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A
Kathy, hey, let me ask you a question. I want to ask you about your digital devices, the smartphone you probably have in your pocket or on your desk. Would you say that your devices have made life better for you, worse for you, or a little bit of both?
B
I would say a little bit of both. I think the whole question that we're going to discuss today is balance. But you know, sometimes it does intrude. I must admit that, like even when I'm away, I still worry about how many emails are piling up. And I know I don't want to look when I'm on vacation, but I do just so that I don't have to get barraged by them when I get home. How do you feel about it?
A
Yeah, same thing. I mean, sometimes I look just to see what the number is like, just make sure there aren't too many. And there are some days where I'm about to drift off to sleep and I realize just how much time I've spent sort of just mindlessly looking at the phone. I don't know that it's really a problem, but I know that there are better ways. I could probably use that time. But that said, you know, it's a lot of fun. I get to keep up with friends and family in ways that I never could have done before, especially if they're far away.
B
Sure.
A
We're going to talk a lot more about that today. You probably recognize a new voice. We have a guest host with us. This is Kathy Hirsch Pasek. And if you're a regular listener of this podcast, you've heard Kathy before. She was actually with us in season five to talk about making everyday spaces more playful. And I know play is something that's gonna come up again and again during Kathy's wonderful guest host tenure here.
B
Well, always, always. I love to play.
A
And if you've read when youn Wonder, your Learning, the book I co wrote with Greg Baer, who's the other co host of this pod. You also know Kathy's work because we were so heavily influenced by a book that Kathy co authored called Becoming Brilliant. She's also the co author of another book that you might be familiar with called Einstein Never Used How Our Children really Learn and why they need to Play More and Memorize Less. It's a wonderful book. Still relevant, more relevant than ever today. She's also a senior fellow at the Brookings Institution, the American Psychological association, the American Educational Research Society, and lots of other places. And her latest book, Making Schools Work, Bringing the Science of Learning to Joyful Classroom Practice is the first education book co written with teachers, administrators and scientists. Kathy, we have a scientist with us today, don't we?
B
We sure do. And I can't tell you how excited I am to have my dear friend the Mediatrician from Harvard University to talk to us about screens today. I just have to give you one quote from his fabulous new and it says digital wellness in mind, body and relationships is best achieved by taking a balanced approach, enjoying the positive affordances of our powerful screen tools, and avoiding or intervening early on negative influences. Doesn't that sound sane?
A
More sanity is always a good thing.
B
I think so too.
A
Dr. Michael Rich practices adolescent medicine at Boston Children's Hospital and is an associate professor of pediatrics at Harvard Medical School at Boston Children's. He's the founder and director of the Digital Wellness Lab and the Clinic for Interactive Media and Internet Disorders. We'll get into what both of those are a little bit later on. And as you heard earlier, he's earned himself a great nickname, the Mediatrician, thanks to his research based and actionable and practical answers to questions about young people's media use and the positive and negative implications for their health and development. Dr. Michael Rich, welcome to Remaking Tomorrow.
C
Thank you. And I'm pleasured and honored to join you in this important effort to remake tomorrow.
B
Well, thank you so much, Michael, because we need you. I mean, you've said that we really have to think of screens and social media a little bit differently now because it's kind of seamless. It's in the environment we're raising our kids in. This is the air they breathe. So I guess as a counterpoint to let's ban it, talk a little bit more about what should we be doing given that our kids are growing up with all this stuff.
C
Well, first of all, we should avoid the fear and dump the guilt. I think one of the problems of this current zeitgeist is that it's all about how a generation has been lost to social media and smartphones and working with kids every day. As a clinician and as a researcher, I don't find that to be true. I think that we can move beyond fear to inform because no decision is made well out of fear. So basically what we need to do is to shift our perspective on these devices, these platforms and these applications, to seeing them as the incredibly powerful tools that they are. And they are largely devoted to things that distract us rather than are constructive. But there are many things on them that are very constructive. And if young people and all of us Learn to use them in effective, mindful, masterful ways. And a big part of mastery is knowing what the tool does, when you need to use it, and when it's not the best tool for the job and needs to be put down.
