Links between difficult childhood experiences and early teen problems with screen use in the United States

Problematic screen use has risen dramatically among adolescents; 45% of adolescents report being online “almost constantly.” [1] Screen use becomes problematic when the user experiences a loss of control over usage and impairments in personal, social, and occupational functioning [2]. More specifically, we define problematic screen use as demonstrating key elements of the six core components of behavioral addiction: salience (the activity dominates thinking), mood modification (the activity impacts mood), tolerance (increasing time spent on the activity is needed to achieve previous effects), withdrawal (mood worsens when the activity is discontinued or reduced), conflict (the activity negatively impacts relationships), and relapse (a pattern of returning to use following a period of abstinence or improved control) [3]. These problematic use patterns can span a variety of modalities, including video games, social media, and phones [2, 4–6]. Problematic video game use is characterized by a sense of euphoria while playing, inability to stop, craving more time, low mood when not playing, and consequences in private, social and professional life [2]. Problematic social media use is characterized by an internalized need to be constantly connected via technology [5, 7]. Problematic mobile phone use includes a broader range of applications (i.e. texting, apps, video chat) but shares the same behavioral characteristics as those described above [6]. Given that excessive screentime and screen addictions are associated with reductions in physical activity [8], increased risk of obesity [5, 9], and psychological consequences including obsessive-compulsive disorder (OCD), anxiety, and depression [2, 5–7, 10], identifying risk factors to inform prevention and intervention efforts is critical.

Recent research has highlighted that adverse childhood experiences (ACEs), defined as potentially traumatic events that occur before the age of 18, are an important risk factor in developing addictive behaviors [11, 12]. Several studies have shown that adolescents who have experienced childhood trauma have a higher risk of developing problematic video game [13, 14], internet [15–17], and mobile phone use [18]. However, few studies have explored this relationship in a large, nationally representative U.S. sample in the setting of recent screen use increases. Further, few studies have used youth self-report screen-time data or focused on early adolescents, an age range when a spike in computer use, gaming, and social media use often occurs [19]. Moreover, the relationship between ACEs and problematic social media use has yet to be explored. This study aims to fill these gaps by examining the associations between ACEs and problematic video game, social media, and mobile phone use among a large, nationally representative sample of U.S. early adolescents. It is hypothesized that higher adolescent ACE scores will be associated with higher rates of problematic video game, social media, and phone use among youth who report screen use.

This study used a prospective design to determine the association between ACE score and problematic screen use among U.S. early adolescents. This study used survey data from the Adolescent Brain Cognitive Development (ABCD) study, a large, diverse, prospective cohort study of brain development and health among adolescents from 21 recruitment sites across the U.S [20]. To maximize retention, research staff connects with families at least every six months by telephone and every year in person. To prevent higher attrition rates from lower-income families, the study provides a free nutrition and exercise program, a meal, homework assistance, childcare for other family members who accompanied the participant to the visits, and transportation vouchers during research visits. Youth who did not participate in any type of screen use (video game, social media, or mobile phone, were excluded (n = 2,112) The final sample consisted of 9,763 adolescents ages 11–12 years old during the two-year follow-up (4.0 release). Centralized institutional review board (IRB) approval was received from the University of California, San Diego (UCSD). Written informed consent and assent were obtained from caregivers and the child, respectively.

The sample of 9,673 adolescents was racially and ethnically diverse (52.9% White, 17.4% Latino/Hispanic, 19.4% Black, 5.8% Asian, 3.7% Native American, 0.9% Other; Table 1). Participants mean age was 12.0 years old (SD 0.7, range 10.6–14). Among adolescents who used screens, 7% reported problematic video game use, 3.5% reported problematic social media use, and 21.8% reported problematic mobile phone use.

In both the unadjusted and adjusted models, among youth who reported screen use, a higher ACE score was associated with a higher odds of problematic video game and mobile phone use. In the adjusted models, an ACE score of four or more was associated with 3.1 and 1.6 times higher odds of having problematic video game use and mobile phone use, respectively ACE score was associated with problematic video game use in a dose dependent manner. Figure 1 highlights how increasing ACE score was associated with greater rates of problematic video game and mobile phone use (Table 2). There was no statistical association between problematic social media use and ACE score. However, a higher ACE score was also associated with higher survey scores of problematic video game, media, and phone use(Supplemental Tables 3, Supplemental Fig. 2).

This large, demographically diverse, national sample of 9,673early adolescents who use screens found that a greater ACE score was significantly associated with greater problematic video game and mobile phone use (when problematic screen use was measured as a binary outcome). Youth exposed to 4 or more ACEs experienced 3.1 times higher odds of reported problematic video game use and 1.6 times higher odds of problematic mobile phone use compared to peers with no ACEs. Given that behavioral addictions can have significant negative personal, social, and professional impacts, understanding risk factors to their development is critical.

