Safer Screens Letter

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  Adrian Ramsay MP co-signed this cross-party letter initiated by Dr Simon Opher MP and Health Professionals for Safer Screens.

  Professor Sir Chris Whitty  

  Sir Frank Atherton 

  Professor Sir Gregor Smith  

  Professor Sir Michael McBride  

  Dear United Kingdom Chief Medical Officers, 

  We are writing regarding your February 2019 commentary on “Screen-Based Activities and  Young People’s Mental Health and Psychosocial Wellbeing: A Systematic Map of Reviews.” 1 2 For the reasons outlined below, we believe this document is outdated and requires an urgent  review. 

  We recognise that the impact of screen-based activities on mental health is complex, and  untangling the various influencing factors can be challenging. However, there is now  substantial evidence supporting the concerns of many health professionals that excessive  screen time and social media use are contributing to mental health issues in children.3 4 5 6 7 This excessive use affects children in multiple ways, leading to problems with sleep,8 9  eyesight,10 11 12 speech and language development, 13 14 emotional and social growth,15 16 eating  habits,17 18 body image,19 educational achievement,20 and cognitive performance.21  Furthermore, research indicates that one in four children and young people are using their  smartphones in a manner consistent with behavioural addiction.22 23 As clinicians, we witness  these harmful effects daily, and academics are now establishing causal connections.24 

  ADHD significantly increases the risk of mental health issues in children, and the growing  evidence linking excessive device use to ADHD symptoms is alarming.25 26 27 28 We are  witnessing a marked rise in ADHD diagnoses,29 with more families seeking assessments for  their children - something the Department for Work and Pensions (DWP) is working to  address.30 It is becoming increasingly evident that preventative measures are crucial. We need  to focus on how we communicate and advise parents about this specific risk rather than just  providing financial support after the fact. 

  As if the existing harms weren't concerning enough, we know that cases of self-generated Child  Sexual Abuse Material (CSAM) continue to increase and children involved are getting younger - including children aged 7-10 in 2023, up 65% from 2022 (104,282 in 2023 vs 63,057 in 2022).31 Additionally, as a likely consequence of greater immersion in radicalised online content, one in  five individuals arrested for terrorism offences is now under the age of 18.32 It's crucial to  highlight that the most vulnerable children are at the most significant risk from these life altering harms. This theme recurs when considering all the issues above, as children in  deprived settings are the most likely to use screens for extended periods without adult  supervision.

  We, the undersigned, call on you to: 

  ● Urgently revise the February 2019 CMO commentary to include updated evidence  linking device use to mental health issues, as well as evidence regarding the broader  harms to children. 

  ● Focus the CMO's positioning on child health by highlighting the serious challenges  technology companies pose. The current approach seems too sympathetic to potential  benefits and lacks urgency regarding the harms children face today. Requesting a  "voluntary code of conduct" from the tech industry on safeguarding children is too  lenient and not adequately centred on child health or safety.  

  ● We note your call for the technology industry to fund independent research over the  next decade. We believe this creates a conflict, as the health and medical science fields  should solely fund such research. We also call on you to demand that researchers in  this area disclose any income from technology companies. 

  ● We urge you to reconsider your support of the age restriction requiring children 13 and  older to consent to data sharing and social media access; we believe the minimum age  should be 16. The Chief Medical Officer should also support legislative changes around  child-safe phones, as recommended in the Education Select Committee's recent  report.33 

  ● Launch a public health campaign addressing screen time and social media use, with  clear messaging directed at parents. An example already in use within NHS settings is  attached. 

  ● Call upon all Royal Colleges, including the RCPCH, to inform their members about the  key issues and evidenced risks of harm. 

  All signatories of this letter are united in their support for the evidence presented herein and the  urgent calls to action it outlines. 

  Yours sincerely 

  1 United Kingdom Chief Medical Officers’ commentary on ‘Screen-based activities and children and  young people’s mental health and psychosocial wellbeing: a systematic map of reviews'. (2019).  Retrieved from  

  https://assets.publishing.service.gov.uk/media/5c5b1510e5274a316cee5be8/UK_CMO_commentary_o n_screentime_and_social_media_map_of_reviews.pdf  

  2There has been a great deal more compelling evidence since the research that the 2019 commentary  above was based on: Dickson K, Richardson M, Kwan I, MacDowall W, Burchett H, Stansfield C, Brunton  G, Sutcliffe K, Thomas J (2018) Screen-based activities and children and young people’s mental health: A 

  Systematic Map of Reviews, London: EPPI Centre, Social Science Research Unit, UCL Institute of  Education, University College London. 

