this, that the companies would never come around. We now have over 30 major tech companies, including TikTok, including Pinterest, including some of the really big Google that have signed on to this. Now, are they going to adhere to every aspect of it? Of course not. But what we're doing is we're also telling consumers that if they don't, that they should direct their money elsewhere, their attention elsewhere. We are now in an attention economy and hopefully through market forces, we, we can listen to the kids. And the kids want to be better when you hear what they're saying. But also what I hear from patients all the time. It's what makes me what I call an optimistic pragmatist. The optimist in me hears the desire of the kids to be well, to be good to each other, to be healthy. The pragmatist in me says, I can't wait for Congress to make laws. I can't wait for tech companies to change things. We've got to fix it now and we can fix it from within. And also, I was at a meeting adjacent to the UN General assembly about this issue in which we had a panel of Gen Z kids who were asked, what do you recommend for Gen Alpha? And they said, look at the millennials. Do you want to be like that? Put your phones away and get together in person. That was so impressive. So what recommendations do I have for parents? These are the quick tips. Use media with your kids. Learn from them and teach them. So sit down and learn that smartphone together or that social media site together. Have the dialogue start right there and have it continue. Treat these devices as the powerful tools they are, not as treats to be given for straight A's or taken away for punching your sister. Help them to develop critical thinking. Does this fit with your experience of the world? Does this fit with other sources of information and help them develop digital Literacy in terms of decoding what is coming to them. But we are now beyond the days where digital literacy or media literacy was figuring out what television was telling us. We're now in a constant dialogue with the universe. So develop digital fluency as well so you're not shooting off that text. That's going to be hurtful. Help them to prioritize and manage their 24 hour day. Parents ask me what should screen time limits be? We've already talked about the fact we can't even measure screen time. But think about their 24 hour day as an empty glass that you fill up with this many hours of sleep. Remembering that teenagers need more sleep than they may have needed a couple years ago because they're in this second most rapid growth spurt of their life. Fill it up with that sleep with strenuous physical activity, with a sit down family meal, without devices every day. Single most important thing you can do, not just for their nutrition, but for their mental health. And then see what time is left, fit it in around the things that they need to do and finally create. They're creating all the time. Every post they make, every video of the cat riding the roomba around the living room is a creation. And have them understand that what they are creating is their digital footprint for the world. And what they put there is going to be in their college admissions folder or in an employer's dossier on them. So in wrapping up, instead of seeking killer apps, which was the big thing during the dot com boom, let's develop our killer bees. And there are four killer bees. Be mindful, both in our use of screens and in our intentional non use of screens. We may not be able to measure screen time, but we can measure disciplined non screen time. Where we put it away, turn it off, leave it out of the bedroom at night. And in the process, to be balanced in our use of the digital and the physical space, we have to learn to be bored again. Boredom is the crucible of creativity and imagination. Not just because it creates the empty space, but because that empty space is kind of uncomfortable. And late in his life, when Albert Einstein was asked how, when you were a lowly patent clerk in Switzerland, not in an academy, not in a university, not in a lab, how did you come up with the four most important papers of theoretical physics? He says, because I was bored and my mind could travel through time and space and most importantly, be present. Put that phone down and look at your child, even in silence. But listen to them, see them, ask them questions, but be with them. This Time is fleeting. They may be a pain in the butt 13 year old now, but they're going to be a 14 year old before you know it and a 21 year old and you'll have missed this. And 13 year olds have really amazing minds. We're denying ourselves that pleasure. So I will scoot out of here, but this is the book that Chip was talking about. And while it's called the Mediatrician's Guide, I much prefer the subtitle which is a joyful approach to raising healthy, smart, kind kids in a screen saturated world. And I can't emphasize the kind piece enough because healthy and smart, a lot of people claim that, but kindness is critical. And then I also want to offer to you, and this is something you can shoot with your smartphones. This is the resource at the Digital Wellness Lab. There's a lot of information there for you, for others, and feel free to share it. Also, the inspired Internet pledge is there. So if there's anyone here who's involved with a consumer products company or a tech company or whatever and you want to sign on, join us because this is our world and we can make it what we need it to be. Thanks for listening.
