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Interview
12 June 2022 2.00 h

Cristina Lombardía

CHILD AND YOUTH PSYCHIATRIST

“We need to help young people fill the gap left when they have to give up their screens”

The psychiatrist talks about how easy it is for young people to become addicted to online activity and how difficult it is to wean them off digital devices and encourage healthier behaviour

“There’s a distinction between abuse and addiction. Abusive use of screens affects 20% of adolescents, while addictive use affects about 4%“

Since June 2019, Dr Cristina Lom­bardía has been head of child and youth men­tal health at the In­sti­tut d’As­sistència Sanitària (IAS), a pub­lic in­sti­tu­tion pro­vid­ing spe­cialised med­ical at­ten­tion to the Girona re­gion.

What are we talk­ing about when it comes to screen ad­dic­tion in chil­dren and young peo­ple?
There’s a dis­tinc­tion be­tween abu­sive con­sump­tion and ad­dic­tion. In fact, screen ad­dic­tion is not yet recog­nised as a dis­or­der. Yet what we gen­er­ally mean by it is using the in­ter­net in an ex­ag­ger­ated way in which var­i­ous char­ac­ter­is­tics occur. First, the dif­fi­culty of con­trol­ling the use; sec­ond, the need to use it more and more; third, stop­ping using it leads to symp­toms of ir­ri­tabil­ity, anger, dis­com­fort, and so on, and has an im­pact on so­cial func­tion­ing, study or work, and fam­ily life. We need to make a dis­tinc­tion be­tween the abu­sive use of screens, which af­fects be­tween 13% and 20% of ado­les­cents, and ad­dic­tive use, which af­fects about 4%.
Who is most at risk?
Above all teenagers, who can spend an av­er­age of four hours a day on­line, es­pe­cially play­ing games or using so­cial media, which have risks. For ex­am­ple, using so­cial media can lead to cy­ber­bul­ly­ing, sex­ual ha­rass­ment, or ex­po­sure to sex­ual con­tent.
Is the high per­cent­age of screen abuse among teens due to the pan­demic?
Usage lev­els were high be­fore but as screens are also used to so­cialise it has gone up tremen­dously dur­ing the pan­demic as it was one of the few ways young peo­ple could con­nect in a healthy way. An ar­ti­cle I read last April said that the time chil­dren spend in front of screens has gone from 2.6 hours a day be­fore the pan­demic to 5.9 now. But the point is not just that kids and teens are spend­ing more hours con­nected, but what hap­pens when they are con­nected.
What are the warn­ing signs?
Sleep­ing less; below five hours a night. Also changes in so­cial func­tion­ing, such as not going out with friends or not want­ing to do fam­ily ac­tiv­i­ties; be­hav­iours show­ing a de­sire for iso­la­tion and a re­luc­tance to leave the house. An­other thing is aban­don­ing or putting off aca­d­e­mic work and other re­spon­si­bil­i­ties. Char­ac­ter changes is an­other thing: if they are more ir­ri­ta­ble, es­pe­cially when lim­its are im­posed and it be­comes clear that their only in­ter­est is being on­line.
What can par­ents and teach­ers do if they see these warn­ing signs?
When you de­tect these signs, it’s im­por­tant to find out who your child is con­nect­ing with and what they’re doing while con­nected and then ask a pro­fes­sional for help. They’ll have to work on re­duc­ing screen time and switch­ing to other ac­tiv­i­ties to com­pen­sate; pro­fes­sion­als can help find what teens need to fill the gap. This can be a big prob­lem be­cause they have no other areas of in­ter­est.
Can par­ents do it by them­selves?
If they see what’s hap­pen­ing and can set a sched­ule and lim­its. It’s very hard but par­ents must su­per­vise their chil­dren’s sched­ules. This can cause huge dis­com­fort for young peo­ple, first be­cause we’re tak­ing away some­thing they con­sider plea­sur­able, and sec­ond be­cause we’re leav­ing them with pe­ri­ods of time that they don’t know how to fill be­cause they have no cop­ing strate­gies.
Dur­ing the pan­demic screens helped young peo­ple to so­cialise, but was it the same for all young peo­ple?
Many used screens for so­cial­is­ing, and con­tinue to do so, al­though boys tend to use screen time for leisure ac­tiv­i­ties while so­cial­is­ing is more com­mon among girls. Al­most 80% of teenagers use screens in what we might call “a healthy way”, but there are so many things on the in­ter­net, such as games or in­for­ma­tion on top­ics that in­ter­est them, that can keep them glued to the screen. We should also keep in mind that for those young peo­ple who have prob­lems with ad­dic­tion, there is a pre­vi­ous his­tory. Whether it is young peo­ple who don’t have ad­e­quate so­cial re­la­tion­ships, low self-es­teem, or who are cop­ing with school fail­ure, there are a se­ries of per­sonal and re­la­tional risk fac­tors.