  3 C, F., A, L., J, S., GL, W., V, B., & M, A. (02/24/2023). Is adolescent internet use a risk factor for the  development of depression symptoms or vice-versa? - PubMed. Psychological medicine, 53(14).  https://doi.org/10.1017/S0033291723000284

  4Tiraboschi, G. A., Garon-Carrier, G., Smith, J., & Fitzpatrick, C. (2023/12/01). Adolescent internet use  predicts higher levels of generalized and social anxiety symptoms for girls but not boys. Preventive  Medicine Reports, 36. https://doi.org/10.1016/j.pmedr.2023.102471

  5 Carter, B., Payne, M., Rees, P., Sohn, S. Y., Brown, J., & Kalk, N. J. (2024). A multi-school study in  England, to assess problematic smartphone usage and anxiety and depression. Acta Paediatr, 113(10),  2240-2248. https://doi.org/10.1111/apa.17317

  6 Carter, B., Ahmed, N., Cassidy, O., Pearson, O., Calcia, M., Mackie, C., & Kalk, N. J. (2024-01-01).  ‘There’s more to life than staring at a small screen’: a mixed methods cohort study of problematic  smartphone use and the relationship to anxiety, depression and sleep in students aged 13–16 years old  in the UK. BMJ Ment Health, 27(1). https://doi.org/10.1136/bmjment-2024-301115  7 Kalk, N. J., Downs, J., Clark, B., & Carter, B. (2024). Problematic smartphone use: What can teenagers  and parents do to reduce use? Acta Paediatr, 113(10), 2177-2179. https://doi.org/10.1111/apa.17365  8 AA, W., & L, H. (10/21/2024). Future Directions for Screen Time Interventions for Sleep - PubMed. JAMA  Pediatrics. https://doi.org/10.1001/jamapediatrics.2024.4009

  9Carter, B., Rees, P., Hale, L., Bhattacharjee, D., & Paradkar, M. S. (2016/12/01). Use of Screen-Based  Media Devices and Sleep Outcomes. JAMA Pediatrics, 170(12).  

  https://doi.org/10.1001/jamapediatrics.2016.2341

  10 Foreman, J., Salim, A. T., Praveen, A., Fonseka, D., Ting, D. S. W., He, M. G., Bourne, R. R. A., Crowston,  J., Wong, T. Y., & Dirani, M. (2021/12/01). Association between digital smart device use and myopia: a  systematic review and meta-analysis. The Lancet Digital Health, 3(12). https://doi.org/10.1016/S2589- 7500(21)00135-7  

  11 Liang, J., Pu, Y., Chen, J., Liu, M., Ouyang, B., Jin, Z., Ge, W., Wu, Z., Yang, X., Qin, C., Wang, C., Huang,  S., Jiang, N., Hu, L., Zhang, Y., Gui, Z., Pu, X., Huang, S., & Chen, Y. (2024-09-24). Global prevalence,  trend and projection of myopia in children and adolescents from 1990 to 2050: a comprehensive  systematic review and meta-analysis. British Journal of Ophthalmology. https://doi.org/10.1136/bjo 2024-325427  

  12 Screen time linked to risk of myopia in young people. (2021, 7/10/2021).  

  https://www.aru.ac.uk/news/screen-time-linked-to-risk-of-myopia-in-young-people 13 Brushe, M. E., Haag, D. G., Melhuish, E. C., Reilly, S., & Gregory, T. (2024 Mar 4). Screen Time and  Parent-Child Talk When Children Are Aged 12 to 36 Months. JAMA Pediatrics, 178(4).  https://doi.org/10.1001/jamapediatrics.2023.6790

  14 Takahashi, I., Obara, T., Ishikuro, M., Murakami, K., Ueno, F., Noda, A., Onuma, T., Shinoda, G.,  Nishimura, T., Tsuchiya, K. J., & Kuriyama, S. (2023). Screen Time at Age 1 Year and Communication and  Problem-Solving Developmental Delay at 2 and 4 Years. JAMA Pediatr, 177(10), 1039-1046.  https://doi.org/10.1001/jamapediatrics.2023.3057

  15 C, F., PM, P., A, L., E, H., FA, R., & G, G.-C. (10/01/2024). Early-Childhood Tablet Use and Outbursts of  Anger - PubMed. JAMA Pediatrics, 178(10). https://doi.org/10.1001/jamapediatrics.2024.2511  16 Konok, V., Binet, M. A., Korom, Á., Pogány, Á., Miklósi, Á., & Fitzpatrick, C. (2024). Cure for tantrums?  Longitudinal associations between parental digital emotion regulation and children's self-regulatory  skills. Frontiers in Child and Adolescent Psychiatry, 3. https://doi.org/10.3389/frcha.2024.1276154  17 J, C., KT, G., A, T., AAA, A.-S., DB, J., RF, R., J, H., FC, B., & JM, N. (09/04/2024). Screen time,  problematic screen use, and eating disorder symptoms among early adolescents: findings from the  Adolescent Brain Cognitive Development (ABCD) Study - PubMed. Eating and weight disorders : EWD, 29(1). https://doi.org/10.1007/s40519-024-01685-1