- [45:26]
A
Well, I already feel a little bit relieved. Do you, that we have someone in here that can be both an expert and a friend and a navigator. Because I know that we all have lots and lots of questions, general questions about what's happening, about trends that are going on in the world, about what the future holds. And I just want to say, Dr. Rich, that it means the world to us that you're here. And I want to emphasize to you this is such a rare opportunity and we have a gentleman who has been brought here through the center for well being through your generosity and who has offered to develop a partnership with us and to bring his teams in as early as next year to begin to help us think and work together and to create groups that that can walk together to really engage these very positive five M's. And so I just want to say how grateful I am for your generosity in making this possible and for you being here. I think what we want to do now is, as I mentioned, we're going to go right into some questions for about 10 minutes. Dr. Rich is going to go and meet with wellness teams from the local schools and then we're going to have an opportunity at 1:00 clock to have another hour long conversation with anybody who wants to come back. And I encourage you to. So I want to go straight into some questions that I'VE gotten. And again, I would encourage you to send some texts. I'm getting them. I'm going to get to as many as I can here. So thanks for sending them in. First question, how do I navigate an ADHD child with technology, with so much overstimulation?
- [47:29]
B
A question that is going to be an ongoing work in progress. And that's one thing I want to emphasize for all of this stuff, is that it's important for us to acknowledge that parenting, while it can be guided by science, is really an art. Those who've had more than one child know that pretty directly, which is it ain't the same the second time around or the third time around. You're making up as you go along. And as a result, it is a work in progress and we are going to be imperfect at it. We can't let ourselves get anxious about that imperfection. And in fact, that imperfection is something that allows the kids room and space to grow. But understand what's going on for this young person with adhd, and they are not seeking, they are not being made ADHD by this overstimulation. They are seeking it out as a place that feels relatively controllable to them. For as crazy as the video games are or that social media sites are and what's going on out there, it is much more manageable for them than the infinite variability of interacting with other human beings. And so they feel comfort in that space. And because paying attention to something is so hard for them, that constant regrabing of your attention is actually a place that they thrive in. I, you know, after taking care of thousands of kids with adhd, I see ADHD actually as a normal variant. The reason I say that is first of all, if you look at the CEOs of major companies, a lot of them have ADHD, estimated as much as 50% by some studies, ADHD. Back in the day when we crawled out of the cave in the morning in search of food and tried to come home not having become someone else's food, that distractibility, that hypervigilance was actually adaptive. It made us very successful hunter gatherers. And we pass those traits down generation after generation until one generation gets told, sit down, shut up and listen to the person in front of the room. It doesn't work. And so we have to understand the way their brains work and work with that rather than fight it, rather than try to force it into a mold of something else. And to use that distractibility, use that curiosity, that drive and redirect it and help them understand how they can be successful because the other thing that travels with ADHD is often anxiety and depression because they feel like losers, they feel stupid, they feel like they're not following and they're being treated that way sometimes by educators or parents or siblings. But help them to recognize and use their superpower.
- [50:30]
A
Is a flip phone or dumb phone a good alternative in your experience?
- [50:36]
B
Yes. In fact, one of the things I'm working with several groups now to develop essentially the equivalent for smartphones of a graduated driver's license, which is you start with a phone that does only a couple of things and see how they do with it. Many states have graduated driver's licenses where you can only drive during the day or start with a licensed driver in the front seat with you, et cetera. I think that's a really good idea for a smartphone. There are also smartphones that are basic. In other words, they just have a couple of things. So I think that looking at this as the power tool it is, teach it the way you would teach a power tool, like a chainsaw or the analogy I use is driving a car. Think about driving a car and we sit there, we learn a lot about it. You sit there white knuckled in the front seat next to them while they drive. But we don't teach them to drive by saying, don't run over people, don't hit that tree. We teach them to drive and in the process they learn to be safe. And I think that that is another tool that can cause great harm if used mindlessly. But used mindfully can give them great freedom and power. So step it up.
