Michael Tsappis, MD
Senior Attending Psychiatrist, Division of Adolescent & Young Adult Medicine, Boston Children’s Hospital
Co-Director, Clinic for Interactive Media and Internet Disorders (CIMAID), Boston Children’s Hospital
Instructor of Psychiatry, Harvard Medical School
What does a typical day look like for you?
It varies a little bit depending on the day. Typically in the mornings, I’m working on a research project, preparing some teachings, or coordinating with other people we collaborate with, which can include meetings with the Digital Wellness Lab team to discuss our joint work or what we call triage meetings, during which we determine how to respond to referrals or requests for care. I also do some supervision of nurse practitioners and clinical fellows in child adolescent psychiatry. During that time, I also try to do any writing or other kind of productive work outside of direct clinical care. Typically on most afternoons, I see patients either in the general adolescent medicine clinic or in our Clinic for Interactive Media and Internet Disorders (CIMAID).
What led you to this work?
Initially, I was a clinical child and adolescent psychiatrist. Then during the early 2000’s, the Internet started to become more and more widely available and utilized for activities like video games and other things. That’s when I really started to see kids struggling with media use problems, so I put a lot of effort into trying to see what could be helpful in those situations. At that time, the available treatments just didn’t seem to be very helpful. There was no standard of care and there was a lot of work to be done to understand how interactive media use was impacting kids, which motivated me.
Through a lot of good luck, I wound up at Boston Children’s working with Dr. Michael Rich and the group here. With that infrastructure, support, and mentorship, I was able to develop some of my own work trying to figure out how to understand media use problems and to treat them, which is the main focus of the work I do today at Boston Children’s.
What are the greatest opportunities and challenges you see for kids growing up in a digitally saturated world?
Kids have access to so much more information and ideas in the course of finding interests and developing opportunities for themselves, which all have a possible benefit to their identity development. I honestly would say the possibilities are endless. That said, I think the term “digitally saturated” gives the impression that there’s too much sometimes, but I don’t know what the right amount is, especially given that technology is so embedded in our everyday lives.
The big challenge is that we’re left to our own devices, to intuitively use our devices in the ways, times, and manners which feel right to us. There isn’t a multi-generational established norm for how we engage with the digital world, and I’m not sure that one is even possible given how quickly things evolve and change.
We need to realize that most interactive media are designed to draw us in and keep us online. With that understanding, we need to learn, and help our kids learn, to be intentional about our digital media use. Put another way, we need to be honest with ourselves about what the nature of technology is and its impact on humans. How can we use that knowledge to do a better job of being intentional with our use?
One of the opportunities that could be capitalized on to a greater extent would be helping kids to learn how to move fluidly back and forth between digital engagement and non-digital real world experiences that are informed, and also supported by, their digital experiences. There’s no track record for this, so it’s not like an automatic or intuitive thing that we just know how to navigate back and forth between those worlds. As clinicians and researchers, we could be helpful in figuring it out, and then providing guidance and recommendations.
How would you change or design technology and or media to be healthier for kids across the developmental span?
I don’t think it’s a matter of changing the media as much as it is changing our perspectives on how we use media ourselves and how we support kids in their use.
However, there’s got to be better ways for parents to understand what content kids are engaging with and who they’re connecting with. For example, if I know my kid went to the park, I can drive to the park and make sure he’s there. I think that companies can do a better job of how access is structured. For example, upping the ante on age verification and developmentally appropriate content access so kids can’t just wander into things that they might not be ready for. Things like this can support parents in keeping their children safe and protecting their mental health.
What guidance or advice do you have for parents and other caregivers to help kids build and maintain healthy behaviors around digital media and technology?
A key part of my job is figuring out how to help kids stay out of my clinic in the first place — we don’t want to help them after they’re starting to have difficulties, instead we want to help them avoid the difficulties. And while I think tech companies have some responsibility for keeping kids safe and promoting health and wellness, the approach we take as parents and caregivers in terms of our self awareness matters just as much. We also need to not be afraid to parent in the digital world the same as we do in the physical.
Model Good Behavior
The first thing I advise parents and caregivers to do is to be aware of their own screen use, and then model healthy behaviors. (“Modeling” is the first “M’ in the Digital Wellness Lab’s 5 M’s of Digital Wellness — available in English and En Español.)
(Try to) Keep Emotions Out of It
Parents should be aware of what their kids are doing, where they’re going, who they’re talking to, what they’re saying, what they’re accessing, both online and off. When something goes wrong, keeping emotions under control and taking opportunities to help your child develop skills, and to connect with you, is a lot more productive in the long run than conflict and arguments.
Use Collaborative Self Discovery
Parents receive a lot of messaging about the dangers of screen time, social media, video gaming, etc. Once emotions kick in, this can create a kind of anxiety that can contaminate parenting. This is why I advise parents to calm down, and then talk with their child in an age-appropriate way about what they are seeing, why it’s worrying them, and ask them what their views are. If a child has engaged in unsafe or unhealthy behavior online, rather than reacting with restriction and punishment, respond with what I would call “collaborative self discovery.” For example, if your child starts using a word you would rather they not, say something like, “Oh! You came across this word on the Internet. Do you understand what that means? How do you think using that word affects people around you? Is there anyone who would be hurt if you used that word?” Engaging with your child with curiosity, discussion, and guidance is much more effective than simply punishing them.
Let Your Child Grow Into Privacy Rights
I get asked a lot about how much privacy kids should have when engaging online. As kids get into adolescence and start gaining more access to their own devices, I really think in the very beginning, parents’ best bet is to not imply that their child will have a right to privacy with their media use, especially as they learn to navigate the Internet. In other words, in the early stages of independent media use, kids should assume that their parents have access to everything, including their search history, social media accounts, and text messages.
Create a Roadmap
Parents and caregivers should learn what the recommendations are for media use at different ages and stages, which they can then use to create a roadmap for themselves planning out when and how they’re going to introduce different media, media access, privacy controls, and all the new advancements as their child gets older. The Digital Wellness Lab Family Digital Wellness Guide includes by age and stage of development.)
Here at the Lab, we welcome different viewpoints and perspectives. However, the opinions and ideas expressed here do not necessarily represent the views, research, or recommendations of the Digital Wellness Lab, Boston Children’s Hospital, or affiliates.
Are you worried about your child or teen’s internet use?
If you think your child or teen’s online activities are causing problems with sleep, school, relationships, or other aspects of their physical, social, and mental health, we can help.
The Clinic for Interactive Media and Internet Disorders (CIMAID) is a specialty clinic within the Division of Adolescent and Young Adult Medicine at Boston Children’s Hospital that evaluates and treats children, adolescents, and young adults – and supports their parents and caregivers – to adopt and sustain healthy lifestyles and behaviors.
¿Le preocupa el uso de Internet de su niño o adolescente?
Si cree que las actividades en línea de su niño o adolescente están causando problemas con dormir, escuela, relaciones, u otros aspectos de su salud física, social y mental, podemos ayudar.El Clínica de Trastornos de los Medios Interactivos y de Internet (CIMAID) es una clínica especializada dentro de la División de Medicina para Adolescentes y Adultos Jóvenes del Boston Children’s Hospital que evalúa y trata a niños, adolescentes y adultos jóvenes (y apoya a sus padres y cuidadores) para que adopten y mantengan estilos de vida y comportamientos saludables.