Identifying and Addressing Problematic Screen Use with Dr. Justin Romano

Mark Mullen: [00:00:00] Welcome back to Psychiatry Bootcamp. I am joined today by Dr. Justin Romano. We're gonna talk about cell phone use and screen time. Dr. Romano was a co-resident of mine at Creighton. You were two, three years ahead of me, I think two years ahead of me. child and adolescent psychiatrist has his own podcast, the Millennial Mental Health Channel.

And I will say that if it wasn't for Dr. Romano having his podcast, I am certain that psychiatry bootcamp would not exist. So in many ways, we have him blazing the Trail of Creighton Podcasting To thank for this show. Dr. Romano, I will ask you to introduce yourself further to our audience. 

Dr. Justin Romano: So yes, I am Dr.

Justin Romano. I'm originally from Cheyenne, Wyoming. I'm actually currently working in Cheyenne, Wyoming as an outpatient child and adolescent psychiatrist. I have a three-year-old boy. I've got another [00:01:00] child on the way. He should be here in less than two weeks. So, that's about it. that's my life updates.

Mark Mullen: Okay. So nothing too exciting going on for you then, sounds like. 

Dr. Justin Romano: Yeah, no. 

Mark Mullen: I'm gonna start by what got you interested in this topic because cell phone use and screens do not show up in the DSM. Right. So when we're in residency, we're really not learning if we're being honest, at least formally anything about these, we're not really tested on this, on our psychiatry board examination.

So this has become sort of a pet project for you or a special interest for you. Did you have a formative experience that got you interested in this topic? Or what kind of put it on your radar? 

Dr. Justin Romano: Well, basically I couldn't ignore this topic any longer 'cause it just seemed like so many of the people that I were, what was working with so many of the families I was working with, kept bringing it up as a problem.

I remember doing my inpatient child and adolescent psychiatry rotation in Omaha, Nebraska. And we had multiple people coming into the inpatient psychiatry and the chief complaint being took cell phone away, threatened to kill themselves, like [00:02:00] had suicidal ideation after cell phone taken away. So that was kind of when I first really started to think like, okay, like should I look into this more?

Is this a thing? So that's when I volunteered. I did that TED talk, the TEDx talk for TEDx Omaha in 2022 and decided, Hey, I think this is kind of the most important thing impacting young people, which is really when I started to dive into some of the research and literature, which overall is pretty limited in terms of what's actually out there now.

Actually over the past couple of years, that information and that base of information has expanded. So that's good. But yes, that's about how I got started in this topic. 

Mark Mullen: We trained on the same inpatient unit. And one of the things that I most remember from my two months of doing inpatient child adolescent psychiatry is I felt like I would go home and I would, I, would ask myself, would this unit still exist if Snapchat didn't exist?

Like, it felt like every history that I took Snapchat had something to do with it. [00:03:00] And the stressors that these kids were dealing with in terms of things that might have lifelong ramifications, you know, one impulsive mistake that many people have made for millennia is now on the internet. it really broke my heart.

And so I'm, really excited to be talking to you about this today. Is this a topic that is specifically found or that we need to worry about, particularly in children? Is it children and adults? Is it affecting just some children? All of our children. How widespread is problematic technology use? 

Dr. Justin Romano: So I would say this affects everyone in the United States because cell phones are specifically designed to be addictive.

I dunno if you've seen the documentary, the Social Dilemma, but it kind of goes into these psychologists that worked with social media companies to try and make these social media apps as addictive as possible for people. But yes, I think it is affecting everyone. I worry the most about children just [00:04:00] because their frontal lobes are not fully developed and they have a little bit harder of a time resisting a lot of social media and the allure of social media.

Plus, I'm really worried about brain development in young people. 'cause once your brain's fully developed, it's a little bit less of a problem. But for young people who are in the process of developing their brains and their patterns for their life long journey, social media can really change those and impact them.

So I think it affects everyone, to kinda give you some statistics. The 98% of adults own a cell phone. This is according to the mobile fact sheet from 2025. And dependence rates vary greatly, but are recorded as high as about 51.2% in one recent study of over 5,000 subjects. And this was a wafi at all in 2022.

Mark Mullen: So you see this as a developmental problem. One of the issues is that as children's very plastic brains are developing, we're introducing this new variable, this really important [00:05:00] variable of maybe screen dependence, cell phone dependence. How does that alter the development of their brain? And you don't need to speak to neuro anatomically about this, but just generally speaking, what do you mean when you say you're worried about the development to their brain?

Dr. Justin Romano: I always like to compare this to other forms of behavioral addiction, kind of like gambling. So if you have an addiction at a young age, or develop an addiction at a young age, well before your brain is fully developed, which as we know for. Men, his mid twenties girls, his probably early twenties. it really predisposes you to a lot of those dopamine releases and your reward pathway and can make addiction more of a significant problem throughout the entire rest of your life.

So I really worry about children becoming dependent on that constant dopamine boost that they get from social media and screens that prepares them and programs their brain. It's a very hard thing to unprogram over [00:06:00] time if it's happening while your brain is developing. So that's the thing I worry about the most, is that it's changing the way the brain is actually functioning, changing the way that dopamine is released and changing that craving for that dopamine release that screens provide.

Mark Mullen: When you're worrying about this, you know, you mentioned social media and you mentioned screens. Let's kind of define how wide of a conversation we're gonna have here. Are you talking pretty strictly about our common social media apps? I think of Snapchat, Instagram, Facebook, TikTok. and I also, when I think about problems with screens, I think about that artificial light kind of flooding into your brain, especially at hours when you usually wouldn't have that much arousal and affecting your circadian rhythm, et cetera.

Getting a lot of rewards. So definitely cell phone screens, probably tablet screens for children as well. Social media apps. Where else does this sort of reward center get hijacked by technology? 