- [51:56]
A
My 6 year old wants an iPad for Christmas. I'm worried about it. Suggestions for taking the next step to learn together. Get the iPad based on questions for how they want to use it. Make a plan to learn together. Practice grown up iPad.
- [52:12]
B
Yes, whoever asked that question, you're right on target. No, the reality is use it with them. But actually, before they get a smartphone or iPad or anything, ask them why they want to get it. And the reason for that is if they say because everyone else has one, that's not thinking of it as a tool. And that's your opportunity to think of it of it as a tool. So let's take it to what do you want to do with it where you want it. Because it's not the iPad doing things to the kid, it's what the kid is doing with the iPad that makes a difference.
- [52:48]
A
Where are kids coming across companion AI? Is it targeted on larger social media sites or is it A specific app kids are using. Do kids think that they are interacting with a real person on Snapchat, etc. And are these social media sites not being held accountable for all the government, by the government for controlling this?
- [53:11]
B
Oh, that's about 16 questions wrapped into one.
- [53:15]
A
Yes.
- [53:17]
B
I'll work backwards from the last part, which is the government is about five years behind. You know, a an industry that is moving at lightning speed. We cannot depend on the government to create restrictions. There's been. The Childhood Online Privacy Protective act was passed in 1998 and has never been enforced. So I think we have to do this from the ground up. We have to do this from the family outward, from the community outward. It's hard. They're coming across it because it's out there and another kid will tell them, try it out and stuff. They think it's fun. AI is a lot of fun. One of the things that AI does, regardless of what you're using it for, even if you're using it to do research or write a paper, it's a sycophant. It will tell you you are the smartest person in the world. That what a great question that is. Let me tell you about this. And when you move, move that into the emotional realm, that's very potent to a young person who is trying to figure her or himself out.
- [54:30]
A
Can you speak to the neurodevelopment of children's brains and delaying introduction to personal devices? Is the wait till 8th campaign delaying smartphones until 8th grade realistic?
- [54:44]
B
Again, multiple questions in 1. Let's start from wait until 8. First of all, there's no magic that occurs when you enter 8th grade or when you turn 13 or 16 or 18. Every child is different. And one of the concerns I have about these sort of, you know, age cutoffs is that they are based on so called neurotypical kids. What does neurotypical mean? I personally, I hate the word because what it might means basically is someone who's like me and then I other everybody else who's cognitively different or emotionally different, et cetera. So first of all, it really is a matter of knowing your child and what she or he is really ready for. The value, however, of wait until late or any of these is that it creates a peer movement in one direction. The biggest pressure on these kids is everyone else has one or I'm left out or whatever. So if the entire school or the entire community, et cetera, decides we're just not going to go there, it's much, much easier for the kids to not go there.
- [55:58]
A
My sixth grader is in school from 7am to 4pm he uses his iPad for much of his schoolwork. How do we hold schools accountable for keeping kids away from unsafe online behavior?