Increased rates of problematic screen use among a nationally representative study of U.S. screen-using youth with higher ACE scores builds upon prior findings. Previous studies have shown that ACEs are associated with higher video game use among Japanese adolescents [14] and Chinese university students [13] and higher mobile phone addiction in Chinese university students [18]. In addition, a 2019 study of exclusively high-risk U.S. youth found a dose-dependent relationship between ACEs and problematic media use using parent-report data [16]. This study builds upon these prior findings by using youth self-report data and showing that ACEs are an important risk factor for problematic screen use among a demographically diverse sample of U.S. early adolescents. Our study further contributes to the literature by focusing on early adolescents, who represent a critical age group because this developmental period is vulnerable to developing health-related risk factors [1, 48]. This study also found that problematic social media use, a contemporary, novel measure associated with adverse physical and mental health consequences, was not associated with ACEs in the logistic model (Table 2), though a dose-dependent relationship was observed in the linear model (Supplemental Table 3) [49, 50] It is important to note for these mixed results that rates of problematic social media use were low at3.5%, which may be due to relative younger age of the participants in our study (11–12 years old). Accordingly, it is important to continue to examine the association between ACEs and problematic screen-use in a broader sample of adolescents of older ages, during which time social media use – and the possibility of problematic social media use – may be elevated.

This study found that 7.0% of US adolescents who used screens endorsed problematic video game use and 21.8% reported problematic phone use. These rates are similar than prior studies that have found that 7.6% of German adolescents report video game addiction [51] and 22.9% of Chinese adolescents report problematic phone use; however, as our study excluded youth who did not report screen use, the true average use is likely lower; we suspect may be partially secondary to the lower average age in the ABCD cohort (11–12 years). The high rates of problematic mobile phone use, approaching one in four early adolescents, is concerning for early education around mobile phone use and behaviors.

Limitations to this study include vulnerability to confounding variables; however, given the breadth of the ABCD cohort measures we did include many covariates (sex, race/ethnicity, income, parent education, mental health conditions). In addition, the ABCD dataset does not include a single, validated scale, so this score was generated from questions across different surveys capturing the same themes as the original ACEs screener. Therefore, future research should reassess the questions posed in this study using such a scale. In addition, we analyzed data from youth who reported screen use, so findings cannot be generalized to all adolescents regardless of screen use. Also, cutoff scores for the VGAQ and SMAQ have not been clearly established in the literature and were extrapolated conservatively from the Bergen Facebook Addiction Scale. Finally, mobile phone and social media behavior may have areas of overlap (Supplemental Table 3) [52].

This study demonstrates that, among adolescents who use screens, higher ACE scores are associated with problematic screen use, particularly problematic video game and mobile phone use, which has important clinical and public policy implications for screen time recommendations. For example, clinicians should be aware of the increased risk of problematic screen use among youth with high ACE scores, explore video game, social media, and mobile phone use among this population, and collaborate with families to implement a family media use plan informed by the American Academy of Pediatrics [53]. In addition, schools may consider implementing curricula focused on promoting healthy digital habits [54]. Future studies should explore protective factors to problematic video game, social media, and mobile phone use among ACE-exposed adolescents and the effectiveness of clinic-based interventions for this population.

The ABCD Study was supported by the Nacional Institutes of Health and additional federal partners under award numbers U01DA041022, U01DA041025, U01DA041028, U01DA041048, U01DA041089, U01DA041093, U01DA041106, U01DA041117, U01DA041120, U01DA041134, U01DA041148, U01DA041156, U01DA041174, U24DA041123, and U24DA041147. A full list of supporters is available at https://abcdstudy.org/federal-partners/↗. A listing of participating sites and a complete listing of the study investigators can be found at https://abcdstudy.org/principal-investigators.html↗. ABCD consortium investigators designed and implemented the study and/or provided data but did not necessarily participate in the analysis or writing of this report.

J.H.R. was responsible for the co-development of the research study design, methods, and data analysisand methods; she also drafted the initial manuscript. A.A. co-developed the methods and formal analysis and completed the formal analysis. K.T.G, A.T., and D.B.J. co-developed the study design, methods, and formal analysis; they also provided oversight and participated in the revision of the manuscript. G.S and O.M.S. completed the data cleaning and critically reviewed the manuscript. J.M.N provided supervision; he also co-developed the conceptualization of the study, methods, and supported the analysis and manuscript revision. All authors approved the final submitted version.

J.M.N. was funded by the National Institutes of Health (K08HL159350), the American Heart Association Career Development Award (CDA34760281), and the Doris Duke Charitable Foundation (2022056). The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Data used in the preparation of this article were obtained from the ABCD Study (https://abcdstudy.org↗), held in the NIMH Data Archive (NDA). Investigators can apply for data access through the NDA (https://nda.nih.gov/↗).