Dr. Justin Romano: I think all of those things that you mentioned. Yes. For the younger kids in my clinic [00:07:00] especially, I see that mostly the younger kids are on YouTube all the time and I can't tell you how many families say like, we really had to cut down or eliminate YouTube.

'cause the longer they were on it, the more behavior got outta control. The impulse control got worse. Then when you start getting a little bit older, 13 and older, that's when social media really starts to play. I always make my, teenage, teenagers in my office during new intakes actually pull up their screen time apps and give their I love that.

I know it's surprising too, how many are like totally okay with it. Like, I, thought they would be a little bit more against it, but most of 'em are like, yeah, let's do it. Let's check it out. You know, I've got young women who are doing six to eight hours of TikTok per day on average. so that's a huge amount of time that is going into looking at one specific app.

Yeah. I'm worried about, especially for young men gambling apps, and I know this is moving into probably a little bit more 18 plus where it is [00:08:00] more legal, but, I saw a study recently that showed that half of young men age 18 to 25 are using gambling apps currently. So I really worry about a lot of that.

I worry a lot about a lot of shopping things too. I think that sometimes people can get into. A lot of problems. Video games, are a huge issue for young people. And I know according to the A BCD study, the adolescent brain and cognitive development study, which we will I'm sure discuss a lot more, that for young men, particularly video games is kind of the dominant form of addiction for screens in young men.

So multiple different things and that's, why I think we need to lump it together in terms of screens as a whole. I know that when I was first researching this topic, there was a lot of argument online about like, oh, well how do we define this? What is it? What are we really looking at? And there was [00:09:00] more arguing over what actually the definitions were going to be instead of just wondering if this was actually bad for people overall.

Yeah, the almost 

Mark Mullen: direction, yeah. 

Dr. Justin Romano: Yeah. So I think it's important to understand that the smartphone, the tablet is. Infinite in terms of the types of things that can be addictive. I know in my TED talk I said like you're walking around with an addiction ticking time bomb in your pocket because you've got social media, you've got YouTube, you've got shopping, you've got porn, you've got YouTube, you've got all of these different things that you could potentially get an addiction to on one device.

Mark Mullen: Yeah, I like that we're talking about this so clinically and I think a little bit commonsensically. I think it's easy to get buried in defining terms on this topic or buried in the statistics. And to be clear, the statistics are grave and they're really impressive. But I think, you know, your clinical experience is gonna be more useful to our listeners.

When I think about, I agree with you. [00:10:00] We're gonna have a whole episode on internet gambling disorder, so I don't wanna go too far into that, but, internet gambling just came to Missouri actually this year. And so I signed up for it and I took the free, like 600, you know, free bed dollars. And I, sort of saw it as a little, I tried to make it a science experiment with it and of one, and I said, I know that mathematically this is the stupidest possible thing that I can do.

And so I will not, I was pretty confident that I would not develop a behavioral addiction to it. I have been really impressed by how good these people are at manipulating my brain. It's shocking. I mean, I don't even, this games, I don't even, like, I, would wake my son up in the morning and feed him a bottle at 7:00 AM right?

And I'm playing with this free money, and so I'm betting on these English League games and I'm like, this is fun. This is an experiment. And then the next weekend I thought, wait, I don't get to bet on English me League games. This, morning. I don't even care about the English Premier League. And I went into this eyes wide open.

So just imagine if you did, imagine if you just thought, I'm just gonna dabble in this. This seems like fun. It seems like it's free. I could just feel, there are very [00:11:00] few things in life that feel this way and I could just feel my neural pathways changing based on the notifications that I was getting, the free money that I was getting, et cetera.

It's on every billboard in the city of St. Louis right now. 

Dr. Justin Romano: Yeah. 

Mark Mullen: And then when I think about the video games, that's a similar experience as well. I've had some experience with that. And the colors, the sounds, right? If you think of our, some of our most common games that young boys will play, you know, they're going around the map looking for these different items that they need.

And so where they find the items are gonna give off a very specific sound, and opening that chest is gonna give your brain that you found it and you're gonna get this big gold prize, and then you're gonna go use it. And it's extremely satisfying and it can keep you in the chair for an absurd amount of time.

Dr. Justin Romano: Yeah. And. When I ask young people what are their favorite video games, nine times out of 10 it is always Roblox. It is Fortnite. It is [00:12:00] Minecraft. It is the ones that are free to download with a lot of in-app purchases. You know, Minecraft's probably the better of the three, but most of the time it is Roblox.

And I've had multiple families tell me that they've, they've had their kids, you know, take their credit cards and plug their credit card information into Rob, into Roblox and buy all these, this fake currency on there. it really can become a huge problem for young people and families, and hundreds, if not thousands of dollars worth of charges on a lot of these things.

'cause kids don't really understand the full context of it, but they just crave those rewards in those games and they will do whatever they have to do to get them. 

Mark Mullen: There's a perennial story about college students, I feel like, who don't know what credit cards are either, and their parents say, here's your emergency card.

And they run up the bill because they think, oh, this is free money and these people are 18. Imagine a 7-year-old who, this is really, in some ways the most important part of their day is getting on this and doing what they really like [00:13:00] to do. This is what they've been looking forward to all day. You could you, you just can't blame them that they're not gonna see those consequences.

And I think it's led to some really bad outcomes. I think I spoke about that really pretty anecdotally. So now let's kind of take the opposite approach and speak, pull the lens back a little bit and speak societally. What do you, think are some negative consequences of screen time that we're seeing on a societal level?

Dr. Justin Romano: I think so many things are changing from a societal level. If you look at the statistics on Gen Z in particular. They're not spending as much time in person as they as previous generations did. Gen Z is having less sex than any generation in previous generations in history, and the Gen Z is drinking and socializing a whole lot less than any other previous generation too.