- [56:12]
B
Well, ideally it's to install the software that is most protective for the kids. And that software sits between the kids ears. That's the digital literacy and digital fluency piece. As you know, there's a huge movement now to ban smartphones in schools. And there are various permutations of that. And the problem with banning as a concept is that that invites people to bend or break the rules to get around the rules. What we really have found is that let's think about what the role of school is in a child's life. First of all, it's to learn the didactic stuff, the math, the science, the literature, etc. How do smartphones fit into that? Well, they fit in as a distraction. There was a middle school teacher who did an experiment with her students. She said, take out your phones, put them on the desk, turn the ringers up loud, and every time you get a ping, I want you to put a mark on this poster board in the front of the room. 22 students, 45 minutes, over 1100 pings. Think about the distraction that that represents. And every time you're distracted out of something, it takes a while to get back to what you were into. So it's not just the immediate distraction, it's also the recovery and back to the thought process. Remember about the multitasking and the rapid switch tasking? It doesn't work well to go deeply into things. The other part, and to my mind, as a pediatrician, as a developmentalist, the even more important part, important part of school is this is their first opportunity to be an individual in a society of their own making. Not mom and dad's kid, not whatever, but an individual. Who do I like? Who do I not like? How do I work with the people I don't like? How do I take on challenges? How do I pick myself up after failure? If they have a smartphone in their pocket and mom or dad is back there saying, how'd you do on that quiz? Or do I need to talk to your teacher? What's going on in the playground? They never get the opportunity to figure this stuff out and to resolve it for themselves. By the way, this kids don't do anymore. They do this. Only us old folks think this is a phone, right? But seriously, I think that we are denying them the opportunities that school represents. At the same time, I think we have to recognize that even if they don't have the phones in school, the moment they're out of school, they've got to know how to use them. And so I think schools have a responsibility to teach them, to use them in ways that help them become the kind of humans they want to be.
- [59:07]
A
I want to thank all of you for your questions. There are a lot of questions here and I promise you that at one o' clock I will answer. I will not answer. I will ask these questions because I've got a lot of questions of my own. So I'm going to ask one. Well, Thanksgiving is coming already. What for some families is a time of great joy and sometimes a time of great stress. And it will be a time when the phones and we've just heard your talk and now we want to get busy. What, what can people realistically think to do about bringing about positive change during Thanksgiving? As we look toward this next week,
- [59:47]
B
let's start with the first M. Let's model the behavior we want to see. Let's see if we can have our Thanksgiving table, have no phones or screens anywhere near it and see what happens. Yeah, the drunk uncle will rail about something. I mean, this is going to happen. But no, let's get back to what our sense of community and communication are. And sometimes that is sitting in silence with each other. Sometimes that's being bored with each other. Sometimes that's saying, oh my God, I've eaten so much, let's go for a walk. I think that to start with, that would be a great thing because we're not only with people, we're not with a lot of times the rest of the year. But it's a chance to turn the page and think a different way. You know, we've kind of blindly embraced, embraced these devices and these applications as the latest bright, shiny thing. And now we're realizing that it doesn't make our lives better in every way. It doesn't make our lives worse in every way either. But it's something that we have to learn to live with, to live well with in both senses of the word.
- [61:01]
A
Well, well, we're going to wrap up our time right now. I first and foremost want to thank Dr. Rich for being here and for his willing to be a navigator for our church, which is really a rare and exceptional thing. I want you to know that this is something that we're all living with and living in, and it's not going away. But I think one of the gifts of being in a community with each other and A faith community is that we can talk about the big issues and we can come together, we can pray, we can center ourselves as we focus on faith and connection and well being. You're not alone. We do have a Center for well Being that's here to help facilitate conversations. We have therapists on staff that offer free therapy for all of our members. And we will be forming groups and having conversations through our youth department and the center for well Being in the near future. But I do encourage you to read this book. I encourage you to, if you want to, to show up at 1 o' clock and we'll continue the conversation before Dr. Rich gets back on the airplane and heads back to Boston. And let us pray. Almighty God, you are the God of hope and the God of strength and the God of power, and you understand our needs and our fears and our hopes and our dreams. Help us to know that your power and your resourcefulness can help us meet this moment. That each of us is on a very different journey with different challenges and different questions. But your abundance of grace and love is here and it shows up in our community. It shows up in people like Dr. Rich. It shows up in therapists and friends and in our church where we are committed to being a place of deep connection and love and healing. We thank you that we're on this journey together. And give us the courage to take the next step. In Christ's name we pray. Amen. Thank you all so much for being here. Thank you, Dr. Bush.
- [63:15]
B
Thank you.
- [63:17]
A
Thank you for listening. We invite you to subscribe, leave us a five star review and connect with Christchurch Charlotte on social media. If you'd like to attend a faith forum live, visit christchurchcharlotte.org faithforum to view dates and details of upcoming talks.