A
Kathy mentioned the word seamless and I want to be sure I'm orienting myself correctly here because I'm one of those people, maybe the last of the generations, the great grew up before all this stuff was invented, right? I didn't grow up with smartphones or social media. Kids now are digital natives. Do we need to be thinking differently about how kids relate to these technologies? Is it a child growing up now thinking about smartphones and social media differently than maybe I might or Kathy might or the listeners of this program might?
C
Absolutely. First of all, we are guilty not only of being fearful of them, but of not having learned them and taught them to our children as they grew up. And what we've done is treated them pretty much as toys to reward them for good behavior or to be taken away for bad behavior. So I think that the first thing we need to do is be honest with ourselves and them about how powerful they are, recognizing that they are a tool that should be introduced when they need that tool, when they can handle it responsibly and with respect for themselves and others. I often draw the analogy to driving a car. We don't throw the car keys to a 4 year old because they're throwing a tantrum. What we do is we wait until the child, first of all, is responsible enough to take care of that privilege and responsibility and can reach the pedals. But we give them driver's education, we step them into this. And then we do not teach them to fear this environment. But we sit white knuckled in the front seat and say, learn to drive the car. We do not say, don't hit that tree, don't run over that person. We guide them into this experience in a gradual, thoughtful and highly communicative way. So I think that we need to do that with these devices as well. So, for example, when a kid says I want a smartphone, ask them why they want it. And if the answer is because everyone else has one, that's not treating it as a power tool. When they figure out what they need to say to get to the next stage of the conversation, you sit down with them and talk with them before they get the phone about how it is to be used, where and when and what they are to use it for, and explicitly when, where and how they are not to use it. Including talking about content that may be disturbing. And finally with them, if they've agreed to everything and they've heard it all, to decide with them what the consequences should be if they misuse these devices. And before they get it, they'll say, oh, you know, take it away for a week once they have it. They'll never offer that. So I think it's really important to treat these tools with the respect that they deserve.
A
Michael, I like how optimistic you sound about this. It is a refreshing. I think Kathy used the word counterpoint earlier to the sort of reaction we're seeing to some very convincing and very solid research about what these devices can do, both positive and negative. And I just want to linger on the positive for a few minutes. Can you give us examples, you know, of healthy uses of these devices? You've talked about these devices as tools that can be used for positive or for negative, maybe something neutral in between. But what are some of the benefits that you've seen for smartphones, social media, et cetera, for young people and their families?
C
Well, I want to correct one sort of phrasing before we even jump into that, and that is saying what these devices can do to us. It's what we do with these devices that makes the difference. It is not them doing something to us. It's actually kind of a cop out to point to the smartphone did it to me or the social media did it to me. It's what I chose to do with that, maybe inadvertently or maybe intentionally that has led me to this place. So I want to take away the fact that these devices are doing something to us and take responsibility for all of our behavior with them. But in terms of positive uses, I think we ran into a lot of those and found a lot of those. And during the pandemic lockdown where we can reach out and be connected as best we can with distant relatives, friends, et cetera. In fact, many young people spent more time with their grandparents because they had video chat during the lockdown than they typically do when everything is open and free because it was a way to reach each other. This is especially pertinent and poignant for young people who are typically marginalized in their communities. LGBTQI kids who often have no one that validates them, no one that encourages and loves them and supports them in their physical environment, but they can reach out and find their tribe online and find people who support and care for them. This goes for disabled kids, physically disabled kids, and also for kids who have trouble in social situations, social anxiety or autism spectrum disorder. Oftentimes they can connect in more fulfilling and meaningful ways to them online, but not exclusively. It's all a matter of taking those relationships and moving them into the IRL in real life space safely with people that they really recognize as opposed to being scammed by people. So I think there are lots of good uses. And when you get into education, which is really Kathy's realm, think of it. These kids can sit in their classroom and be on top of Mount Everest. These kids can be in the depths of the ocean. They can be on their way to the moon. They can see things that they would never have chance to see and to connect with cultures and people and languages they would never be able to be in touch with in their physical environment. So the seamless thing is absolutely on the mark. It's that they live in a single, seamless, digital, physical environment that they move in and out of all the time, which means that we can no longer measure screen time.