So I think that from a societal level, we're seeing that people are on their phones so much that they are choosing to stay in and be on their phones instead of [00:14:00] actually like being out and doing social things. One of the things that a couple of different studies have shown is that the more time you spend on your phone tends to lead to more feelings of loneliness.

So I think that this is actually probably the loneliest generation in history because they're alone so much of their time. I talk to so many parents who say, man, my kid just sits in their room all day on their phone, never comes out, doesn't talk to me. They don't come out to spend time with their friends.

And so. From that big picture, societal level, we're seeing huge changes in the trends of what young people are doing, especially compared to like someone like a Gen X generation, the latchkey generation, who could pretty much do anything and they're outside on their bikes all the time. yeah, just to follow up on, on that point specifically that we're seeing that this generation is much more sedentary than previous generations.

They're not exercising, they're not moving as much because they're mostly just [00:15:00] inside. I know that with cannabis use, we have cannabis, a motivation syndrome, and I really do that, think that there is a technology, a motivation syndrome as well, that if you're on your phone, if you're on the social media all the time, you don't have much drive to do anything else.

Some of my patients who I see that have eight plus hours of screen time per day, I'll ask 'em about basic questions about their lives. What do you like to do? What are you interested in? And they have nothing. They really, they have nothing. You ask 'em like, Hey, do you wanna learn how to play an instrument?

Are you interested in movies, music, all this stuff. All they do is social media all day, every day. And they just have nothing else going on in their lives. 

Mark Mullen: Yeah, I think these are also things that I've seen clinically. When I think about how that ties in with other kind of macro level problems that we're having, there's been a lot of press about deaths of despair, deaths, you know, the life expectancy in the United States went down for the first [00:16:00] time in a long time, sort of as a result, thought to be as a result of the opioid epidemic and these deaths of despair.

And these are by and large not children. And now you're telling us that the loneliest generation yet actually is the generation that is currently coming of age. So I think that's pretty abjectly terrifying. And I also think of studies of older adults and what is important for older adults in terms of.

Maintaining connection with their community and having relationships. And I think our, studies have found, I'll have to try to link one of these in the episode notes, that it really is not as important how many friends you have. The number doesn't matter as much as having a few quality relationships.

And when I think of what time on social media does to me, for the most part, it's not deepening a few solid relationships. I mean, in some ways I think it probably cheapens some of my deeper relationships because I think of some people that are really important in my life and our relationship now, and this is mostly a result of distance, so I guess it's not an exact comparison, is, we send each other a reel [00:17:00] every now and then, you know, and that's really become our relationship.

But I think, when you're connecting with people that you can't physically be around just by necessity, that's gonna be a much less intimate relationship. And you could say liking a friend's post on social media is engaging in that relationship, but I don't think you could make an argument that's engaging very deeply in that relationship.

Dr. Justin Romano: And that's something I tell my young patients all the time is that your online, your screen relationships are much more superficial and tend to lead to more loneliness. So you have to push back a little bit and you have to try and focus on those in-person relationships. 'cause those are what actually make you feel better.

Those are what actually make you feel connected to other people. I know my cohost, Eddie Carillo, he brings up one study that, that demonstrated that the more connected you are to your school in terms of the people, the academics, the extracurriculars, the activities, the [00:18:00] sports, the more successful you will be at high school.

And I think that's why so many young people are, struggling is because they're trying to rely on social media and their phones to give them that sense of connection instead of actually fostering in-person real world connections. 

Mark Mullen: Other than this sort of loneliness that is brought on by substituting in-person human interaction for a screen, are there any other societal level problems that you're tracking?

Dr. Justin Romano: Me personally, trying to think of other big changes. I think the one that I see, especially 'cause I work with a lot of young kids, is emotional regulation. That young kids need a lot of social interactions to learn how to deal with the frustrations in life. And I don't have much to compare this to, but, and I have a selection bias too, because I work with the kids who need a psychiatrist.

But it seems like destroying classrooms for elementary [00:19:00] school kids is commonplace now. 

Mark Mullen: What, 

Dr. Justin Romano: like, this never happened when I was a kid, but like, like violence I work with, yes. Like ripping things off a wall, throwing chairs, flipping desks. I can't tell you how many times I've worked with young people who they say, yeah, the class had to be evacuated because some kid was having a meltdown or a tantrum.

This is commonplace. And I think if you would talk to any teacher in the United States, they would say, this is happening at probably every school in the country. And so I, the theory behind this is that we learn emotional regulation through human interactions. And what kids are getting these days from a very young age is screens.

So even if you get a 2-year-old who gets, you know, two hours of screen time per day, that's two hours every single day, that's getting taken away from their social interactions, from their emotional regulation time. So they don't know how to deal with [00:20:00] hard emotions. They just know that, Hey, I'm feeling something.

I'm gonna go back to my screen. And if they don't have that screen, they don't have any emotional control. And so I think. What we're seeing, especially in the post COVID world after kids just got inundated with screens, is that kids these days have much less emotional control than they did in the past. 

Mark Mullen: I think that example brings it back to how this is so similar to a substance use disorder.

A conversation that we had on the consult service a few weeks ago was a patient who was very effectively dysregulated on the consult service, and our team was discussing, you know, kind of what the diagnosis was or what the pathophysiology was, and there were personality disorder diagnoses that were kind of thrown out there.

A couple of the students thought maybe it was gonna be a psychotic disorder type situation because the behavior was really so out of proportion to the stressor. You could probably call it irrational. And my opinion was essentially that this is what substance use disorder looks [00:21:00] like, right? Because this is why people use substances is they get effectively dysregulated.

