Mar 28, 2023 - Technology

The Digital Wellness Lab aims to mediate between TikTok and parents

Illustrated collage of TikTok’s logo and a hand holding a phone.

Illustration: Shoshana Gordon/Axios

As some states try to regulate children's social media use and TikTok emerges as a geopolitical chew toy, a new clearinghouse has emerged for mediating between tech companies and those concerned about their products' impact on kids: the Digital Wellness Lab at Boston Children's Hospital and Harvard Medical School.

Why it matters: Young people live their lives on social media, and it's not going away — so parents and pediatricians need to learn to recognize when it becomes a problem, says pediatrician Michael Rich, the lab's founder.

  • At the same time, tech companies need to set appropriate guardrails, Rich tells Axios.
  • Rich argues that unhealthy internet use is not an addiction, but rather a disorder he's dubbed Problematic Interactive Media Use — or PIMU — that indicates other underlying problems, including mood disorders and ADHD.
  • PIMU is "a collection of symptoms of kids seeking to soothe themselves, to comfort themselves, to distract themselves," he tells Axios.

Where it stands: Rich founded the Digital Wellness Lab in 2021 to look at the unknown health consequences of the surge in kids spending six-plus hours a day online.

  • With sponsorship from major tech platforms — such as Twitch, Roblox, Snap, Discord and TikTok — the Lab is trying to address the concerns of parents, doctors and lawmakers without villainizing the companies involved.

What they're saying: "After close to 30 years of doing this research, I grew tired and frustrated with the fact that it was in a polarized, adversarial environment," says Rich, a professor at Harvard Medical School and a doctor at Boston Children's Hospital.

  • "The pediatricians were saying, 'The kids are in trouble,' and the policymakers are freaking out and saying, 'We've got to make laws about this.' And the tech and entertainment companies are in siege mentality and defensive mode."

Rich — a former filmmaker who calls himself the "Mediatrician" — is pulling the constituencies together to hammer out ground rules based on science and common sense.

  • The Digital Wellness Lab aims to provide "serious, rigorous, unbiased research" for consumers and producers of technology, Rich says.
  • "Kids are on these screens all the time. We have to figure out when it becomes dysfunctional — at what point."
  • "It's really about their behavior," he adds. "It's not about the device itself because there are tons of kids with smartphones and social media who do fine, right?"

Driving the news: Bowing to pressure, TikTok recently set a 60-minute screen time limit for children under 18 (albeit one that kids or their parents can bypass by punching in a code) — after seeking advice from the Digital Wellness Lab.

  • While Rich and his colleagues recommended more muscular rules, the constructive dialogue they had with TikTok can point to a more collaborative future, he says.
  • "I've been very pleasantly surprised by not just the openness of the tech world, but real yearning for finding a better way," he says.
  • "A lot of people in my pediatric world said, 'You're a turncoat. You're going to the dark side.' But I do think that we need to take a step back from blaming the technology — because any technology can be used for good or for harm."

State of play: Heavy social media use has been linked to mental health issues in children — most notably, depression in teen girls — and there's a cottage industry of lawyers and treatment programs aiming to help desperate parents.

  • By contrast, the Clinic for Interactive Media and Internet Disorders (CIMAID) at Boston Children's Hospital — which Rich co-runs — is a leading medical program for kids with health problems related to internet and social media use.
  • Founded in 2017, CIMAID has seen "close to 1,000 kids," but the population "should be larger," Rich says. "It's only limited by the amount of staff I have to see them."

The intrigue: Bucking the prevailing nomenclature, Rich and his colleagues reject the label of "addiction" to describe PIMU.

  • Nearly all of CIMAID's patients have other underlying diagnoses, such as ADHD, mood or anxiety disorders, or autism.
  • In a 2019 scholarly article, Rich and colleagues defined PIMU as falling into four categories: "uncontrolled video gaming, social media use, pornography viewing, and information-bingeing on short videos or websites."
  • To qualify as problematic, the media use has to contribute to "academic failure, social withdrawal, behavioral problems, family conflict, and physical and mental health problems," they wrote.

Yes, but: The only internet-related problem listed in the "psychiatrist's bible" — the Diagnostic and Statistical Manual of Mental Disorders, or DSM — is Internet Gaming Disorder, which is described as needing further study.

  • Because PIMU-related problems largely "remain non-diagnoses, you can't get medical insurance to pay for the treatments," Rich says.

Check out: The Digital Wellness Lab offers a toolkit for doctors and other clinicians to assess kids' media use, plus resources for parents — such as a digital wellness guide and webinar.

  • Rich's advice? Instead of yelling at your kid to stop playing video games, "sit down next to them and play 'Grand Theft Auto' with them."
  • "Because you are saying, 'I love you. I respect you. I want to understand what engages you here.'"

The bottom line: Social media isn't going away. "We have to learn to live with it, not point fingers at it and say, 'This is horrible — get rid of it,'" Rich says.

  • "We need to take a shift and say, 'Look, this is the environment we're raising these kids in — this is the air they breathe,'" he said. "Let's figure out how to breathe well and how to improve the air."
Go deeper