The iPhone Generation Comes of Age

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Recently I sat across from a 19-year-old patient, listening to him recount his myriad symptoms. They included anxiety, racing thoughts, sweaty palms, “fear about everything” and waking up every morning with anxiety in his stomach. He described a constant dread of something terrible happening and engaged in a lot of “catastrophizing.” Hard not to diagnose an anxiety disorder, right? However, he originally came to see me for ADHD. He had been convinced by another mental health provider that he had an attention deficit and was prescribed a stimulant, Adderall. He was here for a second opinion, as he was leery of medication.

I did a little more investigation and some further testing. Adrian, not his real name, was brilliant. He was in the gifted classes in high school and had a GPA of 4.28. He wanted to pursue medicine or even become a pilot. But after high school he stalled, and currently was working as a host at a local chain restaurant. I asked him what happened after high school and he struggled to tell me. We reviewed his typical day and what it looked like. He shared that when he was not working, he was at home, playing video games or watching endless YouTube videos. “I deleted most of my social media apps,” he told me, noting that they had caused him to feel bad about himself, his body image, and his self-esteem. The more time he spent on social media sites, the more anxious and depressed he was. But he couldn’t let YouTube go.

We discussed that a lot of what he was feeling was anxiety, which could look like ADHD. He seemed relieved, telling me that many of his peers in high school shared Adderall, even when they didn't have a diagnosis, and used it recreationally. He didn’t want to end up on an abusable drug. We talked about sleep, exercise, and nutrition as methods to manage his anxiety. I also encouraged a “social media purge.” I challenged him to delete YouTube and evaluate how he felt after 30 days, telling him it wouldn’t be forever, but it was worth finding out how he felt without a constant digital diet.

Time will tell if Adrian is going to follow the plan. But this patient had me thinking. Adrian was part of the iPhone generation; the children born around 2005 and later, who have only known smartphones, iPads, and social media. How has this changed their view of the world and their brain development? Do they learn differently, and do they manage their emotions differently?

There is research on all this. Social psychologist Jonathan Haidt just published a book titled, “The Anxious Generation,” last March. A fascinating read, its premise is that yes, the generation of children and now young adults born after 1995 have been inculcated into the digital world. There are consequences he argues, to this. Kids have been poorly monitored when it comes to digital technology and the internet, which has led to a generation of children and young adults who may have altered social and brain development.

The human brain is born with approximately 100 billion cells, which over time is culled to around 80+ billion. This culling is called “pruning,” kind of like how it sounds. But in this case, our brain is pruning out pathways and cells that are not as important as others. This pruning depends on a lot of things; our physical health, nutrition, genetics, childhood environment, nurturing or lack thereof, emotional support, and many other factors. Why is pruning important? Because it allows our brains to become super efficient, laying down new pathways to allow us to learn new skills and information. Adolescent brains are pruning and developing up to age 25 or 26. If an adolescent brain is exposed to digital technology and a constant diet of internet algorithms, there will be consequences.

A 2023 study published in the Journal of the American Medical Association Pediatrics measured social media activity in teens. Habitual social media users, those who checked their socials 15 times or more a day, had brain scans that showed increased activity in the reward center of the brain. They also had higher rates of emotional sensitivity to feedback from peers. They showed a decrease in positive emotions with normally rewarding stimuli, kind of like a tolerance effect. This drove them to seek more stimulation.

Source: Natasha Connell Unsplash

Another 2024 study showed similar changes seen in the brains of teens with “internet addiction.” These changes were found in the reward center of the brain and the areas that managed physical and mental health development.

As an addiction psychiatrist, none of this sounds good to me. Of course, this doesn’t mean that every adolescent or young adult who uses the internet or social media has developed abnormally or is addicted. Many I know are successful and happy. However, there is a greater risk of problems with unmonitored use. How does a parent navigate this brave new world of digital life?

Looking at the research I advocate for the following:

1. No phones: Haidt advises no iPhones or iPads before the age of 14 and no social media before the age of 16.

2. Heavy family and parental involvement: Be active in their lives, know what their days consist of, know their friends, and attend their soccer games, volleyball tournaments, or theatre performances. Expose them to older generations, so they have more social integration into the family.

3. Monitor what they look at online: Get into their business. Check their phones and apps. Know their friends online and in person.

4. Play: Haidt is a big proponent of play, allowing children to play without structure. There is a lot of good research showing that this fosters creativity and social and emotional development.

5. Build resilience: One interesting finding in the studies talks about a higher emotional sensitivity to feedback or criticism when a teen spends excessive time on social media. Helping children build emotional reserves to navigate disappointments and hurts will make them stronger adults.

6. Get involved: This week, Congress is working on the Kids Online Safety and Privacy Act. It is a bipartisan bill designed to regulate the big companies like Meta and TikTok to make their platforms safer for teens and children. Parts of this bill include forcing platforms to require parental controls to help manage a minor's platform use, safety setting options, and methods to track screen time. The question of freedom of speech plays in here as well. It is best to educate yourself.

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These tips can be applied to adults, too. We could all use a little more play, in-person socialization, and a little less digital time suck.

And my patient, Adrian, we will see how he does. I hope he at least deletes YouTube.