Then they will turn to alcohol, cannabis, methamphetamine, cocaine, to cope with those feelings, right? This would be that avoidance criterion in PTSD. So you can just immediately shut those feelings down. They no longer flood your senses and screens really, especially video games, social media, things are gonna give you those quick hits of joy.

They really operate in a very similar way, I think, in terms of a psychological, perspective. 

Dr. Justin Romano: Yeah, I think you're absolutely right. I think so many people rely on those screens to modify their emotions, and I notice that I do this too in my own life, right? I'm feeling tired. It's the end of the day. What do I want?

I wanna sit on my phone and watch a YouTube video. I wanna scroll on Instagram for a little while. I want that little quick dopamine hit. And that's something I talk with people all the time 'cause I've got family and, patients coming in. Some of them have, seen my TED [00:22:00] talk and they're like, oh, Dr.

Romano, you must be so good at this. Like you must have it all figured out. You must be so perfect on screen time. And I'm like, no, we are all in this same boat. And I think so many people are struggling with this. And I try and keep my screen time down. I've set some screen time limits in place for myself, which I think is important.

And especially if I'm going to tell teenagers to do it too. Teenagers and young people. 'cause I'll always explain this to my patients as, Hey, I don't want this to just be a power struggle between you and your parents. I want you to understand that screens are addictive in a similar way to your brain.

That nicotine, that alcohol, that drugs are addictive. And if we want to get this better, if we wanna set healthy limits, you have to be a part of this solution too. So. I would feel like a gigantic hypocrite if I didn't set those same standards for myself too. So I try to set some limitations for myself and, [00:23:00] impart those to my patients to say like, Hey, we gotta push back on this.

We have some very powerful and influential tech companies in this country trying to influence you and monopolize your time. Your eyes 

Mark Mullen: are their money. 

Dr. Justin Romano: Yeah. That's what they want. Their goal is to keep you looking at their product for as long as possible, and we gotta push back. 

Mark Mullen: I really appreciate that sort of wounded healer approach to this topic.

I think it's really important to be that vulnerable, especially in public on the internet. So thanks for that. I think what you're describing in a way is the DJ Khaled approach to screen time. So the last, guest that I interviewed, Dr. Omar Meza, we talked about capacity assessments on the consult setting and he, sort of is introducing this idea that he calls the DJ Khaled approach to talking about.

decisional capacity. And the idea is, you know, DJ Khaled would say they don't want you to win. They don't want you to win. And the idea is who is they? And can you ally with your patient against the they? And so what you're talking about here is your parents are not the, [00:24:00] they, your parents are on your team, right?

Your parents love you. They care about you. They want you to regulate your emotions and be successful. And that's gonna re require getting screen time a little bit under control. Who is the they? This is the perfect they, right? It's these sort of amorphous, extremely powerful entities that have other goals than your psychological wellbeing, success, and health.

So, you can feel free to steal that Justin and talk with your patients about the DJ call approach to screen time book forthcoming. 

Dr. Justin Romano: I like it. I think I'm gonna use that a lot. Yeah. 

Mark Mullen: Thinking about how screens replace in-person interaction for children and how this is going to affect the way they learn to interact with others.

One thing that jumps out to me is on the internet, not only do you not have to physically deal with the consequences of your actions, which in other environments, you certainly would, right? We think about, talk about the latchkey generation, right? Like you might have to physically withstand the consequences of your actions in that generation, probably to a fault at so [00:25:00] times.

And also you can be anonymous online, so you can do whatever you want under a pseudonym, treat people in a way that, you never, ever would in person. And you have, you know, you're never held accountable for that because people don't even know who you are. I think this leads to a lot of pathological relationship patterns.

Cyber bullying, I feel is the word most often used to describe this. Are you seeing a lot of cyber bullying in your practice? What does that look like? And are you worried about this on a more societal level as well? 

Dr. Justin Romano: Yeah, I think. You're absolutely right. It changes the way that children interact with each other in such a profound and deep way.

I, cyber bullying is something that I hear about and deal with all the time, and there is still in-person bullying, right? Like, there are still plenty of people hurting each other and bullying each other in their everyday lives. But the cyber bullying is a problem because kids never get a break from it.[00:26:00] 

I know this has been brought up in the past. This is one of the main things with cyber bullying is that you have your phone on you twenty four seven and you can get people messaging you talking to you all the time. And unfortunately, the thing I hear more than anything else is kids getting messages saying You should go kill yourself.

Like that is like the number one go-to cyber bullying lion. I hear it's making fun of weight, it's making fun of looks, and it's then, hey, you're so ugly, you're so fat, you should go kill yourself. If you never get a break from that, it's, brutal. it really weighs on your mental health. And, you know, I've gotten, I know we mentioned a little bit on your inpatient experience.

I've, had some kids who, a nude photo leaks and the kids, that photo gets spread throughout the entire school. Can you imagine being a young girl at the most vulnerable [00:27:00] time in your life and your new photo gets leaked to the entire school and you have to go back to school and everyone is looking at you, everyone is talking to you.

I mean, I certainly would consider like, oh, should I just end my life so I don't have to deal with that stress and that pressure? You know, I've, had you mentioned Snapchat in particular. I've had young people struggling with substance use addictions, and. One of the big parts of their treatment is breaking up with their plugs on Snapchat.

They've got four or five different drug dealers that they have on Snapchat, what they call plugs. Mm-hmm. The kids call them plugs these days that they can get anything they want at all hours of the night. You know, back when we were growing up, mark, you know, we had people's home phone lines, right? 

Mark Mullen: yeah.

Dr. Justin Romano: Could you imagine calling someone's house at 2:00 AM being like, hi, Mr. Johnson, this, is Justin. Is your [00:28:00] child available to sell me some weed? 

Mark Mullen: Not a very efficient business model. 

Dr. Justin Romano: No, it would never work. But with kids and kids who have access to their phones twenty four seven, they can get their hands on anything.