B
I think that's such an important point. And we spend so much time talking about how much time everybody's spending on a screen without actually looking at what they're doing. But Michael, I think I have to put it out there. The question that's on everybody's mind right now, isn't it the case that we have, like a lot of kids who are suffering from anxiety, they're telling us they have some sort of mental problems. And of course, there are many articles out there that are saying, well, we know why it has to do with screen time. I thought you might want to address that.
C
Absolutely. First of all, as a clinician who takes care of adolescents, anxiety and depression are a part of adolescence that's always been there. And they are usually transient experiences, but they're part of the bumps and lumps of growing up for many kids. And this is not something that is a standalone. In other words, I don't see kids who everything was going perfect for, then they got a smartphone and instantly went down the tubes, or even gradually went down the tubes of anxiety. What we are seeing in the hundreds of kids we've seen in the last seven and a half years at simaid, the clinic for interactive media and Internet disorders, is that every single one of them has had an underlying psychological distress that they were actually seeking to alleviate by being online. In fact, the vast majority of the kids we see have one of four conditions operating either known and pre existing, but under, treated or unknown, previously in subclinical. And those are Attention deficit hyperactivity disorder, social anxiety, Autism Spectrum disorder, and depression. What we say is that acronym ASAD is a SAD or a SAD patient is at higher risk for these disorders. What they are doing here is trying to seek an environment that both distracts them, but perhaps more importantly, they can master in ways that they can't master the world outside the screen.
A
Michael, I wanted to ask you a little bit about that clinic. I think it's so interesting. And you call unhealthy Internet use, among other things, a disorder called problematic interactive media use. And I'm curious about how you work with young people at your clinic. Is it just a matter of figuring out what that underlying issue is and then getting them the proper treatment, or is it teaching also alongside healthy device practices or media use practices? Can you talk a little bit about the treatment protocols for this kind of thing?
C
Absolutely. And I do want to talk about why we call it problematic interactive media
A
use, which you differentiate from addiction.
C
Absolutely. And I think addiction is a very poor model for what's actually going on. In fact, we see this as much more akin to binge eating disorder. And why I say that is addiction, as we think about it colloquially, is use of a pleasurable but unnecessary substance that continues despite negative consequences. And our therapeutic goal is abstinence. What we have with interactive media is a behavior that is actually necessary for life at this point in time, for learning, for working, for connecting, for communicating. And it does continue for some young people despite negative consequences. And our goal is self regulation. The reason we call it Pai mu problematic interactive media use is we have to move away from this term of addiction. We also have to not name the technology as the problem, because it's not the problem. It's our behavior with it. It's the use that's the problem. And also that leaves it open for future technologies yet to be developed, such as Gen AI. So what we do with the kids, first of all is we usually see them with the parents. One of the really interesting side effects of the pandemic lockdown is that we went, as many places did overnight to remote care. Before we went to lockdown and remote care, we had about a 25 to 30% no show rate for first visits with these kids because the parents would wuss out and not tell them till the night before or the morning of, and they would refuse to come to the hospital. When we went to virtual care, the no show rate dropped to zero. Because this is an environment they feel comfortable and safe in. But we see them with the parents. And one of the first things I do is I ask the kid, how can I help you. You know, one of the biggest first reasons is get my parents off my back. I'm like everybody else. And I will say to the parents right directly, I want you to stop being the police and start supporting success. Identify those things that your child is doing well and notice them, applaud them, talk about them, and build them. See this issue as a glass half full. And both the parents and the kids have this sigh of relief at this point. And then I go to the kids and I say, what are your pain points? What's going on for you? And they'll say things like, I wish I were doing better in school. I wish I weren't tired and sleepy all the time. I wish I had more friends. And we start to look at their behaviors and think of alternative ways to do it. It's really interesting that when the kids realize that they do have control over what they do and they do get manipulated by the algorithms, et cetera, and once we recognize and adequately treat that underlying driver of these behaviors, it's remarkable how easy they are to correct, sometimes even spontaneously, but often in response to very typical and easy behavioral modifications. If we can recognize how we are behaving, how we are being manipulated, and how we can have control of our own destiny, if you will, we can help them a lot. And it's amazing. We were just looking at the number of kids who only had one or two visits, and it's the large majority of the kids that we care for that are able to turn this around quite easily once they get out of the conflictual relationship with their parents.