As well as parental su­per­vi­sion, what else can be done?
Par­ents have to talk to them and try to un­der­stand them. If they are al­ready too de­pen­dent on de­vices, they don’t see it as an ab­nor­mal or patho­log­i­cal sit­u­a­tion. No young per­son recog­nises the prob­lem and they say they do it be­cause they want to, be­cause their friends do it. It’s hard for them to see it as a dis­or­der. This is where pro­fes­sion­als can help, work­ing on this aware­ness and show­ing them how it af­fects them. When signs of abuse are de­tected, par­ents should be on the look­out to pre­vent it get­ting worse, and when it is ad­dic­tive, they need to in­ter­vene.
How im­por­tant is pre­ven­tion?
Very im­por­tant. Par­ents should be aware that in­form­ing teens about the dan­gers of using the In­ter­net is not enough. There has to be su­per­vi­sion of be­hav­iour, of en­forc­ing times for using screens, and only using them in com­mon areas, where par­ents can see who their chil­dren are con­nected to and what con­tent they are ac­cess­ing. Par­ents can also in­stall pro­grams to re­strict on­line ac­tiv­ity and con­tent, es­pe­cially sex­ual ma­te­r­ial, which is a very wor­ry­ing issue. But this must be done after talk­ing about it, and not rigidly im­posed, be­cause that way does not work.
Par­ents should be ex­am­ples but we also spend hours on our mo­bile phones.
That is an­other as­pect of pre­ven­tion. Pre­ven­tion be­gins by set­ting an ex­am­ple from an early age when chil­dren mir­ror what they see. Par­ents must be the first to put their mo­bile phones aside dur­ing fam­ily meals, for ex­am­ple. Par­ents should su­per­vise their chil­dren so that they do home­work with­out a mo­bile phone next to them. But what wor­ries me more than the ex­ces­sive use of the in­ter­net is the con­tent they ac­cess.
For ex­am­ple?
Il­le­gal con­tent, pornog­ra­phy, hate mes­sages against peo­ple of dif­fer­ent races or sex­ual iden­tity. Up to 36% of young Spaniards look at pornog­ra­phy on­line and 32% up­load im­ages of them­selves that can be mis­used. There’s also the pos­si­bil­ity of adults im­per­son­at­ing mi­nors, con­tact­ing them, pos­ing as an­other teenager, win­ning their con­fi­dence so that the can try to meet up with them or black­mail them with pho­tos or mes­sages.
Are these sit­u­a­tions com­mon?
They aren’t un­com­mon but lit­tle spe­cific data is avail­able. Since the pan­demic, the rates of eat­ing dis­or­ders and self-harm have risen sharply. In girls with eat­ing dis­or­ders, for ex­am­ple, we see that they use the in­ter­net to mimic cer­tain be­hav­iours, to get ad­vice, and so on. It should also be noted that patholo­gies such as Autism Spec­trum Dis­or­der (ASD) and At­ten­tion Deficit Hy­per­ac­tiv­ity Dis­or­der (ADHD) have been been linked to in­ap­pro­pri­ate in­ter­net use.
Can the sit­u­a­tion of these young peo­ple be turned around?
Yes, but some take more than oth­ers. The most im­por­tant thing is to help par­ents to be nei­ther too tyran­ni­cal nor too per­mis­sive, for both par­ents to act to­gether, and for them to act as ex­am­ples for their chil­dren. Par­ents need to un­der­stand that tak­ing con­trol of their chil­dren’s lives will cause a lot of dis­com­fort; they should be aware that it will not be easy. And then we have to help the young peo­ple to fill the empty space that these ac­tiv­i­ties leave. And de­tect what is un­der­ly­ing the be­hav­iour and work on it to pre­vent a re­lapse. The ad­dic­tive be­hav­iour is just the tip of the ice­berg.
Some par­ents may think that this is just a teenage phase and that it will pass.
This is the case with many par­ents. But this is one way of al­low­ing the prob­lem to grow and when they reach adult­hood the prob­lem is still there. If par­ents are wor­ried, they should seek ad­vice and help, be­cause the young per­son will not seek help.

in­ter­view health

Recognised in her specialty

Born in Avilés (Asturias) in 1962, she studied medicine in Oviedo and Madrid. “When I finished medicine, I spent three years working as a traumatologist. After spending a few months at La Paz Hospital in Madrid, I spent over half a year in England at Saint Mary’s Hospital with child psychiatrist Elena Garralda, which left a lasting impression on me,” she says. In 1995, she tried her luck in Girona and was accepted by the IAS. Dr Lombardía is one of the first psychiatrists in Spain to be recognised as a child and adolescent specialist. After 60 years of demands, the Spanish government approved this specialty last year. “For years it was the little sister of psychiatry and now it finally has the recognition it deserves.”

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