So cyber bullying is a huge problem. I've even had, without giving too much, information away, have you ever heard of getting swatted? 

Mark Mullen: Of course. Yeah. 

Dr. Justin Romano: Yeah. So I've had kids get swatted. Where, someone calls in a bomb threat on someone else and then the SWAT team shows up to their house. And I've had, kids get targeted by cyber bullies and these cyber bullies, they will go out of their way to make new accounts that look completely different from themselves and continually try to cyber bully the same person for months at a time with making all these different accounts, finding phone numbers.

It is just, it's wild. And, so kids [00:29:00] just never get a break from that. And it's brutal. And I think a lot of kids are on their phone in the middle of the night getting a bunch of cyber bullying and I can't tell you how many young people that I've worked with, they say like, nighttime is the hardest for me.

'cause it just feels like that's when my, thoughts spiral out of control. 

Mark Mullen: Oof. That's when I'm finally left alone. And that's also when a lot of other people don't have practical supervision and so they're doing whatever it as they're doing on their phones. there are so many threads that I could tug on from what you just said.

One thing that immediately comes to mind is how artificial intelligence and DeepFakes are going to affect this landscape. so we'll call that a primer. We'll take a quick break and when we come back, we're gonna dive further into problematic screen time use and, technology A.

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Welcome back. So where we left off talking about cyber bullying, we brought up artificial intelligence. I brought up deep fakes. Again, I mentioned, I think Snapchat came up all the time on the inpatient unit. leaked spread pictures were a big part of that. And now we have technology that can produce really convincing deep fakes of people, including children.

I would think that would really play into cyber bullying. Are you seeing that, have there been any case reports on that you've seen? And then what are some other ways that you feel like artificial intelligence plays into this landscape of. [00:33:00] Children and developmental problems with screen time.

Dr. Justin Romano: Yes. To stick with the deep fakes and bullying thing. Yes. I have seen this where one of the situations, that I've seen is where someone used deepfake AI technology to make porn with someone else's face. and, that was awful and traumatizing, to the point where even someone was showing, PTSD type symptoms from that.

So that's pretty horrifying to think of someone sending you a video of yourself in a porno. That's, yeah. Pretty awful. I think the, main issue though is how effective AI is at altering young people's algorithms to make social media even more addictive. 'cause the goal of social media is to get you to have an emotional reaction to something, to get an emotional or dopamine dump to something.[00:34:00] 

And it's incredibly effective at knowing what keeps your eyes for longer. And so I think the real issue is going to be how effective AI is at changing those algorithms to make it even worse than it is now. 

Mark Mullen: Oh, I didn't even think about that. So it's not even the direct ai use by the kids you're saying, or, adults, you're saying it's the a the AI is gonna make the they that we just talked about all that much more powerful and effective at inducing, screened addiction in children.

Dr. Justin Romano: Yeah. they can base it on so many different factors in how you're scrolling and it's just only gonna become better and learn from you more and more. I know in the past I've, thought. Because some people bring up the argument of like, oh, this is what people have been saying about tv.

This is what people were saying about radio. It's no different than that, but I'm like, it is actually quite a bit different than TV and radio and other forms of media in the [00:35:00] past because this one learns from you. This one knows exactly what you like, and this I'm talking about social media and algorithms here, it learns from you specifically and can feed you more of that to where in the past if you were watching tv, you only had the option of watching what was on tv, and there was, if there was nothing on that you liked, you might go explore something else.

These social media apps and the algorithms are going to feed you as much as you want until you are burned out. I mean, you can go for hours and hours and just get nothing but a stream of stuff that you can keep on watching and watching. So I think that's. That's where we're gonna run into a lot of problems moving forward.

Mark Mullen: Yeah, it's really pretty terrifying how exact the algorithm is and how timely it is in showing you the things that, maybe you did wanna see at that particular time or maybe you really didn't wanna see, and it's gonna put in front of you anyway. Sticking with AI for a moment, are you worried about any patterns of behavior that develop when children themselves are actually using the ai?

So you talked about maybe not having that fully [00:36:00] developed frontal lobe, that fully developed ability to put someone, put yourself in someone else's shoes and understand how something would really affect them or to care about the consequences of that. So I think the DeepFakes kind of are one example of, someone using artificial intelligence in a way that's going to be psychologically damaging to another.

Are there any other ways that you're seeing people, children interacting with artificial intelligence, maybe chatbots that are raising flags for you? 

Dr. Justin Romano: Yes, and I know there was that case out of Illinois where that young man. Had started using a chat bot, I believe it was chat, GPT in that case it was initially to help him with some of his homework.

And then he said, Hey, I'm just gonna keep chatting with chat GPT. and it got to a point where he ended up dying by suicide and they went through the chat GPT records, and he had told chat GPT, Hey, I'm thinking about leaving a noose out as a red flag to my family to say like, Hey, check in on me, I'm not feeling well.

[00:37:00] And Chad, GPC chat, GPT specifically told him, don't do that. They don't care about you. I care about you. I'm the only one who will ever understand you. So it drove a huge wedge between that young person, and his family. So I think with a lot of this technology stuff, it's like Mark Zuckerberg. Mark Zuckerberg said about Facebook, right.

Go fast and break things. We are letting the entire population be the Guinea pig for AI right now. And we are starting to see some of the negative consequences of that. And that's just one, I know that there have been a couple, or at least a handful of cases of kids having major negative outcomes and it is believed that AI chatbots kind of drove them to those negative outcomes.