B
Yeah, that's a biggie. I have a question for you though, Michael. It's always seemed to me that we talk about, you know, screen time, digital environment, and we lump together a lot of stuff like TikTok, Instagram, Facebook, and in some of the research that I read, it looked like they pattern a little differently. Should we be not lumping everything under one umbrella and maybe talking to kids about how to balance in each of these domains? Are they different?
C
They are absolutely different. And the other thing that's overlaid on this is nobody has the same definition of social media. And I would argue that all media are now social, even watching television or Netflix, where kids will be across town from each other and starting it at the same time and on the phone with each other on FaceTime or texting as they experience it together. Many of the most successful games among kids are inherently social, whether it be Fortnite or Minecraft or Roblox. And interestingly, during the pandemic, the lockdown. This was the place that they got to play with their friends. And it was the equivalent of the basketball court or the city park or the ball field.
B
Michael, can I interrupt you just for a second?
A
Sure.
B
Because I hear you saying equivalent, and yet, you know, I just want to challenge a little bit.
C
Okay.
B
So, I mean, there is research to show that you do get some, you know, a little bit of social dopamine hit by, you know, doing Fortnite together with someone else or being on zoom with someone else. But it's not the same hit you get when you're, like, right next to them across from a dinner table.
C
Or maybe it's the same dopamine hit you get when you score a soccer goal. When I came to that is, I would ask the kids about playing Fortnite or Minecraft, and they don't talk about the game. They don't talk about winning or losing. They talk about it as hanging out with their friends. So maybe it's the equivalent of what the shopping mall was in the 1980s. Right. It's where they hang out. And yes, it is not nearly as good as being together IRL in real life, but it is all that they had. And one of the concerning things actually for me is we were measuring their screen use amount of time and what they used during the pandemic and lockdown and after. And if you remember in that summer after the. What I called the year of learning remotely, that we thought, wow, everything's going to go back to normal before Omicron hit. And it didn't. Their screen use continued at the same high rate and in some cases increased, even including the time they were on screens for school. So we actually shifted to a whole new way of being with each other, for better or for worse. And for that reason, I don't talk about the new normal because it's always changing. I talk about the next normal.
A
Michael, one thing I've noticed come up again and again in this conversation is the importance of communication. You know, from how things are framed to how clearly our terms are defined, to even, you know, the tone of conversation between clinician and patient and parent. And I'm curious how much of that comes from your previous career, because despite your many accomplishments as a physician, as a clinician, as a professor, you actually started out as a filmmaker. And I'm wondering what kind of films you were making. Can you tell us a little bit about that and maybe how it's informing your current work as the mediatrician?
C
Yes, I spent my wicked youth in the film industry. And interestingly, when I was being interviewed for medical school, I had over and over again, why would you give that life up for this? From physicians who are maybe tired and a little burned out? And I said then, and I agree now with the sentiment that the connection between filmmaking, directing, actors, telling stories, etcetera, and medicine is that this is a highly technical skill that you need to learn really well and then apply to becoming truly intimate with the human condition. And so I really approach these interactions with kids and their families much the way perhaps a director approaches a cast. In other words, the best acting comes when the actor believes they have discovered something for themselves, not when you tell them to do something, but when you help lead them to a eureka moment. And I think that that's a really important part of this recovery, which is helping young people and their families gain insight into what is going on and what the implications of that are, and then to redirect their behavior in ways that help enhance their physical, mental, and social health.