  18 Robinson, T. N., Banda, J. A., Hale, L., Lu, A. S., Fleming-Milici, F., Calvert, S. L., & Wartella, E.  (2017/11/01). Screen Media Exposure and Obesity in Children and Adolescents. Pediatrics, 140(Supplement_2). https://doi.org/10.1542/peds.2016-1758K

  19 Dane, A., & Bhatia, K. (22 Mar 2023). The social media diet: A scoping review to investigate the  association between social media, body image and eating disorders amongst young people. PLOS Global  Public Health, 3(3). https://doi.org/10.1371/journal.pgph.0001091

  20 Skills, O.-D. f. E. a. (2023). Programme for International Student Assessment.  https://www.oecd.org/en/about/programmes/pisa.html

  21 Böttger, T., Poschik, M., & Zierer, K. (2023 Sep 11). Does the Brain Drain Effect Really Exist? A Meta Analysis. Behavioral Sciences, 13(9). https://doi.org/10.3390/bs13090751

  22 Sohn, S. Y., Rees, P., Wildridge, B., Kalk, N. J., & Carter, B. (2019). Prevalence of problematic  smartphone usage and associated mental health outcomes amongst children and young people: a  systematic review, meta-analysis and GRADE of the evidence. BMC Psychiatry, 19(1), 356.  https://doi.org/10.1186/s12888-019-2350-x

  23 Carter, B., Payne, M., Rees, P., Sohn, S. Y., Brown, J., & Kalk, N. J. (2024). A multi-school study in  England, to assess problematic smartphone usage and anxiety and depression. Acta Paediatr, 113(10),  2240-2248. https://doi.org/10.1111/apa.17317

  24 Tiraboschi, G. A., Garon-Carrier, G., Smith, J., & Fitzpatrick, C. (2023/12/01). Adolescent internet use  predicts higher levels of generalized and social anxiety symptoms for girls but not boys. Preventive  Medicine Reports, 36. https://doi.org/10.1016/j.pmedr.2023.102471

  25 KF, H., B, A., K, S., & DS, B. (03/01/2024). Early-Life Digital Media Experiences and Development of  Atypical Sensory Processing - PubMed. JAMA Pediatrics, 178(3).  

  https://doi.org/10.1001/jamapediatrics.2023.5923

  26 Ra, C. K., Cho, J., Stone, M. D., Cerda, J. D. L., Goldenson, N. I., Moroney, E., Tung, I., Lee, S. S., &  Leventhal, A. M. (2018/07/17). Digital Media Use and ADHD in Adolescents. JAMA, 320(3).  https://doi.org/10.1001/jama.2018.8931

  27 M, K., R, K., R, S., S, H., S, O., T, O., Y, A., K, M., H, Y., & Z, Y. (04/01/2022). Association Between Screen  Time Exposure in Children at 1 Year of Age and Autism Spectrum Disorder at 3 Years of Age: The Japan  Environment and Children's Study - PubMed. JAMA Pediatrics, 176(4).  

  https://doi.org/10.1001/jamapediatrics.2021.5778

  28 Nagata, J. M., Al-Shoaibi, A. A., Leong, A. W., Zamora, G., Testa, A., Ganson, K. T., & Baker, F. C. (2024).  Screen time and mental health: A prospective analysis of the Adolescent Brain Cognitive Development  (ABCD) Study. BMC Public Health, 24, 2686. https://doi.org/10.1186/s12889-024-20102-x 29 Significant rise in ADHD diagnoses in the UK. (2023). National Institute for Health and Care Research.  https://www.nihr.ac.uk/news/significant-rise-adhd-diagnoses-uk

  30 Murphy, L. (2024). Growing pressures Exploring trends in children’s disability benefits.  31 Annual Report. (2024). https://www.iwf.org.uk/annual-report-2023/trends-and-data/self-generated child-sex-abuse/ 

  32 Hymas, C. (2024, 29/09/2024). Children under 10 being reported to counter-terror police. The  Telegraph. https://www.telegraph.co.uk/news/2024/09/29/children-under-10-being-reported-to counter-terror-police/ 

  33 Committee, H. o. C. E. (2024). Screen time: impacts on education and wellbeing. Retrieved from  https://committees.parliament.uk/publications/45128/documents/223543/default/