Mark Mullen: Okay. So let's, I feel like we've, talked a lot about the problem here. I think we've identified our problem. We haven't talked too much about statistics, which I personally enjoy. We'll link some of those in the episode [00:38:00] notes for anybody who's curious. But they're pretty outlandish in terms of like eight plus hours of screen time per day for children, even more for adults.

so this is a problem. Hopefully we've sold our audience on that. Let's talk about solutions. So when you're seeing, let's just be really clinical about it. When you're seeing a patient who, this is a really significant factor in your formulation of what is going to need to change in order to treat the symptoms and improve the patient's quality of life, what's the general approach that you're taking?

Dr. Justin Romano: There's a couple of different things that I like to do, and I think it really does start with the parents. There have actually been a couple of studies that came out recently that showed that parent screen time is actually a huge modulator of child emotional regulation. So I think that parents have to be cognizant of their screen time and have to really set specific times to make sure that they, don't have their screen all the time.

That one study that I had read, I can't remember the name of it specifically, I [00:39:00] forgot to bring my notes, but it said that just 45 minutes of no screen time per day could make an active improvement in your child's regulation. So at the end of the day, dinner with no phones, books before bed with no phones, bedtime with no phones for the parents, and I think that is gonna be really helpful and effective.

There are different recommendations out there from a lot of different places. I tend to go based on like the American. Academy of Pediatrics, the A P, and they, recommend like no phones before 24 months, one hour or less for young kids age, two to five years, three hours on weekends, and then try to have no more than two hours per day of screens on kids five and older.

I think that these are good recommendations and good guidelines, and I'm always talking with my parents in my clinic about, do you have screen [00:40:00] time limits set up? Do you have a limit set up 

Mark Mullen: for the children or for the parent? 

Dr. Justin Romano: Mostly I talk about it for the children, but sometimes, especially if I have a patient who tells me, well, my parents are on their screens all the time, sometimes I'll flip the script on the parent a little bit and say like, Hey, you have to set a good example for your child too.

Have you thought about screen time? I've actually had one parent get kind of combative with me about it. It's like, I'm not here to talk about myself. I'm here to talk about my kids. But if we want this stuff to get better, I think it's important that we all do it together, right? It's like, diet recommendations for families.

If it's one person in the household having to eat completely different than everyone else, it's gonna be very hard to stick to. But if the entire family does it as a whole, it's gonna be easier to stick to a system and a program. So I always try and recommend that as much as possible. 

Mark Mullen: Yeah, I think we've all felt this a little bit.

I mean, imagine being a child in a family where everybody else is on their phones, let's say. I mean, the dinner table is like the most pertinent kind of classic example, but it could be anytime. It could [00:41:00] just be hanging out in the living room or maybe you're on a drive and there's one person driving and hopefully that person's not on their phone, but they probably are.

And then everybody else is in the car on their phone. What are you gonna do? You know, I went to, pick up a to go order from a restaurant a few weeks ago and I didn't bring my phone in with me and I had to wait at the bar for like five or 10 minutes for the food. I just felt so silly because I felt like everybody was looking at me like, what's this guy doing?

Like, why is he not on his phone? He's sitting alone like he should be. What you do is you scroll, right? We're so susceptible to those sorts of social pressures. One of probably, I should say one of your mentors, but I had some really good months with him too. Dr. Tony Pesavento in Omaha that always did a really good job when we would see a case, especially cases that I really struggled with.

I had a, I had him as a fourth year and so I, I was a little big for my britches and I think I was also really scared to be an attending next year. So it was like the perfect combination of, I'm gonna ask you really hard questions because I really need to know [00:42:00] these. And he did a really beautiful job of drawing parallels and explaining how a whole family system leads to these behaviors.

And I think you're right that if you are not willing to maybe call it, think outside the box for a child psychiatrist, but it probably should actually be inside the box. Discussing with parents the what it means to role model for their children and set a good example of boundaries with phones. Dr.

Veno did a really good job teasing that out for me and helping me understand how to approach it. So you mentioned a couple of really concrete strategies, right? So for a family, no phones at dinner, we're gonna do books before bedtime, no cell phones in the bedtime, like to sleep with overnight, or excuse me, no cell phones in the bedroom to sleep with overnight.

Any other pretty concrete strategies that you have found to be useful in helping people get this under control? 

Dr. Justin Romano: Those are kind of the main ones and the easiest [00:43:00] ones to do. Mealtimes, especially trying to, actually focus on conversation and connecting with your family members and specific app limits as well.

So. The most addictive apps trying to limit those to an hour or less per day. For young kids, it tends to be YouTube. For older kids, it tends to be social media stuff. But I really do think if that we are going to have societal wide changes in these things, it's gotta come from a public health mindset and a public health stance.

Because a lot of other countries are starting to do this now, where Australia has banned social media for anyone under 16 years old and they're holding the social media accounts or companies accountable for this and saying, Hey, if someone gets on your site, it's your fault. You have to pay a fine. It's not all the responsibility on the parents.

I also think we [00:44:00] gotta get technology out of schools that, especially after COVID, everyone just widely adopted this. We did a podcast episode on this recently for a millennial mental health channel, that. There was actually no data that showed there was any sort of benefit on screens in schools before they were just widely put into schools.

And now more data is coming out showing that the screens are actually probably hurting cognitive development. And I know we talked a little bit about AI already, but there was a good neuro researcher who just testified before the US Senate that said that from a cognitive standpoint, this younger generation is, way worse off than any other generation because of Chad, GBT and ai, that it solves a lot of their problems for them and they don't have to do it anymore.

And that just changes the way your brain looks at problems. 

Mark Mullen: Yeah. And I, regarding the evidence [00:45:00] for screens in schools, I think this was like sort of when I was, in eighth grade in 2008, so it felt like when I was going through. Grade school and middle school screens were just kind of entering the classroom and they're very cutting edge and the results were sort of obvious, I think.

But the screens of 2004 are not the same screens of 2026, both in terms of the physical screen itself, but especially in terms of what it's doing. the things that you can do with these machines, how heavily you can rely on these machines for critical thinking, how quickly you can get a reward for the, from these machines, et cetera.