A
I think that's wonderful. You know, Fred Rogers, who's sort of the lodestar of this podcast, said there's a world of difference between telling somebody to do something and creating an atmosphere in which they want to go do it themselves. And it sounds like that's what you were doing in both filmmaking and medicine.
C
And I worked for a long time with the Fred Rogers center, so he's kind of on my shoulder all the time.
A
I can hear the similarities.
B
Yeah, it's a little bit more authenticity, right, Michael?
C
Absolutely. And, in fact, you touched on a really important thing there, Kathy, which is you talked about my optimism earlier, and optimism is inherent to being a pediatrician, I think. But here's my optimism approach to social media. I believe that if we can stop using social media as a way of marketing ourselves to the world like companies do, showing all the great things we're doing, how satisfied and fulfilled we are, and become truly authentic as we are with our close friends, where we are able to talk about not just our strengths, but our fears, our limitations. And in fact, the best relationships we have are not with people who seem perfect, but with people who are flawed because they accept and love us, not despite our flaws, but because of them, because we can complete each other. So my optimistic fantasy about social media is if we can get a young person in, say, Ukraine and a young person in Russia being authentic with each other on social media, and their leaders say, that's the enemy. Go kill. They will say, no, I know that person better. Than I know you, my ostensible leader. And I can see social media becoming an instrument of peace.
A
Michael, thank you so much for that.
B
Ryan, do you see why I'm in awe of him?
A
I do, I do.
B
I just wanted to make sure you got it.
A
I, I get it in a big way. And, Michael, so we, we always ask one question of, of every guest at the end of this program. You may have just answered it, but I'm going to have Kathy do the honors just in case you have something else to say, because. Yeah, Kathy, I am getting it.
B
Okay. And here you go, Michael.
C
Okay.
B
What's one thing listeners can do today to make tomorrow a more promising place for every learner?
C
Listen and respond.
B
Doesn't get better than that.
C
I think we have gotten out of the habit of listening to each other, listening to ourselves, and listening to Mother Earth. And really, we've allowed ourselves to be seduced away by the ease of the devices. As you might imagine, working with these very troubled kids and families is exhausting for me. I came out of the hospital one day, turned to my right toward where my car was parked, and in the west was a brilliant, stunning sunset. And all of my exhaustion, all of my cares fell away. And I looked around myself at the street, and everyone was staring at their phone. They didn't see it.
A
Michael, we are so grateful for the time to listen to and respond to and connect with you. Thank you so much for being here with us.
C
Well, thank you for being here. And that awe that Kathy talks about is mutual, believe me.
A
Remaking tomorrow is powered by remake learning. Learn more@remakelearning.org.
Date: September 12, 2024
Host: SLB Radio Productions, Inc., guest-hosted by Kathy Hirsch-Pasek
Guest: Dr. Michael Rich (“The Mediatrician”), Founder & Director, Digital Wellness Lab, Harvard University
This episode of Remaking Tomorrow explores the concept of “digital wellness” for young people, focusing on how technology and screens impact learning, development, mental health, and relationships. Dr. Michael Rich, a specialist in adolescent medicine and media use, shares his optimistic and research-based perspective on helping children and families navigate the digital world. The discussion covers balancing technology’s risks and opportunities, rethinking screen time, and treating media challenges as behavioral rather than addictive issues. The conversation is filled with practical advice, empathy, and a call for authenticity and communication.
[00:00–04:31]
[04:31–08:41]
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[12:17–15:02]
[15:02–18:57]
[18:57–22:06]
[22:06–26:05]
[26:32–27:40]
"Listen and respond." – Dr. Michael Rich [26:42]
"We've allowed ourselves to be seduced away by the ease of the devices...I looked around at the street, and everyone was staring at their phones. They didn’t see [the sunset]." – Dr. Rich [27:22]
The tone is empathetic, optimistic, and practical, combining scientific rigor with warmth and humility. Dr. Rich advocates for authentic connection, growth, and agency—eschewing fear-based narratives in favor of solutions crafted through listening, communication, and supportive collaboration.
For more information:
Visit remakelearning.org and the Digital Wellness Lab.