Cristina Lombardía


“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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