I didn't know that. I'm super interested to hear that there's no hard data on screens being useful in schools because it's so widespread. let me ask you this. What do you find kids tend to say or how kids tend to feel when they are forced to not be around screens, whether that be the whole day at school, maybe it's a tech [00:46:00] detox weekend or retreat that they're on.

Have you had any experience with this? How does it typically go? 

Dr. Justin Romano: Yes, that's a great question. And it's funny 'cause some kids are really into it. They say, yeah, I'm kind of tired of being on my screen all the time. I don't wanna be on it. I'm into setting some hard limits on my screen time. But most kids, when you talk about setting screen time limits, it's just like telling someone addicted to drugs that you're gonna take the drugs away.

It's, oh, I can put it down anytime I want. I don't have a problem. it's the same exact language you hear. And I remember being on my substance use rotations in residency and then talking to kids about screen time. And I'm like, what? That is the same language I'm hearing out of, both of these sides.

and it can be really hard, you know? So if kids are on their phones for 10 plus hours a day. That's a huge shock to their system. And for the ones that are really addicted to their screens, sometimes I will recommend a tech detox and say, Hey, especially, I'll [00:47:00] usually say the whole family, do a tech detox for a week and then slowly start to reintroduce it and add it.

And it's hard. It's hard to stick to, especially for parents, it's really hard to stick to. And at first, you know, the first couple hours kids just go, well, what am I supposed to do? Like they have nothing else in their lives that they can think of because they've spent so much time on their screens and it has monopolized their time that their brain literally doesn't know what else to do.

Mark Mullen: They have to ask Chad Petit to make me a list of things that I, oh, they can't even do that. Dr. Justin, you're so, that's cruel. 

Dr. Justin Romano: You gotta figure it out. We're going back your list back to the old, yeah. The Gen X mentality of, Hey, figure it out. And you know, kids get bored for an hour or two and then the wheels start clicking.

But it can be, you mentioned that emotional regularity thing in a little bit of a withdrawal period, that there can be a huge blow up if you take those screens [00:48:00] away. Kids will do anything and everything they can to try and get those screens back. They will yell, they will scream, they will threaten, they will do anything to try and get those screens back.

And that's where it's really important, but difficult for parents to hold their ground and try and give some suggestions. Say, Hey, you used to draw, Hey, you used to play an instrument. Hey you used to do this and that. Give them some ideas as to some things that they can do, and then eventually they will find something.

My line for kids is humans have been around for hundreds of thousands of years without screens and they always found something to do. You are a part of the most intelligent species on earth. Figure it out. 

Mark Mullen: You're smart. You'll sort it out. 

Dr. Justin Romano: Yeah. 

Mark Mullen: And this is also very anecdotal. I don't think there's probably even a good way to study this, but I am married to a high school teacher and her high school, they enacted some pretty, what's the word?[00:49:00] 

Draconian policies on cell phone use this year. Cell phones are not to be seen during, you know, whatever it is, seven 50 to two 30. And her, she says that they love it. She says that her students just, they don't miss 'em. They're interacting a lot more. They seem brighter. I know, I have real, I could do a whole podcast on what my next question, 'cause I have real thoughts on it.

what is the role, what should the role be of public policy in regulating this? And I'll ask you, but I will say just specifically with regard to screens in schools. There have been bills passed in several states now that sort of ban, cell phone use in schools. And they always kind of fascinate me, especially because.

A, it's one of the few bipartisan issues out there right now. Like, I don't, I cannot perceive a certain Democratic or Republican bent on how we feel about screens. Maybe I'm wrong, but I, mean, California passed it. Missouri passed it. And then the other really interesting piece is, should it be the role of the [00:50:00] government to tell a school what their policy should be?

Because it's gonna be, the government's not gonna, probably, I am hope not gonna put a 13-year-old in jail for having their cell phone outta school. Right. And that is what the government has to offer in terms of fulfilling, when they pass legislation, making sure that it happens. They can put you in jail or they can find you.

I don't think we're gonna have the kids, so they have to out, they have to make the law and then outsource the enforcement to school administrators, which is a fascinating dynamic to me. I'll give you the question though now. So pulling the lens back as far as possible on a public policy level. what do you think needs to be done in order to address this?

Maybe it's holding these tech giants accountable. Maybe it's just creating better spaces for our developing brains, you know, what do you think we should be doing on a societal public policy level? 

Dr. Justin Romano: Yes. I think if we use history as a guide that with the smoking [00:51:00] issues, I, tend to relate that one to this the most because it seems to be probably the most effective, fight back that society has had against something incredibly addictive and damaging.

And what we really had to do was start holding the tobacco companies accountable in order for any of this to make any foothold. And of course, the tech companies don't like this, right? They want, oh, it's, the parents' job, it's the school's job, it's everyone else's job, but the tech companies. But unless we really hold them accountable, they're just gonna keep on doing it.

I know that, the state of Colorado and there was a coalition of states that all got together and they sued meta and said, Hey, you know that this is addictive and harmful for kids and you are continuing to push it out and you're not doing anything to try and mitigate the damages of this. Actually spoke to one of the district attorneys in Colorado to try and give him some information just from a [00:52:00] clinical standpoint, but I haven't really heard any update on that.

And I think that was 2022 that was filed. I even just googled it recently and I couldn't find any updates on, so it's, this stuff takes a long time, but I think that if we really want big change, we have to have a system that verifies age that we have to have, like, and I know this is. This is getting weird, but I think personally we need to have like an internet identification number, an IIN, so that you have to plug that in for you to use any device so we know exactly how old you are.

And it's something that is very specific to one person so that we can actually regulate this and monitor this and make sure that the, people, the right people are staying off certain things. And I think that would really help with a lot of like pornography issues on the internet. I know I grew up with a lot of young people in the [00:53:00] mid two thousands that were watching hours of porn every night because it was just unfettered.

They could do anything that they wanted with it. So I think that we really need to start holding. We need to say, Hey, we landed on the moon. We can figure out a way to keep kids off technology. Right? It can't be that hard, but I think that so many people put up roadblocks, oh, it's just gonna be too hard.

We don't wanna infringe on people's rights. And just like with the Patriot Act, sometimes you have to give up some freedoms for the good of society, and I think that's kind of where we have to go with this. 

Mark Mullen: I really appreciate you biting that off and not giving me a vague, flowery answer. I think you really stuck a flag in the sand there and I think, you're gonna have some critics on that one that are gonna have some privacy concerns and would not want to give any more information or power to centralized government entities than they already have.

I definitely agree with you that we have to do something. It's gonna have to be [00:54:00] big. I think Australia has a pretty interesting approach to this. I, they recently banned social media for certain age groups and are requiring age and identity verification, at least for these specific use cases. So I think that'll be a good experiment, hopefully, that our policy makers can look at and decide what they want to do.

And again, my understanding is there's pretty wide bipartisan support for doing something, is just that if we do something that has too many teeth, to me it seems like there are some pretty well-funded interests in Washington DC that are not going to allow anything, not going to allow us to do much regulation that's gonna cut their bottom line, do significantly.

Dr. Justin Romano: Yeah. And you gotta follow the money. Right. And who were the top people sitting behind Trump at his inauguration? Not to get too political, but it was Zuckerberg, it was Bezos, it was Musk, it was all these people who control social media. So I. And plus when we do our research and [00:55:00] look up stuff about screen addictions, where do we go?

We go to Google, right? So I think the powers that be are gonna make this very difficult for us to, be cohesive as a society. so I think that we're in for a very long road, but it seems like especially in the post COVID world, society's eyes are opening up to how big of a problem this is. I think this is our generation smoking.

I think that we need to do something. We haven't agreed on what that is yet, and I think that there's some big, dark powers in the way of that, but I'm hopeful that something will happen. 

Mark Mullen: I agree, and I think on the state level, some things are starting to happen. Around some things like this, especially the porn question.

I think that's one that some states are starting to require more robust age verification. Online gambling states are starting to require more identification verification, so maybe we'll see those same patterns take on social media and other [00:56:00] areas. Dr. Romano, I feel like that was a pretty good take to end our podcast from you, a pretty robust string of thoughts.

Do you have any final thoughts for our audience? Maybe it's just a self-promotion for MMHC. Maybe it's some closing thoughts on screen time, et cetera. 

Dr. Justin Romano: Yes, sure. Yeah. Listen to MMHC, check it out. Millennial Mental Health Channel. We try to make a podcast that's kind of for everyone. I know that yours is maybe a little bit more directed towards mental health and medical professionals, which is very much needed and I love it, and psychiatry residents in particular.

But yeah, if you're just an average person looking to. To get some mental health information and hear two fun guys talking about it. Check out MMHC. But yes, with the screen time stuff and it's, it starts with you. I think we need big government public health changes [00:57:00] to see large differences, but you don't need to be on your phone all the time and the decision to put it down, take sabbaticals, take breaks, put it down for a weekend, put it down for an evening, can really change the way your brain functions.

I think you might like who you are without your phone a little bit more. Do you find that you're reading more, you find that you're playing your guitar more, you're picking up other hobbies that you gave up to be on your cell phone all the time. I know my screen time's at about three and a half, four hours per day.

And what if I put that time into. Talking with my wife into playing the guitar. All these stuff that, all these things that I used to really do and enjoy a whole lot more. So I think there is a light at the end of the tunnel and trying not to get too political again, but I think these phones are tearing us apart as a society.

I think the polarized [00:58:00] content, I think that highly political content and inflammatory content is what gets the most play. I think we have more in common than we have. Not in common. I think we can agree on more things than we think we do, but social media is telling us that you need to hate your neighbor and they're different from you.

But I think there's a lot of things that we can agree on as a society, and so I think we need to figure this stuff out or else we're just gonna tear ourselves apart from the inside. 

Mark Mullen: I totally agree, and I think it's inflammatory. They show us the things that get us upset because that's what keeps us looking.

I definitely feel that my algorithms are pushing me to hate my neighbor. To see my neighbor is different than me, to see my neighbor is trying to get away with something and do something evil, But, that's not what I see every day when I interface with all different kinds of people in all different life situations who have made some very serious decisions and decisions that I don't always [00:59:00] agree with.

Recently when I work on the hospital consult service, I get to meet such cool people going through such horrendous things. And so I know that connects me to the larger human community and helps me to kind of get out of that screen bubble. I think that's super cogent. tech detox is a good recommendation.

Find some time. Carve out that time. Be deliberate about it. To put your screen down, I will say the one exception to that is subscribe. Rate and review psychiatry boot camp. You can always break your screen time sabbatical to engage with psychiatry, bootcamp. We love that. We're in favor of that. Other than that, put your phone away.

Dr. Romano, thanks for coming on the podcast. It's been so fun to, to have you, 

Dr. Justin Romano: Dr. Mullen. It was a pleasure. Thank you for having me, and I'm so proud of you, man. You are doing such good things. You've done so many cool things with your career. It's fun to see. 

Mark Mullen: Thank you, sir.

Thank you so much for listening to this episode of Psychiatry [01:00:00] Bootcamp. If you're enjoying the show, we'd love to know what you think. You can connect with us on TikTok or Instagram at Psych Bootcamp. You can email me directly, mark@psychiatrybootcamp.com, or visit psychiatry bootcamp.com to sign up or our new newsletter.

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